Identification Number:
HI 01120 TN 11
Intended Audience:See Transmittal Sheet
Originating Office:Centers for Medicare & Medicaid Services (CMS)
Title:New Initial Determinations Using Beneficiary Information
Type:POMS Transmittals
Program:Medicare,Medicaid
Link To Reference:
 

PROGRAM OPERATIONS MANUAL SYSTEM
Part HI – Health Insurance
Chapter 011 – Medicare Income-Related Monthly Adjustment Amount
Subchapter 20 – New Initial Determinations Using Beneficiary Information
Transmittal No. 11, 05/13/2020

Audience

PSC: BA, CA, CS, DS, ICDS, IES, ILPDS, IPDS, ISRA, PETE, RECONR, SCPS, TSA, TST;
OCO-OEIO: BET, BIES, CCRE, CR, CST, CTE, EIE, ERE, FCR, PETL, RECONE, RECONR;
OCO-ODO: BET, BTE, CR, CST, CTE, CTE TE, DEC, PAS, PETE, PETL;
FO/TSC: CS, CS TII, CSR, DRT, FR, OA, OS, RR, TSC-CSR;

Originating Component

OISP

Effective Date

Upon Receipt

Background

The IRS Modified the form 1040 for CY 2020. As a result, a minor edit is required for technician reference.

 

Summary of Changes

HI 01120.060 Married, Filing Separately – Lived Apart All Year

:The Social Security Benefits Row, is now shown in line 5a of the IRS1040, previous years’ had it shown in line 20a.

 

HI 01120.060 Married, Filing Separately – Lived Apart All Year

A. Policy

B. How to Process the Request

 

A. Policy

When IRS supplies SSA with the tax filing status of “Married, Filing Separately,” SSA assumes the couple lived together at some point in the tax year and uses the “Married, Filing Separately” Table (See HI 01101.020B.3) to determine the IRMAA. If one or both of the members allege living apart throughout the entire tax year, we will obtain an attestation to that effect under penalty of perjury.

The change will be effective only for the individual who attests to the living arrangement under penalty of perjury. Do not apply the change to the other spouse unless the other spouse also attests to the living arrangement. SSA will make any necessary adjustments to IRMAA by using the table in HI 01101.020B.1 to determine the IRMAA.

The timeframe for a beneficiary to request a new initial determination, alleging a filing status of “Married Filing Separately” and living apart for the tax year used, begins with the date of the IRMAA determination notice until the end of the affected premium year. For request filed after the allowed period, good cause for late filing may be established, per GN 03101.020.

B. How to process the request

If

Then

Beneficiary had a tax filing status of “Married, Filing Separately” but alleges he lived apart from his spouse throughout the tax year that is being used to establish his IRMAA.

  • Request a copy of the IRS form 1040. If there is a “D” in the block next to the Social Security benefit amount on 5a, then accept that the couple has lived apart throughout the year.

  • Otherwise, obtain attestation from the beneficiary. Explain that a false statement would be punishable by law as perjury.

  • Ask the beneficiary to provide the last known address for his spouse.

  • Access the IRMAA screens (See MSOM T2PE 008.001 through MSOM T2PE 008.019)

  • On the IRMN screen

    • Enter the Beneficiary's Own SSN.

    • In the “Select the Desired Option” field select “1” Establish

    • Input the premium year that the new initial determination request is for.

    • In the “Select the Desired Function” field select “2” Tax Information

    • Input the Tax Year the beneficiary has amended return for

    • Press Enter

  • The PYTY screen appears when there is data on file for the tax year requested and it is displayed under the Highest Probative Value Data Field. (For an explanation of Highest Probative see MSOM T2PE 008.019.)

    • Select “1” Use Highest Probative Data, the system will process the determination using the data on file.

  • Press Enter.

  • On the IRMA screen the information will be propagated

    • Complete the “Select Filing Status” field by selecting “6” Married Filing Separately Living Apart All Year.

  • Document the statement received on the EVID screen in Shared Processes (See GN 00301.286 through GN 00301.300 and MSOM EVID 001.003).

  • Select “OTHER” as the document submitted as proof.

  • For “Issuance/Recordation Date” show “Y.”

  • For the “Date Issued” show the date of the beneficiary statement.

  • For “Document Type” enter: allegation-living apart.

 


HI 01120 TN 11 - New Initial Determinations Using Beneficiary Information - 5/13/2020