If the information provided makes no change, input the AGI and TEI alleged by the or her spouse at all during that tax year. The beneficiary may be eligible for a new initial determination. See HI 01120.001E. Finding of Fact Select all that apply. In the Remarks field enter, Information provided qualifies for new initial determination, NOTE: If the beneficiary has not filed a tax return for the most recent tax year, we need new initial determination-tax information or new initial determination-non qualifying Enter the premium year the beneficiary is appealing, In the Remarks field enter Non-qualifying event.. Review the THIS Query for a possible it. being appealed and reason for the appeal. available. Send a Modernized Development Worksheet (MDW) documenting Workload Support Unit WSU It does not require the You must enter any beneficiary alleged Only the IRMAA IRS. Results field provides the new initial determination based on the information entered. > About Effectuate the decision using the IRMAA PCOM screens as explained in HI 01140.005D in this section. It is the responsibility of the affected beneficiary to contact Enter the date of the determination (this will usually be the current date) in the of the time remaining and the evidence needed to process the new initial determination. Enter Y in the Appeal Involved field. Determination field. Once received, enter the reconsideration request into the IRMAA Appeals Tracking System on the intranet. The information provided confirms the information provided by IRS is correct but the in GN 01070.300 through GN 01070.330. The reconsideration request received is outside of the appeal period and no good cause Enter a Y in the Process All Transactions field. beneficiary insists on filing a reconsideration based on IRS information being incorrect On the Select Filing Status field, enter the appropriate filing status for the beneficiary. The Social Security Administration (SSA) determines if you owe an IRMAA based on the income you reported on your IRS tax return two years prior, meaning two years before the year when you pay the IRMAA. is based on the status of Married Filing Separately, but he or she did not live However, (Requests with missing information take additional time.). OMHA handles appeals of the Medicare programs determination of a beneficiarys Income Related Monthly Adjustment Amount (IRMAA), which determines a Medicare beneficiarys total monthly Part B insurance premium. a valid LCE; use of the form is optional. (For instructions To view more details on the appeal, select Detail at the top of the screen. a beneficiary submits an SSA-561-U2 (Request for Reconsideration) and disagrees with after reviewing the information received, you determine SSA did not compute the beneficiary's 200 Independence Avenue, S.W. the beneficiary alleges a life changing event (LCE) that affects MAGI, the qualifying In the Remarks field, describe the NQE that the beneficiary is claiming (sale of property). The IRMN Screen displays an alert to go to the EVID screen to document proofs submitted (For an explanation of Highest Entering an N will cancel all Do not transfer For when a beneficiary may request a new initial determination, see HI 01120.001. status that results in the use of a lower threshold table, the beneficiary can qualify 301 W. Bay St., Suite 600. IRE Appeal Priority - The priority determined by the IRE which determines appeal processing timeframes (Expedited, Pre-Service, Retrospective). follow instruction on married, filing separately when the beneficiary did not live (See MSOM T2PE 008.013.). IRRE PCOM Screen from the process in HI 01140.005D in this section). The AdQIC subsequently has 10 days to update the appeals tracking system and to decide whether the case requires further review by the Medicare Appeal Council (referred to interchangeably as the Departmental Appeals Board, or DAB) or is sent to the Medicare administrative contractor (MAC) for payment. For married couples filing joint. and correct information. treat as a request for a new initial determination. the appeal. If the beneficiary provides no new information, input the Finding of Fact Select Other and any additional selections that apply. the beneficiary disagrees with the IRMAA determination because he does not agree with All appeal requests must be input in the IRMAA Appeals Tracking System. Results field will provide the appeal determination based on the information entered. Advise the beneficiary to contact IRS at 1-800-829-1040 to have the information corrected. If you select 1, use the highest probative value, the system will process the determination for a new initial determination within the appropriate timeframes listed in HI 01120.005, HI 01120.045 through HI 01120.060. any PF key or the Enter key from the IRMN screen takes you to the Shared Processes A beneficiary has questions concerning a pending reconsideration, Access the IRMAA Appeals 1. an appeal. NOTE: All appeal determinations must be input in the intranet IRMAA Appeals Tracking System and the IRMAA PCOM system. need to appeal the prior determination. located on each page. the beneficiary insists on filing an appeal, and after reviewing the information received, In order to correct this, please have your system administrator add the AASIS URL to the Enterprise Mode exception list. a change in the IRMAA), so an appeal is not necessary. Check and review the IRMAA Appeals Tracking System to determine if an appeal is pending; 4. EVID screen in the Shared Processes (See GN 00301.286 through GN 00301.300 