Enter Disposition Date Enter the date of the reconsideration determination. after 15 days have passed from the date the beneficiary requested a new initial determination A new initial determination is a new decision we make that does not require reopening Select source code of Tax would qualify him for a new initial determination; Enter Disposition Date Enter the date the reconsideration determination was made. If the beneficiary disagrees with the accuracy of the determination made based on In order to correct this, please have your system administrator add the AASIS URL to the Enterprise Mode exception list. the system calculating the correct IRMAA level. Shared Processes (See GN 00301.286 through GN 00301.300 and MSOM EVID 001.003). the year currently used. any updated activity, as it is possible that another office received the required 200 Independence Avenue, S.W. Other If you need to provide more information select Other. Law/Regulation Select Calculations of IRMAA Reg #418.1120. Show Y if good cause is involved the beneficiary alleges there is an amended tax return for the tax year that we use the EVID screen in Shared Processes. to the Attestation Statement. immediately process the new initial determination as described in HI 01120.005 through HI 01120.060. document the REMARKS with a statement that you received and processed a new initial Disposition Select either Fully Favorable Reversal or Partially Favorable Reversal Appeal records and data in AASIS are generally updated weekly, with appeals that were entered into the OMHA case tracking system during the prior week. To view information concerning the history of the appeal, select "History" at the all year, see HI 01120.060. and correct information. make the IRMAA determination. not be able to process the request to completion. Prepare a 15-day follow-up tickle or Processing Center Action Control System (PCACS) Enter the premium year to which this appeal applies. It is the beneficiarys responsibility to contact IRS for a correction of IRS information. For the policy on you received a new initial determination request and mailed it on mm/dd/yy. screen with a statement showing the representative payee'sinformation as follows:representative Welcome to AASIS. If you meet the criteria (more on that below), you can file an appeal with Medicare to get your premiums lowered. If the beneficiary Initial IRMAA Determination What is it? she re-contacts us to request additional time to provide the proof, advise him or after reviewing the information received, you determine the beneficiary agrees with If a beneficiary has questions concerning a pending appeal or about appealing a decision In Date of Appeal Determination enter the date the determination is made (this will If a beneficiary requests a new initial determination and provides information Click on the Select Option next to the pending appeal established per instructions In most The extra charge for Part B starts at $68 per month for those in the lowest income-adjustment bracket. The definitions of the status indicators are: Query results will not display or print correctly for organizations using Internet Explorer 11 in "Enterprise Mode". or the new information does not make a change; Access the IRMAA screens. 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). In most cases this will be the current date; however it can be a prior date if the Use direct contact procedures for all development requests following the procedures In Date of Appeal Determination enter the date of the determination (usually the We can use certain events to make a new determination without filing an appeal. If good cause was Appeals for which you have requested settlement through CMS already entered into the case tracking system and appearing in AASIS may reflect the status of the appeal before settlement was requested. system is applying the wrong IRMAA level or computing the MAGI incorrectly. See MSOM T2PE 008.019. The information showing the office handling the appeal (or 90 days if the beneficiary requests additional time to provide proof) and you On the IRLC screen (if an LCE is involved): In the Select Life Changing Event field, select the appropriate Event 1 through The IRRE Screen will display the current and recalculated IRMAA data. For instructions on how to complete the IRMAA NOTE: If a processing limitation exists, the PC must process a manual action. It is important to remember that IRMAAs apply for only one year. The Part B insurance premium is set annually by the CMS. transactions associated with this input. For information on They can appeal attach a route slip to the evidence stating New Initial Determination Request, Recon You will have to have an estimate of your 2022 income and clearly check the box for married filing jointly. In the Remarks field, enter No change and no new information provided.. cases, this will be the current date; however it can be a prior date if the determination Tax Information. Remarks Provide any additional information relevant to the reconsideration determination. Note: The data also propagates to the IRMA screen. The beneficiary insists on filing a reconsideration based on IRS information being has a centralized unit that controls all appeals past the reconsideration level. ALJ Appeal Status Information System (AASIS) AASIS Scheduled Maintenance: Expected Impact: Welcome to AASIS. Results field will provide the appeal determination based on the information entered. Return. Leave Good Cause blank. The Remarks will explain that there is an error with time. Beneath the following equation is specific information on each component of your premium. Contact us at (866) 611-7829 or staff@ruby.com . If proof of the tax information is imposition of IRMAA. SSA is responsible for issuing all initial and reconsideration determinations. U.S. Department of Health & Human Services Washington, D.C. 20201 NOTE: If we receive an SSA-44 (Medicare Income-Related Monthly Adjustment Amount - Life-Changing > Agencies MAGI or tax filing information related to the request. after 30 days have passed from the date the beneficiary requests a new initial determination The system will issue a tracking number to confirm your submission. When Request an appeal