Identification Number:
EM-22033 REV
Intended Audience:All RCs/ARCs/ADs/FOs/TSCs/PSCs/OCO/OCO-CSTs/OHO/OARO/WBDOC
Originating Office:DCO OPSOS
Title:Instructions for Reviewing Medicare Part D Low Income Subsidy (LIS) Claims Partially Awarded or Denied due to COVID-19 Disaster Assistance
Type:EM - Emergency Messages
Program:Title II (RSI); Medicare
Link To Reference:
 
Retention Date: December 02, 2022

A. Purpose

    This Emergency Message (EM) provides guidance on reviewing Medicare Part D Low Income Subsidy (LIS) claims partially awarded or denied due to the receipt and/or retention of COVID-19-related disaster assistance i.e., COVID Economic Income Payments (EIP) as a resource/income when making the initial determination.

B. Background

    The agency may have improperly partially awarded or denied an individual’s Medicare Part D Low Income Subsidy (LIS) claim due to COVID-19 Disaster Assistance based on the receipt and/or retention of pandemic-related financial assistance, which we initially counted for income purposes but later deemed to be excludable disaster assistance in EM-20018 REV 3. Beginning May 31, 2022 through the end of July, we are sending outreach notices to affected individuals because they may now be eligible for LIS or may now be eligible for a higher amount of LIS.

    Refer to EM-20018 REV 3 for updated information on sources of pandemic-related disaster assistance and the policy treatment for identified assistance types. For any assistance classified as disaster assistance in the chart in section C.1 of EM-20018 REV 3, follow the special processing and documentation instructions in EM-22010.


C. Outreach mailer for LIS claims

    An outreach mailer will be sent to individuals whose LIS claims that may have been partially awarded or denied due to the receipt and/or retention of COVID-19 disaster assistance.

    The outreach notices will be stored in the Online Retrieval System (ORS).

    The outreach mailer will let individuals know:

      - We may have either reduced their LIS amount or denied their LIS claim because they received pandemic-related financial assistance; and
      - They may now be eligible for LIS (Extra Help); and
      - They should contact us so we can reevaluate whether they are eligible for LIS.

    The outreach mailer will be released from the System’s centralized Print Management Facility (PMF) to approximately 200,000 beneficiaries.
      - We started releasing the mailers the week of May 31, 2022.
      - They will be released weekly for eight weeks.
      - They will be selected randomly by way of terminal digits, and
      - They will be available in English and Spanish with Special Notice Options (SNO).

    Undeliverable mail will be processed in WBDOC by:
      - Receiving the undeliverable notices, and
      - Remailing, if USPS returns the envelope with a yellow sticker, providing a new address.

    When individuals respond to the outreach mailer, technicians should set up an appointment. This will allow a technician to review the record and reevaluate all factors of eligibility and determine whether a correction needs to be made.

    At this time, the agency will not impose a deadline for individuals to respond to the outreach notices.

D. Appointment scheduling
      The outreach notice instructs the beneficiary to:
      - first, to go online,
      - second, to call the N8NN, or
      - third, to contact their servicing field office.

      If an FO receives the call instead, technicians should:

      - Review MAPS and determine if the LIS claim was denied or reduced due to disaster assistance any time in or after March 2020.

      - Consider this an oral inquiry (HI 03010.020) and schedule an appointment in eLAS. Follow procedures in MS 00601.001 and annotate “Potential partially award or denied LIS claim due to pandemic-related disaster assistance” in the remarks section.

      NOTE: The receipt and/or retention of pandemic-related disaster assistance must be material to the partially awarded or denied LIS claim for corrections to apply. Corrections under this EM are not appropriate for a case where the receipt or retention of pandemic-related disaster assistance did not impact the LIS claim denial or partial award.
E. Processing Instructions

    1. Receipt/Retention of Pandemic-Related Disaster Assistance is NOT MATERIAL to the determination
      If, after speaking to the beneficiary and reviewing the case, you determine that the income/resources that are the basis for the LIS denial is not pandemic-related disaster assistance (this may include income or resources that were not documented previously):
      Document the types of income/resources the claimant received on the DWRC screen following existing instructions in HI 03035.006D and MS 03206.003.
    2. Receipt/Retention of Pandemic-Related Disaster Assistance IS MATERIAL to the determination
      Process the claim following instructions in EM-22010.

      Direct all program-related and technical questions to your Regional Office (RO) support staff using vHelp or Program Service Center (PSC) Operations Analysis (OA) staff. RO support staff or PSC OA staff may refer questions, concerns or problems to their Central Office contacts.

    References:

    EM-20018 REV 3 Medicare Part D Low Income Subsidy (LIS) - Effect of Coronavirus Disease 2019 (COVID-19) Related Assistance
    EM-22010 Special Processing Instructions - Applying Medicare Part D Extra Help Low Income Subsidy (LIS) Income and Resource Exclusions to Coronavirus Disease 2019 (COVID-19) Related Disaster Assistance
    HI 03035.006 Verification and Documentation Process for Medicare Application Processing System (MAPS)
    HI 03010.020 Leads and Protective Filing
    MS 03206.003
    MAPS Report of Contact (DWRC)
    MS 00601.001 Processing Leads/TSC Referrals – Overview

EM-22033 REV - Instructions for Reviewing Medicare Part D Low Income Subsidy (LIS) Claims Partially Awarded or Denied due to COVID-19 Disaster Assistance - 06/14/2022