SI 02301: Posteligibility Changes
TN 18 (10-98)
A. Introduction
When a decision at the first level of appeal is rendered on all issues, FOs must remove protected payment status and adjust benefits to the proper amount reflected in the appeal decision. Sometimes before FOs can adjust benefits, subsequent changes occur that affect continuing benefits. FOs may also have to correct erroneous benefit amounts issued in notices of appeal decisions to recipients.
B. Procedure - Appeal Decisions
When a decision at the first level of appeal is rendered on all issues, follow these steps to adjust benefits and correct the record:
| STEP | ACTION |
|---|---|
| 1 | Obtain a current SSIRD. Do the DPD entries show an appeal pending (GK status codes P, I or S) and payment continuation? |
| IF YES, go to Step 2. | |
| IF NO, go to Step 3. | |
| 2 | Input GK status code R to remove protected payment status, correct the data on the record, and adjust benefits as necessary. Follow systems instructions in SM 01305.570. Go to Step 5. |
| NOTE: A DPD entry of status codeRautomatically deletes all other DPD entries on a record. | |
| 3 | Does the record properly reflect the determinations in the appeal decision? For example, a record in payment statusN01shows the correct amount of excess income in the appeal decision. |
| IF YES, go to Step 5. | |
| IF NO, go to Step 4. | |
| 4 | Correct the data on the record and adjust benefits as necessary. Go to Step 5. |
| 5 | Input the appeal decision and the date of the decision in MSSICS via direct input. Refer to MSOM BUSSR 002.007, Direct Build Appeals, Part 4 MSSICS or MSOM MSSICS 020.001, Appeals Part 4 MSSICS. Go to Step 6. |
| 6 | Determine and resolve any overpayments resulting from payment continuation. These instructions are in SI 02201.005 ff., SI 02220.001 ff. and SI 02260.001 ff. |
NOTE: After the system terminates a record, FOs must establish a start date (SD) record to reinstate benefits. These instructions are in SM 01801.001 ff.
C. Procedure - Subsequent Changes
When a subsequent change occurs that may affect continuing benefits before they have been paid, follow these steps:
| STEP | ACTION |
|---|---|
| 1 | Determine if the change results in an adverse action. Do this by manually recomputing benefits and comparing the new monthly amount with the proper amount reflected in the appeal decision, not with the last payment on the record. |
| 2 | Issue the appropriate manual notice. |
D. Procedure - Errors in Appeal Decisions
Use this chart to determine the proper notice to send when correcting an erroneous amount in an appeal decision:
| If... | then send... |
|---|---|
| the incorrect amount has not been issued | a revised SSA-L8457-U2 (see NL 00803.095). |
|
the incorrect amount has been issued and the corrected amount is a reduction |
an SSA-L8155-U2 (see |
|
the incorrect amount has been issued and the correct amount is an increase |
Form SSA-L8100-U2 (Notice of Change in Payment, see |
E. Examples
1. Example 1
Appeal Decision
Gerald Thurman receives a monthly SSI check of $300. He files a reconsideration request in May 1994 on a proposed reduction in his June check and continues to receive the unreduced benefit of $300. In July, the FO issues an unfavorable decision on an SSA-L8457-U2. The notice explains the correct payment of $200 due for June 1994 and continuing.
2. Example 2
Appeal Decision and Subsequent Change
Same as Example 1 except that before the FO can input to adjust benefits from $300 to $200 each month, Mr. Thurman reports an income change that results in a monthly benefit of $250 beginning in August 1994. The change in the August payment is an increase since $250 is higher than the corrected benefit of $200 in the appeal decision. The FO inputs a GK status code R with all income changes and issues a manual SSA-L8151-U2 for the increase in benefits.
3. Example 3
Error in Appeal Decision
The FO issues an appeal decision on an SSA-L8457-U2 to Megan Flowers in September 1994. The FO discovers an error in the continuing benefit amount in the notice when an input to adjust benefits rejects. Since the incorrect amount has not been issued, the FO inputs again to correct continuing benefits on the record and issues a revised appeal decision on an SSA-L8457-U2.
F. References
Processing SSI Reconsideration Requests, SI 04020.020
Redeterminations as Part of Effectuation of an Appellate Decision, SI 02305.065
Form SSA-L8457-U2 (SSI Notice of Reconsideration (PE)) for Nondisability Posteligibility Determinations, NL 00803.095
Processing of Initial Appeal Decision, SM 01305.570