This EM provides Field Offices (FOs) and TeleService Centers (TSCs) with supplemental guidance for the GK notice (Notice of Planned Action), non-medical request for reconsideration, and GK payment continuation business process. These instructions also explain the additional circumstances in which good cause may exist when we receive a request for reconsideration after the 15-day period (10 days plus 5 mail days) that automatically qualifies the recipient for GK payment continuation or after the 65-day appeal period (60 days plus 5 mail days) due to unusual or unavoidable circumstances due to the COVID-19 pandemic.
As of March 17, 2020, the Social Security Administration (SSA) temporarily suspended most reductions, suspensions, and termination of title XVI payments (i.e. adverse actions) during a critical time in the COVID-19 pandemic. As we resume processing adverse actions, there may be unusual or unavoidable circumstances due to the COVID-19 pandemic that may prevent recipients from filing a request for reconsideration in time to receive GK payment continuation automatically.
When the system identifies a change on a recipient’s record as an adverse action (i.e. when the new monthly benefit amount due is less than the amount due in the last regular first of the month payment), it automatically generates a GK notice to the recipient, or it can be issued online when requested. See SI 02301.301B. The GK notice explains the adverse action, the right to appeal the adverse action, and the right to GK payment continuation at the protected payment level (PPL) if the adverse action is appealed within 15 days (10 days plus 5 mail days) of receipt of the GK notice. This EM refers to the 15-day period as the GK payment continuation period.
This EM provides additional guidance to determine whether to request and issue an online or automatic GK notice, whether good cause exists when a recipient files a request for reconsideration after the 15-day GK payment continuation period or 65-day appeal period due to unusual or unavoidable circumstances caused by or resulting from the COVID-19 pandemic.
C. Good Cause for Filing a Request for Reconsideration after the 15-day GK Payment Continuation Period During the COVID-19 Pandemic
Our current policy provides sufficient flexibility to allow the FO to make a good cause finding for GK payment continuation when the request for reconsideration is filed after the 15-day GK payment continuation period during the COVID-19 pandemic. See SI 04020.020.
Apply existing policy under the good cause provisions to make a good cause finding based on the circumstances of the recipient’s case for a request for reconsideration filed after the 15-day GK payment continuation period. When the circumstance meets our current policy, the FO should find good cause and pay the recipient at the PPL.
Use the following provisions to determine if good cause exists. Listed under each provision are examples of when can find good cause because of COVID-19 related circumstances. Although these examples are the more common circumstances, this is not an exhaustive list.
1. Circumstances impeded the recipient’s or representative payee’s efforts to file the request for reconsideration:
a. Recipient or representative payee attempts to visit the FO to submit the request for reconsideration within the 15-day GK payment continuation period, but the office is closed to the public due to unforeseen circumstances (e.g., COVID-19 pandemic).
b. Interruptions to mail delivery or inability to access mailbox (e.g., post office or private mailbox service).
c. Transportation services are interrupted or there is limited access to transportation.
d. Recipient or representative payee moved from the address of record and did not receive the GK notice or did not receive the GK notice in sufficient time.
e. Recipient or representative payee could not complete the request for reconsideration in time because of child or family care changes due to stay at home orders or school at home requirements.
2. The recipient’s physical, mental, educational, or linguistic limitations (including any lack of facility with the English language) prevented him or her from timely filing the request for reconsideration:
a. Recipient, representative payee, or recipient’s primary caretaker is seriously ill or hospitalized, preventing him or her from contacting us.
b. Death or serious illness in the recipient’s or representative payee’s immediate family, including being seriously ill due to COVID-19.
c. Non-English speaking recipient received an English language notice, did not understand the instructions in the notice to call for assistance, and due to stay-at- home orders could not obtain assistance from a friend or relative.
3. SSA or the Centers for Medicare and Medicaid Services (CMS) actions were confusing or misleading.
4. The recipient or representative payee did not understand the requirements of the Social Security Act (Act), resulting from amendments to the Act, other legislation, or court decisions.
a. Recipient or representative payee received multiple closely dated GK notices and was confused about the number of days that he or she had to file the request for reconsideration in order to receive GK payment continuation.
b. Recipient or representative payee contacted us by telephone and we gave incorrect or incomplete information.
E. GK Notice Procedure
1. GK notice: printing the GK notice during the GK temporary period
When an adverse action is processed during the GK temporary period, FOs can select an online GK notice with options to print locally and either hand or mail to the recipient. Printing the GK notice locally allows us to reduce the next month’s payment in a timely manner. During the COVID-19 pandemic, FOs should select an online GK notice only when they are able to hand or mail the GK notice to the recipient the same day that they produce it. Otherwise, FOs must select the overnight automated notice to automatically generate and send the GK notice to the recipient per E.2 below.
When local printing is not available, or after the deadline to mail a notice, FOs must select an overnight automated GK notice with a later adverse action month so that the next month’s payment is not reduced. This option may result in an overpayment.
2. GK notice: local printing not available or after the mail deadline
When an adverse action requires a manual GK notice, use the instructions in SI 02301.307 to generate it. Suppress the automated notice so that the DBGK screen becomes available so that you can record that the GK notice was mailed and the SSR can be updated with the due process data (DPD).
3. GK notice – adverse action requires manual GK notice
F. Appeal Procedure
Direct all program–related and technical questions to your RO support staff. RO support staff may refer questions or problems to their Central Office contacts.
A recipient, representative payee, or appointed representative may contact SSA within 15 days of the date on the GK notice by telephone either through the 800# or directly to the FO indicating disagreement with GK notice and the recipient’s intent to file a request for reconsideration that automatically qualifies him or her for e GK payment continuation at the PPL. If a recipient, representative payee, or appointed representative contacts SSA more than 15 days from the date on the GK notice, consider that the recipient may qualify for GK payment continuation. Develop for good cause for extending the time limit to receive GK payment continuation, file the appeal, or both as appropriate.
1. National 800 Number Network (N8NN)
When a recipient (including a representative payee, or appointed representative) contacts the TSC to file a request for reconsideration in order to receive GK payment continuation, follow the current procedures in TC 03001.020. When establishing the lead referral (step 2), select “Requests Payment Continuation” and any other options that apply; and send SSA 561-U2 Request for Reconsideration to the recipient.
a. Contact with a recipient during the 15-day GK payment continuation period
b. Receipt of a request for reconsideration after the 15-day (10 days plus 5 mail days) GK payment continuation period or after the 65-day (60 days plus 5 mail days) appeal period
When a recipient (including a representative payee or appointed representative) contacts the FO directly within 15 days of the date on the GK notice stating or indicating that he or she wishes to file a request for reconsideration in order to receive GK payment continuation, follow current procedures in SI 04020.020C.1. In addition, take the following actions.
· Explain that the quickest way to file the request for reconsideration is by completing and submitting the i561 available on the iAppeals Non-Medical application at ssa.gov/iApplNMD.
· Explain the option to print, complete, and mail the printable version of the SSA-561-U2 available at https://www.ssa.gov/forms/ssa-561-u2.pdf.
· If a recipient does not have Internet access or is uncomfortable with using electronic devices, explain that he or she can send us any writing by mail that states he or she disagrees with our determination and includes information that will enable us to identify him or her.
· Document the call on the DROC
If a good cause statement is not included with or written on the request for reconsideration, develop for good cause per GN 03101.020D.1 and SI 04020.020C.1. FOs should find good cause when the reason for filing the request for reconsideration after the 15-day GK continuation period or 60-day appeal period is due to a personal circumstance caused or impacted by the COVID-19 pandemic. Refer to section C above for examples.