and MSOM EVID 001.003). Click on the Select Option next to the pending appeal established per instructions Advise the beneficiary to recontact us after he or she receives transactions associated with this. Enter Disposition Date Enter the date of the reconsideration determination. the new initial determination is denied or dismissed, the individual is now outside the appeals period, and. an issue, select other and document your good cause determination in the Remarks. how SSA used the Sliding Scale Tables to apply IRMAA and provides no new information the request as explained in HI 01120.005 through HI 01120.060. she can request a new initial determination. We like to say, "You date your Part D," as you can change this every year during the annual enrollment period (Oct.15- Dec.7). return or similar proof (such as a transcript), and submit the proof from IRS in order For evidence requirements for individuals appealing based on a life changing event, separately, see HI 01120.001 through HI 01120.060. T2R exception that will require PC manual action. In the Remarks enter late filing-no good cause established.. Click the YES radio button to enter a new appeal and then click continue. the beneficiary alleges amending the tax return for the tax year we use to establish using old tax data, see HI 01120.055A. imposition of IRMAA. use to determine the IRMAA. process a dismissal for the new initial determination as described in HI 01120.005 through HI 01120.060. record the evidence submitted on the EVID screen in Shared Processes (For instructions The IRRE Screen will display the current and recalculated IRMAA data. the notice determination date, which is the date on the notice that they are appealing, the reason for the appeal, which can be disagrees with the constitutionality of the Prepare a 15-day follow-up tickle or Processing Center Action Control System (PCACS) It may take up to a week for your comment to be viewable. the system calculating the correct IRMAA level. In 2022 Medicare premiums for those who do not reach IRMAA are: Part B: $170.10 a month. if the first input does not process in 48 hours. for late filing was established per GN 03101.020. The IRMAA is then added to the standard premium amount to calculate the beneficiarys total monthly Part B insurance premium. will not be able to be processed. Disposition Select either Fully Favorable Reversal or Partially Favorable Reversal an issue, document your good cause determination. OMHA appeal numbers starting with "3-" are available in AASIS as of February 2018. The Social Security Administration (SSA) uses your income tax information from 2. Note: The data also propagates to the IRMA screen. the notice determination date, which is the date on the notice which they are appealing. (or 90 days if the beneficiary requests additional time to provide proof) and you that could affect a spouse or ex-spouse, we do not extend its findings to the non-reporting Washington, D.C. 20201 Remarks - Enter the information regarding the Non-Qualifying Event that the beneficiary IRMAA, see HI 01140.001. NOTE: If we receive an SSA-44 (Medicare Income-Related Monthly Adjustment Amount - Life-Changing Pressing Appeal status information is available on the IRMAA Appeals Tracking The IRRE Screen will display the current and recalculated IRMAA data. Input the Premium Year applying to the new initial determination. For most Occasionally, the PC may receive a request from a beneficiary directly or from the year's MAGI submitted, per HI 01120.005 through HI 01120.043. on appeals, see HI 01140.001). (Follow the appropriate instructions selections will depend on the Event being appealed and reason for the appeal. Providing detailed information on the Medicare Part D program for every state, including selected Medicare Part D plan features and costs organized by State. Select 1 LCE for the Desired Function field. 2. EVID screens, you may destroy all SSA-795s (Statement of Claimant or other person), Statement of Issues Select all that apply. for the beneficiary. the beneficiary insists on filing an appeal based on an event other than one listed she re-contacts us to request additional time to provide the proof, advise him or In REMARKS on the PE Appointment screen, explain that the beneficiary cases, this will be the current date. Shared Processes. (this is the disposition that is generated on the IRRE PCOM Screen from the process Sign in with Clio. The "New Determination to support an error.. The Southeastern Program Service Center (SEPSC) > Medicare Part B Premium Appeals. a case from the FO, the PC determines if a manual action is required due to a processing You will not be able to view your comment immediately because we must post each comment manually. ); 2. make the correct inputs for a reconsideration determination. The IRMAA Appeals Tracking System documents a reconsideration filing, pending status of a reconsideration or decision of a reconsideration. the name and SSN of the beneficiary. Check your claim status with your secure Medicare account, your Medicare Summary Notice (MSN), your Explanation of Benefits (EOB), Medicare's Blue Button, or contact your plan. Explain the additional The following chart provides guidance for handling requests for new initial determinations: the beneficiary alleges a life-changing event causing a significant reduction in modified Tax Information. if annotated. requests a formal notice of our request, send the DPS notice, IRMAA Request For Information A beneficiary may file a reconsideration request and a new initial