SSA - POMS: HI 03035.005 - Verification Policy within the Medicare Application Processing System (MAPS)

A. Policy when MAPS require verification

The Medicare Part D Extra Help eligibility process is an automated and paperless process. MAPS base determinations of Extra Help eligibility on a comparison of the income and resource information provided on the Extra Help application with income and resource data that the Social Security Administration (SSA) obtain through matching agreements with other agencies.

MAPS sends the following issues for verification:

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income,
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liquid resources, and
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real property.

MAPS may need verification for any single issue or a combination of the three issues. MAPS selects Extra Help applications for verification based on a comparison of the application data with the agency data.

IMPORTANT: Since a combination of issues may need verifying, it is important to review each item listed on the Issue Verification screen (VRAI) with the beneficiary before completing the Report of Contact screen (DWRC) and sending the application to subsidy determination.

B. Process for MAPS verification issues

1. MAPS verification of Income

The subsidy determination system compares the application data for earned and unearned income with the agency data obtained. If the application data and agency data for income are not within certain tolerances, the system sends the Extra Help application to the verification process. For Income Verification Process instructions, see HI 03035.010.

2. MAPS verification of Liquid resources

The subsidy determination system compares the application data for liquid resources with agency data obtained from other agencies. If the application data and agency data for resources are not within certain tolerances, the system sends the Extra Help application to the verification process For Verification Process for Liquid Resources instructions see HI 03035.020.

3. MAPS verification of Real property

When an Extra Help applicant indicates on either a paper or an internet application that he or she owns real property other than the primary residence, MAPS sends the application to the verification process. You must contact the applicant to determine the equity value of the real property and enter that value as a countable resource. For instructions on Verification Process – Real Property see HI 03035.030.

REMINDER: To prevent improper subsidy determinations, check and resolve all income, resources, and real property issues sent for verification and complete the DWRC screen before submitting the application to subsidy determination

4. Effect of Public Law (P.L.) 110-275 (The Medicare Improvements for Patients and Providers Act (MIPPA) of 2008) on verification of income and resources

Under P.L. 110-275 (MIPPA), in-kind support and maintenance (ISM) is not countable as income and the cash surrender value (CSV) of a life insurance policy is not countable as a resource for purposes of determining eligibility or the amount of Extra Help received by an applicant.

The changes in counting ISM as income and the CSV of a life insurance policy as a resource because of MIPPA are effective for:

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Extra Help applications effectively filed on or after January 1, 2010; and
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Initial determinations that becomes effective on or after January 1, 2010.

NOTE: An example of an initial determination that becomes effective on or after January 1, 2010, is a periodic or cyclical redetermination initiated in August 2009.

Although MAPS does not select ISM and CSV as verification issues, the Claims Representative (CR) may identify ISM or CSV as an issue to develop while processing another verification issue (e.g., the applicant reported ISM or CSV incorrectly on the application). In those situations, ISM and the CSV of a life insurance policy are countable for Extra Help applications filed December 31, 2009, or earlier. If the applicant filed an Extra Help application January 1, 2010, or later, ISM and CSV are not countable when determining Medicare Part D Extra Help eligibility or the amount of the Extra Help.

C. Procedure processing issues that require exception resolution but not verification

When an applicant files a paper application (Form SSA-1020-OCR (Application for Extra Help with Medicare Prescription Drug Plan Costs)) for Extra Help, the Wilkes-Barre Direct Operations Center (WBDOC) technicians scan in the application. We designed the paper application to permit successful scanning, but some applications will still have unanswered questions or unscannable answers.

MAPS routes scanned applications with unanswered questions, unscannable answers, or inconsistent answers, to a technician in WBDOC who resolves these exceptions.

The WBDOC technician takes the following steps for processing these exceptions:

1.

Reviews the image of the scanned application, or contacts the applicant by telephone, or mail to resolve these exceptions;
2.

Enters the correct data to the subsidy determination system so that the system can process the application; and
3.

Routes the exception to the servicing field office if WBDOC cannot resolve the exception.

NOTE: For more information about exceptions, see HI 03010.039.

D. References

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HI 03035.007 Verification and Documentation Instructions for Internal Revenue Service (IRS) Data within the Medicare Application Processing System (MAPS)
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HI 03035.008 Chart with IRS Transaction Types for Medicare Application Processing System (MAPS) During the Verification Process
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HI 03035.010 Income Verification Process
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HI 03035.020 Verification Process for Liquid Resources
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HI 03035.030 Verification Process — Real Property
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HI 03020.055 Income Limits for Subsidy Eligibility

Social Security

Program Operations Manual System (POMS)

HI 03035.005 Verification Policy within the Medicare Application Processing System (MAPS)