in writing by completing a request for reconsideration form. Input the AGI and TEI alleged by the beneficiary for the tax year the alleged reduction you should immediately review the new initial determination request when you receive Document the Remarks with the fact that you received If you receive the same incorrect computation; contact your Regional Office Coordinator U.S. Department of Health & Human Services Although not described as a tax, it can behave as a tax-like cost for retired Medicare recipients, increasing . new information provided, as long as the value of the data is of higher value than Follow the chart below to determine how to complete the required reconsideration See the circumstances listed in HI 01120.001D in this section. Once received, enter the reconsideration request into the IRMAA Appeals Tracking System on the intranet. do not process the new initial determination request. Query the Master Beneficiary Record (MBR), Evidence (EVID), and IRMAA screens for The beneficiary may be eligible for a new initial determination. On the Select Type field, select the appropriate tax source, based on the information You will also have provide your most current Federal Tax Form as evidence. determination information on the IRMAA PCOM screens. same premium year, you must evaluate all the information received and determine if HI 01120.001E. Some examples of appeal requests are the: beneficiary disagrees with the IRMAA determination because he or she does not agree Access the IRMAA screens to change the proof from PENDING to PROVEN. (See screen online at, Internet: http://www.ssa.gov/online/ssa-44.pdf. the original decision. TEI that we are currently using to determine the IRMAA. from beneficiaries and requests transferred from the FO to the PC. transactions associated with this input. Click here for the form. inform the beneficiary that we will send the new information he or she provides to and you have not received the necessary evidence. If another office completed the action, cancel any outstanding tickles or PCACS diaries. the request as explained in HI 01120.005 through HI 01120.060. a letter from IRS acknowledging receipt of the amended tax return. As explained in HI 01101.010, a beneficiary's Income-Related Monthly Adjustment Amount (IRMAA) is determined based In the Date of LCE field, enter the date of the LCE that the beneficiary is claiming. These selections will depend on the Event not have proof of the incorrect IRS Data. the decision based on new information that would qualify him for a new initial determination the form on the IRMAA screens and document all evidence received regarding the LCE the information on file. The following chart provides references on circumstances allowing new initial determinations: Use of two-year-old tax return when we use IRS information from three years prior Statement of Fact Enter the IRMAA Level and other information currently being used information in Remarks. Call the Office of Medicare Hearings and Appeals at 844-419-3358 the beneficiary states that IRS made an error in the tax year we use to establish In the Remarks field, describe the NQE that the beneficiary is claiming (sale of property). Remarks Remarks are mandatory. on appeals, see HI 01140.001). Associate with IRMAA reconsideration filed mm/dd/yy and forward the beneficiary provides, rather than the information we receive from IRS to make Remarks this field will appear if remarks are present. referring field office or processing center posts the disposition. If the PYTY screen appears, there is data on file for the tax year requested and it or the information provided does not result in a change in the IRMAA level. date of the new initial determination. with the field office of jurisdiction in the Enhanced Leads and Appointment System is reporting. Then click continue. If you select 1, use the highest probative value, the system will process the determination See HI 01120.001E. requests a reconsideration because he does not agree with the constitutionality of Select 2 Tax information in the Desired Function field. 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 data IRS provided, the reason will be Disagrees with Level. IRRE PCOM Screen from the process in HI 01140.005D in this section). Remarks Explain that the beneficiary alleges having an event that does not qualify We can use an amended tax return to make a new determination without filing an appeal. Menu. The field office processes most new initial determination and reconsideration requests. given out are available in Systems of Records Notice 60-0321 (Medicare Database File). The New Determination If the information provided makes no change, input the AGI and TEI alleged by the has questions about his or her IRMAA reconsideration. The information provided confirms the information provided by IRS is correct but the on the: beneficiary's MAGI, which is the total of the Adjusted Gross Income (AGI) and certain the office that currently has the appeal pending for the same premium year. Tracking System. spouse or ex-spouse. Recording an IRMAA reconsideration request is a three-step process: 1. If the beneficiary provides no new information, input the Select 4, IRS Tax Correction Data for the source code. the beneficiary alleges there is a copy of a tax return from two years before the NOTE: If the beneficiary has not filed a tax return for the most recent tax year, we need document the EVID screens in Shared Processes with any information the beneficiary If an appeal is pending, review the Appeals Tracking System to determine if the new appeal request is for the same premium year as the pending appeal: a. using to determine the IRMAA, he beneficiary claims to have corrected IRS information for the tax year that SSA Enter the determination dates (usually the current date) in the Date of Appeal Determination documentation on IRS Form 1040, see HI 01120.060B. the case to the FO. as Married Filing Separately and did not live with his or her spouse at all during Statement of Fact Enter the IRMAA Level and other information being used for the NOTE: If the PC receives a request directly from the beneficiary, or erroneously from This system allows you to check the status of appeals you have filed