TN 13 (11-10)

SI 02003.024 Processing eIAR Proration Cases

The automated eIAR system cannot process IAR cases when the State and SSA both paid a prorated benefit in the same month. The FO must process these cases manually using the instructions in this section and in SI 02003.025 through SI 02003.050 to ensure that the State and the SSI recipient are paid correctly.

A. Background on eIAR proration cases

SSA no longer prorates SSI benefits for the first month of SSI eligibility on initial claims. We do prorate SSI benefits following certain suspensions, which can occur while an initial claim is pending or when we do a PE reinstatement following a period of suspension. For a list of the suspensions that cause prorated SSI benefits, see SI 02005.008, Proration after Period of Ineligibility.

B. Policy for manually processed proration cases

Here is how to identify which cases need to be processed manually. If SSA:

  • prorates the SSI benefit and the State prorates the IA benefit for the same month, the eIAR system cannot compute the State reimbursement amount correctly for that month. To avoid incorrect payments, you must process the case manually similar to the processing required before implementation of eIAR;

  • prorates the SSI benefit for a month, but the State did not prorate the IA for that month or paid no IA for that month, eIAR can process the claim to completion; and

  • does not prorate SSI for the month or does not pay SSI for the month, and the State prorates the IA for that month, eIAR can process the claim to completion.

Example: The DDS approves Mr. Smith’s disability claim and the FO does a PERC to adjudicate his claim in November 2010. During the PERC, the FO determines that Mr. Smith was ineligible for SSI for May and June 2010 due to residence in public institution (N02). The institution releases Mr. Smith on July 21, so he is eligible for prorated SSI benefits for July 2010.

Analysis: If the State paid a prorated IA payment to Mr. Smith for July 2010, the eIAR system cannot process the case because both SSA and the State would pay a prorated benefit in July. If the State did not pay a prorated IA benefit in July, the eIAR system can process the case to completion.

C. Procedure for identifying eIAR proration cases

1. FO processes SSI claim allowance

The FO adjudicates the SSI claim or PE reinstatement to establish a UPV: V on the SSR. At this point, eIAR will transmit a message to notify the State to input IA payment amounts for the months of the reimbursement period. For more information about UPV: V, see SM 01311.660.

2. State reviews its IA payments to the SSI claimant

Upon receiving notification of the SSI allowance, the State IAR technician must review the State’s IA payments made to the SSI claimant before inputting these payments on the eIAR system. Prorated payments affect processing the case as follows:

  • If there are no prorated IA payments, the technician can proceed to input the IA payments in eIAR system and eIAR will process the case to completion.

  • If the State made any prorated payments to the SSI claimant during the IAR reimbursement period, the technician must call SSA’s IAR regional coordinator to notify SSA that the State made a prorated payment.

3. SSA’s IAR regional coordinator reviews the SSI claim

SSA’s IAR regional coordinator will review the SSI claim to determine if SSA will pay prorated SSI benefits for any month in the IAR reimbursement period.

  • If no prorated SSI payments will be paid, the claim can be processed to completion on eIAR and the regional coordinator will advise the State technician to proceed with inputting the IA payments on the eIAR system.

  • If any SSI payment will be prorated, but not in the same month that the State paid a prorated benefit, the claim can be processed to completion on eIAR and the State technician can input the IA payments on the eIAR system.

  • If an SSI payment and a State IA payment will be prorated for the same month, the regional coordinator will notify the State technician that the case cannot be processed on the eIAR system and that manual processing by SSA is required.

4. SSA’s IAR regional coordinator notifies FO about proration case

The IAR regional coordinator will notify the servicing FO by email or telephone that the FO will need to process an IAR proration case manually.

D. Procedure for manually processing IAR proration cases

After the regional coordinator notifies the FO of a proration case, process the IAR reimbursement as follows:

  • The FO will immediately input a hold on the underpayment on the UOUP screen (select Option 1, HOLD UNDERPAYMENT) to prevent eIAR from erroneously releasing SSI benefits to the recipient due to the 25-day time limit established within the eIAR system. This will build a UPV:U.

  • The FO will prepare an SSA-L8125-F6 (Notice of Interim Assistance Reimbursement) and send it to the State IA agency.

  • The FO will tickle the case for 25 days from the date it sends the SSA-L8125-F6 to the State. This starts the 25-day time limit for the State to request reimbursement.

  • The State IA agency will complete its portion of the SSA-L8125-F6 to provide information about the IA payments made by the State. The State IA agency must return the SSA-L8125-F6 to the FO within 25 days of the date that SSA sent the form to the State. If the State does not submit the completed SSA-L8125-F6 to SSA within 25 days, SSA is required to pay the retroactive SSI benefits to the recipient using SSI payment rules.

  • After receiving the completed SSA-L8125-F6, the FO will review the form for completeness and compute the reimbursement due.

  • The FO will delete the GR code from the SSR and issue the IAR reimbursement payment to the State using option 6 = OTHER on the UPOT screen.

  • The FO will release the hold on the underpayment on the UOUP screen.

E. Procedure for completing the SSA-L8125-F6 for proration cases

1. FO completion requirements

The FO completes the SSA-L8125-F6 with the following information. For more information about completing this form, see SI 02003.040B.

On page 1 of the form, fill in the:

  • Date;

  • Claim number;

  • GR Code;

  • State IAR agency name and address; and

  • SSA FO address.

On page 3 of the form, fill in:

  • Whether the case is an initial claim or a posteligibility case;

  • Recipient’s name and SSN;

  • Representative payee’s name (if applicable);

  • Date of SSI eligibility or reinstatement;

  • Amount of SSI retroactive benefits due;

  • Amount and month of recurring SSI payment; and

  • The SSA FO’s mailing address.

On pages 4, 5, and 6 of the form, fill in:

  • Recipient’s name and SSN; and

  • List of SSI payments in the IAR period (including the From, Through, and Amount Each Month columns).

2. State completion requirements

The State will complete Page 3 of the SSA-L8125-F6 under the heading, “States Account of Reimbursement Claimed” and sign the certification statement.

Because a proration case is processed manually, the State must determine the IAR period and record on the form:

  • the amount of IA paid to the individual;

  • the amount of reimbursement claimed by the State; and

  • the first month for which the State paid IA due the interim IAR period.

After completing the form, the State will send it to the FO address shown on page 3 of the form.

F. State notice requirements

Manual processing of proration cases requires the State to modify the notice it sends to the recipient. The notice must include the information provided by the State’s notices issued before the implementation of eIAR.

The State’s notice will explain the:

  • amount of IA paid to the individual and for which months;

  • amount the State claimed for reimbursement;

  • amount that SSA reimbursed the State for IA paid; and

  • individual’s right to a hearing before the State about any matter for which the individual believes he or she has been aggrieved by an action taken by the State under section 1631(g) of the Social Security Act.

G. References for related instructions for eIAR proration cases

MSOM BUSSR 003.022, One Time Payment (UPOT)

MSOM BUSSR 004.018, Underpayment Processing (UOUP)

SM 01311.355, Withholding an Underpayment (U TAC)

SM 01311.360, Releasing a Manual Hold on an Underpayment

SM 01311.660, Processing an Underpayment

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SI 02003.024 - Processing eIAR Proration Cases - 11/19/2010
Batch run: 05/09/2011