All reconsideration requests are processed by someone other than the person who made
the original decision. When you receive a reconsideration request, evaluate all the
information received as well as the information already in the system in order to
make the correct inputs for a reconsideration determination.
NOTE: All evidence received with an appeal must be input into the Shared Processes EVID screens. For evidence requirements for individuals
appealing based on a life changing event, amended, corrected or more recent tax return
information or a living arrangement change with a tax filing status of married filing
separately, see HI 01120.001 through HI 01120.060. After completing all the required screens, record the evidence submitted on the
EVID screen in the Shared Processes (See GN 00301.286 through GN 00301.300 and MSOM EVID 001.003).
Once you annotate the IRMAA Appeals Tracking System with the reconsideration request, you effectuate the decision using the IRMAA PCOM
screens. Follow the chart below to determine how to complete the required reconsideration
determination information on the IRMAA PCOM screens. Once you effectuate the determination
on the IRMAA PCOM screens, you must post the determination on the IRMAA Appeals Tracking System.
NOTE: When a payee is involved, annotate the Remarks field on the IRMA (Tax Information)
screen with a statement showing the representative payee's information as follows: representative
payee name for beneficiary's name. Check the MBR to verify this is the correct representative payee
for the beneficiary.
If…
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then…
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the beneficiary insists on filing a reconsideration based on information received
about a proposed action in a predetermination notice;
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Access the Online Retrieval System (ORS) to verify the date of the notice.
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Create an MDW with a 21-day tickle from the date of the notice.
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Once the tickle matures, process the appeal. (Follow the appropriate instructions
below that apply to the request for reconsideration.)
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after reviewing the information received, you determine the beneficiary agrees with
how SSA computed their MAGI and/or how SSA used the Sliding Scale Tables to apply
IRMAA but disagrees with the constitutionality of imposing IRMAA;
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Access the IRMAA screens (See MSOM T2PE 008.001 through MSOM T2PE 008.017).
On the IRMN screen:
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Enter the Beneficiary’s Own SSN(BOAN).
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Select “2” Tax information in the“Desired Function” field.
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Input the Tax Year currently used to determine the IRMAA.
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Enter “Y” in the “Appeal Involved” field.
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On the IRMAA Appeals Determination (IRAP) Screen:
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Select “1” Reconsideration for the level of appeal.
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For Recon Dismissal enter “N”.
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Leave Good Cause blank. Annotate the Remarks field if good cause is involved and established.
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In “Date of Appeal Determination” enter the date of the determination (usually the
current date).
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Enter the premium year the beneficiary is appealing.
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In the Remarks field, enter “Disagrees with the constitutionality of the law.”
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On the IRMA screen:
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Input the same exact AGI and TEI used to determine the IRMAA.
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Select “Tax Return” for source code.
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The IRRE Screen will display the current and recalculated IRMAA data. The “New Determination
Results” field will provide the appeal determination based on the information entered.
In this case the determination should be “Affirmation.”
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Enter a “Y” in the Process All Transactions field. If you enter an “N”, you will cancel
all transactions associated with this input.
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Enter the reconsideration determination into the IRMAA Appeals Tracking System following the instructions in HI 01140.005E in this section.
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the beneficiary insists on filing an appeal, and after reviewing the information received,
you determine the beneficiary does not disagree with how SSA computed his MAGI and
how SSA used the Sliding Scale Tables to apply IRMAA and provides no new information
or the new information does not make a change;
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Access the IRMAA screens. (See MSOM T2PE 008.001 through MSOM T2PE 008.017).
On the IRMN screen:
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Enter the Beneficiary’s Own SSN (BOAN).
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Select “2” Tax information in the “Desired Function” field.
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Input the Tax Year currently used to determine the IRMAA.
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Enter “Y” in the “Appeal Involved” field.
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On the IRMAA Appeals Determination (IRAP) Screen
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Select “1” Reconsideration for the level of appeal.
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Enter “N” for Recon Dismissal.
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Leave Good Cause blank. Annotate the Remarks field if good cause is involved and established.
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Enter the date of the determination (this will usually be the current date) in the
“Date of Appeal Determination” field.
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Enter the premium year the beneficiary is appealing.
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In the Remarks field, enter “No change and no new information provided.”