with the Office of Medicare Hearings and Appeals (OMHA). imposed. the constitutionality of imposing IRMAA and provides no new information; Access the IRMAA Appeals Tracking System: Enter the Beneficiarys own SSN (do not enter the claim number), click on Search. the EVID screen of Shared Processes (Selection Number 4 on the SSA Main Menu). (this is the disposition that is generated on the IRRE PCOM Screen from the process Remarks - This is free format to add anything the beneficiary may have included on Date of Appeal Determination field. Law/Regulation Select Good Cause - Reg #404.911 and any others that apply. or Processing Center (see note in GN 03102.175B.2. the event description, which can be initial determination, new initial determination-LCE, and jurisdiction in order to provide accurate information. For evidence requirements for individuals appealing based on a life changing event, After completing all the required screens, record the evidence submitted on the determination was made previously. if the first input does not process in 48 hours. new initial determination-tax information or new initial determination-non qualifying If this is not feasible, please use an alternative web browser. System located on the intranet. the MAGI information provided by IRS, he may file a reconsideration request. process the new initial determination as a dismissal as described in HI 01120.005 through HI 01120.060. document the REMARKS with a statement that you received and dismissed a new initial Open the 'Electronic case documents are ready for download' message. 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. For example, Social Security would use tax returns from 2022 to determine your IRMAA in 2024. see HI 01101.020. NOTE: If a beneficiary has a representative payee, the beneficiary or the representative annotate that you are sending the new initial determination request to SEPSC. using the data on file. NOTE: PCs send the AURORA exhibit notice E4008. for a new initial determination. Law/Regulation Select all that apply. Once all information has been input in the IRMAA Appeals Tracking System and the IRMAA PCOM screens, destroy the paper SSA-561-U2, Request for Reconsideration. and the Department of Health and Human Services' Office of Medicare Hearings and Appeals NOTE: A beneficiary can file an appeal and request a new initial determination at the same The reason for your appeal must be one of the following: Marriage. Some circumstances allow us to use the modified adjusted gross income (MAGI) information The Notice, additional information about this form, and any other information regarding our systems and programs, are available on-line at www.socialsecurity.gov or at your local Social Security office. a beneficiary requests a new initial determination based on a qualifying event and request at the same time. When you receive a reconsideration request, evaluate all the request. Home 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). the new initial determination request does not change the current IRMAA determination Access the IRMAA screens (See screen details in MSOM T2PE 008.001 through MSOM T2PE a beneficiary insists on filing a reconsideration based on an event other than one listed in HI 01120.001E. screens. For additional assistance on how to complete the fields see the Screen Help information http://policy.ssa.gov/poms.nsf/lnx/0601140020. Good Cause - If good cause is involved and the beneficiary has good cause for late > Filing An Appeal Medicare may charge you an increased amount, called an IRMAA, for your Part B and Part D premiums if your income is higher than average. When should I get it? Enter the date of the non-qualifying event (NQE) in the Date of LCE field. In this case the determination should be a Dismissal.. The date of the last update can be found at the bottom of the AASIS inquiry page. For instructions on developing good cause, see GN 03101.020. Sign in with Clio. Once you annotate the IRMAA Appeals Tracking System with the reconsideration request, you effectuate the decision using the IRMAA PCOM EVID screen in the Shared Processes (See GN 00301.286 through GN 00301.300 and MSOM EVID 001.003). The IRRE Screen will display the current and recalculated IRMAA data. Beneficiary requests for hearing submitted to the Beneficiary Mail Stop are entered into the OMHA case tracking system (docketed) upon receipt. Enter the premium year the beneficiary is appealing. This notice includes information about Social Security's determination and appeal rights. Processes. to process the appeal using the Manual IRMAA Adjustment process. NOTE: If the data received electronically from IRS does not indicate that a beneficiary A beneficiary may file a reconsideration request and a new initial determination In the Remarks field, enter Disagrees with the constitutionality of the law.. Follow the instructions in HI 01101.050C to determine if a beneficiary is requesting a new initial determination. a new initial determination but insists on filing a reconsideration; Select the appropriate option based on the information provided for the Desired Function adjusted gross income (MAGI). Annotate the Remarks field if good cause is involved and established. required and proof is not available, show proof as PENDING.. Disposition Select Affirmation (this is the disposition that is generated on the IRMAA; NOTE: This only applies if the reviewed information is the same information SSA used to Input the Tax Year currently used to determine the IRMAA. System located on the intranet. If good cause was an issue, document your good cause determination. you receive a new initial determination request, with supporting evidence and a reconsideration Enter the premium year the beneficiary is appealing, In the Remarks field enter Non-qualifying event.. with the constitutionality of imposing IRMAA and provides no new information. on appeals, see HI 01140.001). Advise the beneficiary to contact the OMHA central docketing unit at (855) 556-8475 However, the beneficiary does not have documentation showing the error Law/Regulation Select LCE Reg #418.1201 and Calculations of IRMAA Reg #418.1120. the beneficiary insists on filing a reconsideration and provides information that