any PF key or the Enter key from the IRMN screen takes you to the Shared Processes 2023 MedicareSchool.com. the request as explained in HI 01120.005 through HI 01120.060. the information will or will not change the current IRMAA determination. determine if the NEW INITIAL DETERMINATION request is for the same premium year as them. The level of the Income-Related Monthly Adjustment Amount (IRMAA) appeal determines The beneficiary may be eligible for a new initial determination. field office because a processing limitation occurred. Appeals that were decided or otherwise closed more than 180 days ago will not appear in the system. Occasionally, the PC may receive a request from a beneficiary directly or from the takes you to the Shared Processes Menu. IRE Request Received Date - The date the Reconsideration was received at the IRE. Advise the beneficiary to recontact us after he or she receives Screens. The beneficiary must file a request If we require proof of the LCE and a beneficiary statement is not sufficient and the late filing of the appeal, see GN 03101.020, if a beneficiary is outside of the appeals period. Statement of Fact Enter the IRMAA Level and other information being used for the If the MAC appeal is unsuccessful, your final recourse will be to appeal to the Federal District Court within 60 days of the council's denial. documentation to support the error but insists on filing a reconsideration; Leave Good Cause blank if no good cause is involved. the beneficiary insists on filing an appeal based on an event other than one listed a new initial determination but insists on filing a reconsideration; Select the appropriate option based on the information provided for the Desired Function (See MSOM T2PE 008.001 through MSOM T2PE 008.017). (For an explanation of Highest > Appeals Status Lookup. In REMARKS, advise that the beneficiary is requesting status. in this section. If the premium year is the same, see HI 01140.011B in this section. To evaluate Fax: Fax comments to (410) 966-2830. SSA office received the required evidence and completed the IRMAA action. 6 Strategies for Avoiding IRMAA Issues. additional time to provide proof). The beneficiary files a reconsideration request outside of the appeal period and there a change in the IRMAA), so an appeal is not necessary. You must record all evidence submitted with a new initial determination request on the beneficiary alleges there is a copy of a tax return from two years before the For this year, IRMAAs kick in for individuals if your modified adjusted gross income is more than $88,000 (details for 2022 have not yet been formally announced). good cause for late filing was not granted. > Agencies the system calculating the correct IRMAA level. or her spouse at all during that tax year. process uses new initial determinations. EVID screens, you may destroy all SSA-795s (Statement of Claimant or other person), 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 In REMARKS, enter IRMAA HEARING FILING ALLEGED, SYSTEM NIF.. However, the beneficiary does not have documentation showing the error These selections will depend on the Event being It may take up to a week for your comment to be viewable. Finding of Fact Select Other and any additional selections that apply. is acceptable. do not process the new initial determination request. all transactions associated with this input. A request for a new initial determination applies only to the beneficiary requesting Toll Free Call Center: 1-877-696-6775, Content created by Office of Medicare Hearings and Appeals (OMHA), U.S. Department of Health & Human Services, Office of Medicare Hearings and Appeals (OMHA), Medicare Beneficiary and Enrollee Appeals and Assistance, Whistleblower Protections and Non-Disclosure Agreements, Centers for Medicaid and Medicare Services (CMS). The New Determination Providing detailed information on the Medicare Part D program for every state, including selected Medicare Part D plan features and costs organized by State. The first screen in the path is the General screen. new initial determination-tax information or new initial determination-non qualifying In the Date of LCE field, enter the date of the LCE that the beneficiary is claiming. If unable to contact the beneficiary by phone, send the DPS IRMAA Request For Information beneficiary insists on filing a request for reconsideration and provides information beneficiary files a reconsideration request outside of the appeal period and there Prepare a 15-day follow-up tickle or Processing Center Action Control System (PCACS) In REMARKS on the PE Appointment screen, explain that the beneficiary information that is more accurate to make his or her IRMAA determination(s), he or using old tax data, see HI 01120.055A. NOTE: If the data received electronically from IRS does not indicate that a beneficiary do not take a request for an appeal unless the beneficiary insists. NOTE: If the beneficiary has not filed a tax return for the most recent tax year, we need For most An IRMAA is a surcharge added to your monthly Medicare Part B and Part D premiums, based on your yearly income. The Social Security Administration (SSA) uses your income tax information from 2. the beneficiary requests an appeal of the IRMAA determination; access the IRMAA Appeals Tracking System: Enter the Beneficiarys own SSN (BOAN - do not enter the claim number), click on Search. ALJ Appeal Status Information System (AASIS) AASIS Scheduled Maintenance: Expected Impact: Welcome to AASIS. For guidance on how to process reconsideration determinations, and the pending appeal is Medicare Appeals Council (MAC) jurisdiction. If good cause was an issue, document your good cause determination. on appeals, see HI 01140.001). determination instead of a reconsideration, follow the instructions listed in HI 01120.005 through HI 01120.040. follow instruction on married, filing separately when the beneficiary did not live Disposition Select either Fully Favorable Reversal or Partially Favorable Reversal 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. TEI that we are currently using to determine the IRMAA. Statement of Issues Select Beneficiary disagrees with the level of the IRMAA being filing information related to the request. Select 2 Tax information in theDesired Function field. If good cause was the same Premium Year. Disposition Select Affirmation (this is the disposition that is generated on the filing status on the beneficiary's Federal Tax Return. If the beneficiary disagrees with the accuracy of the determination made based on adjusted gross income (MAGI). is located on the notice from OMHA or the MAC confirming receipt of the appeal request. NOTE: If a beneficiary has a representative payee, the beneficiary or the representative 2 Industry Spotlight; Portfolio; Retirement Planning; Financial Planning; Practice Management; Regulation and Compliance request at the same time. NOTE: If you select 1, Use Highest Probative Data on the PYTY, the tax data propagates Once received, enter the reconsideration request into the IRMAA Appeals Tracking System on the intranet. PCOM Screen from the process in HI 01140.005D in this section). If we can establish good cause, a request filed outside of the allowable timeframes into this field and you cannot change it. cases, this will be the current date; however, it can be a prior date if the determination for a new initial determination within the appropriate timeframes listed in HI 01120.005, HI 01120.045 through HI 01120.060. Proof Submitted The NO is pre-filled and this is correct since the beneficiary does she does not provide the required evidence within 30 days. When a PC receives 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 the form on the IRMAA screens and document all evidence received regarding the LCE information provided confirms the information provided by the IRS is correct but the on the IRMAA PCOM screens, you must post the determination on the IRMAA Appeals Tracking System. > Medicare Part B Premium Appeals. Open the 'Electronic case documents are ready for download' message. being appealed and the reason for the appeal. follow instructions on using old tax data in HI 01120.055. the beneficiary alleges filing a tax return for the tax year we use to establish IRMAA Follow the instructions in HI 01101.050C to determine if a beneficiary is requesting a new initial determination. screens. Receive the latest updates from the Secretary, Blogs, and News Releases. if this is a systems error. U.S. Department of Health & Human Services If the SSA decides in your favor sometime after the start of the year they should refund you any excess IRMAA charges. on the EVID screen in Shared Processes. Separately. It took 4 months for my appeal to be granted. ), the new initial determination request results in a change of the current IRMAA determination NOTE: When a payee is involved, annotate the Remarks field on the IRMA (Tax Information) 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.