Identification Number:
SI 02220 TN 62
Intended Audience:See Transmittal Sheet
Originating Office:ORDP OISP
Title:Recovery Procedures for Supplemental Security Income Overpayments
Type:POMS Transmittals
Program:All Programs
Link To Reference:
 

PROGRAM OPERATIONS MANUAL SYSTEM
Part SI – Supplemental Security Income
Chapter 022 – Overpayments
Subchapter 20 – Recovery Procedures for Supplemental Security Income Overpayments
Transmittal No. 62, 03/18/2021

Audience

PSC: BA, CCRE, CS, DS, LEAD DS, PETE, TA, TST;
OCO-ODO: CST, CTE, CTE TE, RCOVTA, RECONR, RECOVR;
FO/TSC: CS, CS TII, CS TXVI, CSR, CTE, DRT, FR, OA, OS, RR, TA, TSC-CSR;

Originating Component

OISP

Effective Date

Upon Receipt

Background

This new transmittal addresses the need to delay initial notice of statutory benefit continuation overpayments to individuals who appealed their medical cessation determinations.

Summary of Changes

SI 02220.009 SSI Overpayment - Disability Cessation Cases

This new transmittal addresses the need to delay initial notice of statutory benefit continuation overpayments to individuals who appealed their medical cessation determinations, and provides examples of when to send the overpayment notice.

SI 02220.009 SSI Overpayment - Disability Cessation Cases

A. Policy for disability cessation overpayments

If, after appealing a medical cessation decision, an individual elects to have the payment of their benefits continued and the final decision of the Commissioner of Social Security affirms the determination that he or she is not entitled to such benefits, any benefits paid are considered overpayments. No overpayment exists until the appeals process is exhausted, the agency’s decision is final, and we issue an overpayment notice to the individual.

B. Procedure for overpayment notification in disability cessation cases

POMS GN 02201.009H states, “Do not send the initial overpayment notice until appeal of the medical cessation has been exhausted.” In such cases, do not send an overpayment notice to recover any statutory benefit continuation (SBC) payment during the 65-day period (60-day appeal period plus 5-day period for mailing) after a reconsideration determination, administrative law judge (ALJ) decision, or appeals council (AC) action (e.g., denial of review, extension of time to file action in federal district court, dismissal, or decision), or if an appeal or federal court complaint was timely filed.

Do not send the overpayment notice even when the Title XVI case is listed on the “B3” diary list. Do not send the initial overpayment notice until the recipient’s medical cessation appeal is exhausted; i.e., when:

• The ALJ or the AC returns the folder (electronic file) after the 65-day period for requesting judicial review expires; or

• You receive the court decision, if judicial review is requested.

Once the relevant appeal period has expired and no appeal has been filed, or all appeals have been exhausted, follow normal overpayment notice procedures.

C. Examples of delayed SBC overpayment notification

Listed below are six examples of overpayments due to the claimants' receipt of statutory benefit continuation (SBC) payments and the corresponding TSC or FO actions.

Example 1:

The individual received SBC payments through the reconsideration level of appeal. The reconsideration determination affirmed the medical cessation, but the individual did not file a hearing request within 65 days after the date of the reconsideration affirmation notice.

TSC/FO Action:

Send the overpayment notice no earlier than 66 days after the reconsideration affirmation notice date.

Example 2:

The individual received SBC payments through the reconsideration level of appeal. The reconsideration determination affirmed the medical cessation; however, the individual filed a request for a hearing. The hearing decision affirmed the medical cessation and the individual filed no further appeal within the 65 day period after the hearing decision date.

FO Action:

DO NOT send the overpayment notice while the request for a hearing is pending. Send the overpayment notice after the ALJ/AC returns the folder and the period for requesting further review has expired (see GN 02201.009H).

TSC Action: At the time you discover that a hearing is pending, transfer the overpayment diary to the FO (see the Teleservice Center Operating Guide, OVERPAYMENTS (Title XVI--TSRs) chapter (TC 26010.030B), systems-identified exclusion number 18). The FO should control the overpayment diary for the return of the folder.

Example 3:

The individual received SBC payments through the reconsideration level of appeal. The reconsideration determination affirmed the medical cessation; however, the claimant filed a request for a hearing. The hearing decision affirmed the medical cessation. The claimant then filed a request for review of the ALJ's decision with the AC.

TSC/FO Action:

DO NOT send the overpayment notice while the request for a hearing or the request for AC review is pending. Send the overpayment notice after the AC returns the folder and the period for requesting judicial review expires (see GN 02201.009H.). The FO should control the overpayment diary for the return of the folder. If the TSC gets an overpayment diary, transfer it to the FO (see SI 02220.009C, Example 2).

Example 4:

The individual received SBC payments through the hearing level of the administrative review process. The hearing decision affirmed the medical cessation and the individual filed no request for review with the AC within the 65-day period after the hearing decision date.

TSC/FO Action:

DO NOT send the overpayment notice while the request for a hearing is pending. Send the overpayment notice after the ALJ/AC returns the folder and the period for requesting further review has expired (see GN 02201.009H). The FO should control the overpayment diary for the return of the folder. If the TSC gets an overpayment diary, transfer it to the FO (see SI 02220.009C, Example 2).

Example 5:

The individual received SBC payments through the hearing level of the administrative review process. The hearing decision affirmed the medical cessation; however, the claimant filed a request for review with the AC.

TSC/FO Action:

DO NOT send the overpayment notice while the request for a hearing or the request for AC review is pending. Send the overpayment notice after the AC returns the folder after the period for requesting judicial review expires (see GN 02201.009H). The FO should control the overpayment diary for the return of the folder. If the TSC gets an overpayment diary, transfer it to the FO (see SI 02220.009C, Example 2).

Example 6:

The individual received SBC payments through the hearing level of the administrative review process. The hearing decision affirmed the medical cessation; however, the claimant filed an appeal to the AC level. The AC denied the claimant's request for review of the ALJ's decision and the claimant requested judicial review in the federal courts.

TSC/FO Action:

DO NOT send the overpayment notice while a request for a hearing, a request for AC review, or federal court review is pending. Send the overpayment notice after a court decision affirming the medical cessation decision is issued (see GN 02201.009H). The FO should control the overpayment diary pending the court decision. If the TSC gets an overpayment diary, transfer it to the FO (see SI 02220.009C, Example 2).

In addition, DO NOT send an overpayment notice if the AC remands a case to the ALJ on its own decision, or after the federal court remands the case to the agency for further proceedings. In such a case, the overpayment notice should only be sent when all proceedings on remand (including any appeals of the new ALJ decision to the AC or federal court) are completed, as outlined in SI 02220.009C, Examples 1 through 6.

D. References

DI 12027.065 Appeals Council (AC) Remand Medical Cessation Cases - Statutory Benefit Continuation (SBC) - Title XVI and Concurrent Title II/Title XVI

GN 02201.009 Notification of a Title II Overpayment

SI 02260.007 Waiver Procedures for Disability Cessation Cases

SI 02220.010 SSI Overpayment - Notifying the Individual


SI 02220 TN 62 - Recovery Procedures for Supplemental Security Income Overpayments - 3/18/2021