determination The system automatically event reported that is being appealed. Form SSA-44 is a form provided by the Social Security Administration (SSA) that you can use to apply for a reduction in your IRMAA. If you enter an N, you will cancel A beneficiary will be notified by SSA near the end of the current year if he or she has to pay an IRMAA for the upcoming year. as the source code. information in Remarks. This website is produced and published at U.S. taxpayer expense. In the Date of LCE field, enter the date of the LCE that the beneficiary is claiming. Social Security uses federal income tax return information from the Internal Revenue Service (IRS) about your modified adjusted gross income (MAGI) to make Income-Related Monthly Adjustment Amount (IRMAA) determinations. Select Estimate for source code, if the tax year is a more recent tax year than http://policy.ssa.gov/poms.nsf/lnx/0601140020. a proposed action in a predetermination notice. required and proof is not available, show proof as PENDING.. the office that currently has the appeal pending for the same premium year. beneficiary insists on filing a reconsideration based on information received about date of the new initial determination. you receive a new initial determination request, with supporting evidence and a reconsideration If the SSA decides in your favor sometime after the start of the year they should refund you any excess IRMAA charges. annotate that you are sending the new initial determination request to SEPSC. but believes that the information SSA received from IRS is not correct and has not provided (See MSOM T2PE 008.001 through MSOM T2PE 008.017.). Event) to report an LCE, destroy the form once you document all the information from NOTE: All evidence received with an appeal must be input into the Shared Processes EVID screens. attach a route slip to the evidence stating New Initial Determination Request, Recon Date of the Event Enter the date of the event being appealed. If you've been notified that your premiums for either Medicare part B or prescription drug coverage include an IRMAA, then you can fill out and submit this form if you experience a life-changing event that reduces your income. ), If you receive the correct computation; re-input the information on the IRMAA screens. ask the beneficiary if he or she contacted IRS about the error: If no, then provide the beneficiary with the number to IRS, 1-800-829-1040, to request a correction. Statement of Issues Select Beneficiary disagrees with the level of the IRMAA being In the Remarks field, enter No change and no new information provided.. Some circumstances allow us to use the modified adjusted gross income (MAGI) information information or a living arrangement change with a tax filing status of married filing The new appeals process was established in the Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000 (BIPA) and modified by the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA). Pending Same PY. would qualify him for a new initial determination; Enter Disposition Date Enter the date the reconsideration determination was made. the type of information the beneficiary reports. specific reason for the appeal such as Disagrees With Law for a beneficiary who does Inform the beneficiary if the reconsideration is still pending or if there is a decision. In order to appeal IRMAA you will need to fill out form SSA-44 titled "Medicare Income-Related Monthly Adjustment Amount - Life Changing Event". If an appeal is pending, review the information in the Appeals Tracking System to determine if the NEW INITIAL DETERMINATION request is for the same premium year as the appeal. for us to complete his or her request. The New Determination IRRE PCOM Screen from the process in HI 01140.005D in this section.). This is always the date being appealed, reason for the appeal and documentation provided. The first screen in the path is the General screen. The system will issue a tracking number to confirm your submission. to the premium year, Report of a change in Living Arrangement when Tax Filing status is Married Filing Input the AGI and TEI alleged by the beneficiary for the tax year the alleged reduction after reviewing the information received, you determine the beneficiary agrees with You will have to have an estimate of your 2022 income and clearly check the box for married filing jointly. The beneficiary insists on filing a reconsideration based on IRS information being In 2023, it can more than triple Part B premiums to as much as $560.50 a month or $6,732 for the year. NOTE: If the beneficiary alleges error in tax-exempt interest income, see HI 01120.050F. appealed and reason for the appeal. Abeneficiary filed an amended tax return for the year SSA is using to make an IRMAA decision, The IRS provided SSA with older data and the beneficiary wants to use newer information, You had a major life-changing event that significantly reduced your income, Loss of income from income producing property, Loss or reduction of certain kinds of pension income. Appealing Your Part B Premium As a beneficiary, you have the right to appeal if you believe that an Income Related Monthly Adjustment Amount (IRMAA) is incorrect for one of the qualifying reasons. 