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On the IRMA screen
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If the beneficiary does not provide new information, input the same exact AGI and
TEI that we are currently using to determine the IRMAA. Select source code of “Tax
Return”.
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If the information provided makes no change, input the AGI and TEI alleged by the
beneficiary. Select source code of “Estimate”.
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Select Proof of “proven”.
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The IRRE Screen will display the current and recalculated IRMAA data. The “New Determination
Results” field will provide the appeal determination based on the information entered.
In this case the determination should be “Affirmation.”
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Enter a “Y” in the Process All Transactions field. Entering an “N” will cancel all
transactions associated with this input.
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Enter the determination into the IRMAA Appeals Tracking System. Follow the instructions in HI 01140.005E. in this section.
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a beneficiary insists on filing a reconsideration based on an event other than one listed in HI 01120.001E.
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Access the IRMAA screens (See MSOM T2PE 008.001 through MSOM T2PE 008.017).
On the IRMN screen:
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Enter the Beneficiary’s Own SSN (BOAN)
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Select “1” LCE for the “Desired Function” field.
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Enter “Y” in the “Appeal Involved” field.
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On the IRMAA Appeals Determination (IRAP) Screen:
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Select “1” Reconsideration for the level of appeal.
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Enter “N” for Recon Dismissal field.
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Leave Good Cause blank. Annotate the Remarks field if good cause is involved and established.
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Enter the date of the determination (usually the current date) in the “Date of Appeal
Determination” field.
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Enter the premium year the beneficiary is appealing
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In the Remarks field enter “Non-qualifying event.”
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On the IRLC screen:
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Select “8” Non-Qualifying Event” for the LCE Field.
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Enter the date of the non-qualifying event (NQE) in the “Date of LCE” field.
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In the Remarks field, describe the NQE that the beneficiary is claiming (sale of property).
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On the IRMA screen:
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Input the AGI and TEI alleged by the beneficiary for the tax year the alleged reduction
in MAGI took place.
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Select “Estimate” for source code, if the tax year is a more recent tax year than
the year currently used. If the beneficiary provides no new information, input the
same exact AGI and TEI currently used to determine the IRMAA. Select “Tax Return”
as the source code.
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Show the estimate as Proven.
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The IRRE Screen will display the current and recalculated IRMAA data. The "New Determination
Results" field will provide the appeal determination based on the information entered.
In this case, the determination should be "Affirmation."
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Enter a "Y" in the Process All Transactions field. Entering an "N" will cancel all
transactions associated with this input.
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Enter the determination into the IRMAA Appeals Tracking System. Follow the instructions in HI 01140.005E in this section.
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after reviewing the information received you determine the beneficiary qualifies for
a new initial determination but insists on filing a reconsideration;
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Access the IRMAA screens (See MSOM T2PE 008.001 through MSOM T2PE 008.017).
On the IRMN screen:
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Select the appropriate option based on the information provided for the “Desired Function”
field. See HI 01120.001E.
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Enter “Y” in the “Appeal Involved” field.
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On the IRMAA Appeals Determination (IRAP) Screen:
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Select “1” Reconsideration for the level of appeal.
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Enter “N” for Recon Dismissal.
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Leave Good Cause blank. Annotate the Remarks field if good cause is involved and established.
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Enter the determination dates (usually the current date) in the “Date of Appeal Determination”
field.
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Enter the premium year the beneficiary is appealing
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In the Remarks field enter, “Information provided qualifies for new initial determination,
insists on appeal”.
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NOTE: Complete all other screens as if you are processing a request for a new initial determination.
See MSOM T2PE 008.001 through MSOM T2PE 008.013.
The IRRE Screen will display the current and recalculated IRMAA data. The “New Determination
Results” field will provide the appeal determination based on the information entered.
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Enter a “Y” in the Process All Transactions field. Entering an “N” will cancel all
transactions associated with this input.
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Enter the determination into the IRMAA Appeals Tracking System. Follow the instructions in HI 01140.005E in this section.
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after reviewing the information received, you determine SSA did not compute the beneficiary's
MAGI correctly or did not apply the proper level of the Sliding Scale Tables to determine
IRMAA;
NOTE: This only applies if the reviewed information is the same information SSA used to
make the IRMAA determination.