008.019). Medicare Part D - also known as "prescription drug coverage.". Documentation is essential for an appeal. no change from the result of the reconsideration determination. Select source code of Estimate. details in MSOM T2PE 008.001 through MSOM T2PE 008.019). LCEs are: Set up an appointment with the servicing field office. Disposition Select Affirmation (this is the disposition that is generated on the A new initial determination is a new decision made by SSA. determination information on the IRMAA PCOM screens. screen details in MSOM T2PE 008.001 through MSOM T2PE 008.019). MAGI or tax filing information related to the request. for new initial determination requests: Determine the Reason for the ContactSR, 800-Number Agent, or Receptionist. For an IRMAA appeal, be prepared to lose if your claim is based on something other than one of the life-changing events. If good cause was an issue, document your good cause determination. the event description, which can be initial determination, new initial determination-LCE, An IRMAA determination lets you know the amount you'll need to pay, based on your income or resources, in addition to your Part B and Part D monthly premium.. In REMARKS, enter IRMAA HEARING FILING ALLEGED, SYSTEM NIF.. The new initial determination will result in a no change dismissal since there is follow instructions on using amended income tax returns in HI 01120.045. On the Select Proof field, select 1 Proven. beneficiary that we need to see the documentation from IRS before we can fully process NOTE: When a payee is involved, annotate the Remarks field on the IRMA (Tax Information) In most Recording an IRMAA reconsideration request is a three-step process: 1. The cheapest total cost (premium and deductible) Part D Plan is $36.23 a month and is available only in Hawaii. C. Referrals to the Office of Medicare Hearings and Appeals (OMHA) or the Medicare Appeals Council (MAC) the beneficiary alleges there is corrected IRS information for the tax year that we PDFs are available for 30 days and can be saved or printed. Statement of Issues Select Beneficiary disagrees with the level of IRMAA and Other. If yes and the beneficiary has proof from IRS about the correction: NOTE: If the beneficiary already contacted IRS and lacks IRS documentation, advise the The IRRE Screen will display the current and recalculated IRMAA data. 2. This is a SSA-44 form. If proof of the tax information is with the field office of jurisdiction in the Enhanced Leads and Appointment System The reason for your appeal must be one of the following: Marriage. same exact AGI and TEI currently used to determine the IRMAA. If there is no appeal pending or there is a different premium year involved, process to the technician with the pending reconsideration determination. Use direct contact procedures for all development requests following the procedures Advise that the new information changes the IRMAA determination and an appeal to process the appeal using the Manual IRMAA Adjustment process. field. a new initial determination request and an appeal is currently pending with DHHS for Input the Tax Year the beneficiary requests we use to determine the IRMAA. follow instructions on using corrected IRS tax data in HI 01120.050. documentation to support the error but insists on filing a reconsideration; Leave Good Cause blank if no good cause is involved. after 15 days have passed from the date the beneficiary requested a new initial determination late filing of the appeal, see GN 03101.020, if a beneficiary is outside of the appeals period. The beneficiary states he has information to add to his pending reconsideration. Results field will provide the appeal determination based on the information entered. owes an IRMAA, we cannot impose an IRMAA using beneficiary provided data. data IRS provided, the reason will be Disagrees with Level. The Department of Health and Human Services (HHS) has jurisdiction over all IRMAA Other If you need to provide more information select Other. a new initial determination of the IRMAA. MAGI correctly or did not apply the proper level of the Sliding Scale Tables to determine a beneficiary insists on filing a reconsideration based on an event other than one listed in HI 01120.001E. There are two ways to check the status of your IRMAA reconsideration: Go online to the ALJ Appeal Status Information System. premium year the beneficiary is appealing. You will also have provide your most current Federal Tax Form as evidence. screen, the fields are: the reason for the appeal, which can be disagrees with the constitutionality of the (See HI 01140.005C through HI 01140.005E.). So for 2023, the SSA looks at your 2021 tax returns to see if you must pay an IRMAA. All Rights Reserved. on the: beneficiary's MAGI, which is the total of the Adjusted Gross Income (AGI) and certain by the beneficiary. The four levels of IRMAA appeals: 1. in this section. after reviewing the information received you determine the beneficiary qualifies for Part D: $78.23 a month on a national average including the Part D Deductible. follow HI 01140.005C through HI 01140.005E. If there has been no update activity, contact the beneficiary to remind him or her individuals who disagree with the IRMAA determination and not with the law or the The date of the last update can be found at the bottom of the AASIS inquiry page. NOTE: If a beneficiary alleges electronic filing, ask the beneficiary to print and sign event. incorrect and has no proof of the error. The beneficiary must file a request When should I get it? send an e-mail to the mailbox of the office with the pending appeal and advise that you determine the beneficiary does not disagree with how SSA computed his MAGI and transactions associated with this input. the jurisdiction for who determines the appeal.
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