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Access the IRMAA calculator. (See MSOM T2PE 008.013.)
On the IRMAA Menu (IRSU), select Function “3” Calculator.
On the IRCA Screen:
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Re-input the same information currently used in the IRMAA determination to determine
if this is a systems error. (See MSOM T2PE 008.013.)
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If you receive the correct computation; re-input the information on the IRMAA screens.
(See MSOM T2PE 008.001 through MSOM T2PE 008.017.)
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The IRRE Screen will display the current and recalculated IRMAA data. The “New Determination
Results” field will provide the appeal determination based on the information entered.
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If you receive the same incorrect computation; contact your Regional Office Coordinator
to process the appeal using the “Manual IRMAA Adjustment” process.
NOTE: The Regional Office Coordinator will provide the referring technician with the disposition
so it can be posted to the IRMAA Appeals Tracking System as instructed in HI 01140.005E in this section.
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after reviewing the information received, you determine the beneficiary agrees with
how SSA computed their MAGI and how SSA used the Sliding Scale Tables to apply IRMAA
but believes that the information SSA received from IRS is not correct and has not provided
documentation to support the error but insists on filing a reconsideration;
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Process a “Dismissal” decision.
Access the IRMAA screens. (See MSOM T2PE 008.001 through MSOM T2PE 008.017).
On the IRMN screen:
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Enter the Beneficiary’s Own SSN (BOAN).
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Select “2” Tax information in the “Desired Function” field.
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Input the Tax Year currently used to determine the IRMAA.
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Enter “Y” in the “Appeal Involved” field.
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On the IRMAA Appeals Determination (IRAP) Screen:
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Select “1” Reconsideration for the level of appeal.
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Enter “Y” for Recon Dismissal.
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Leave Good Cause blank if no good cause is involved. Show “Y” if good cause is involved
and established, or “N” if good cause is involved but not established.
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Enter the determination date (l usually the current date) in “Date of Appeal Determination”.
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Enter the premium year the beneficiary is appealing.
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In the Remarks field enter “Does not agree with IRS Information and no documentation
to support an error.”
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On the IRMA screen:
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Input the same exact AGI and TEI currently used to determine the IRMAA.
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Select “4”, IRS Tax Correction Data for the source code.
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Select “2”, Not Proven for proof .
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The IRRE Screen will display the current and recalculated IRMAA data. The “New Determination
Results” field will provide the appeal determination based on the information entered.
In this case the determination should be a “Dismissal.”
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Enter a “Y” in the Process All Transactions field. Entering an “N” will cancel all
transactions associated with this input.
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Enter the determination into the IRMAA Appeals Tracking System. Follow the instructions in HI 01140.005E.
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Advise the beneficiary to contact IRS at 1-800-829-1040 to have the information corrected.
Inform the beneficiary to recontact SSA if they receives a letter from IRS confirming
the error and the correct information.
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The reconsideration request received is outside of the appeal period and no good cause
for late filing was established per GN 03101.020.
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Process a “Dismissal” decision.
Access the IRMAA screens. (See MSOM T2PE 008.001 through MSOM T2PE 008.017).
On the IRMN screen:
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Enter the Beneficiary’s own SSN (BOAN).
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•
Select the appropriate option based on the information provided in the “Desired Function”
field. See HI 01120.001E.
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Enter “Y” in the “Appeal Involved” field.
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On the IRMAA Appeals Determination (IRAP) Screen:
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Select “1” Reconsideration for the level of appeal.
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For Recon Dismissal enter “Y”.
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In “Date of Appeal Determination” enter the date the determination is made (this will
usually be the current date).
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Enter the premium year to which this appeal applies.
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In the Remarks enter “late filing-no good cause established.”
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On the IRMA screen enter the information regarding MAGI and Tax filing status alleged
by the beneficiary for the more recent tax year.
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The IRRE Screen will display the current and recalculated IRMAA data. The “New Determination
Results” field will provide the appeal determination based on the information entered.
In this case the determination should be a “Dismissal.”
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Enter a “Y” in the Process All Transactions field. Entering an “N” will cancel all
transactions associated with this.
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Enter the determination into the IRMAA Appeals Tracking System. Follow the instructions in HI 01140.005E in this section.
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NOTE: The system will automatically release all notices.