TN 13 (11-11)

A. Policy on requests for policy interpretation

The Assistant Regional Commissioner (ARC), Management, Operations, and Support (MOS) provides the Field Office (FO) and Processing Centers (PCs) with guidance in general policy questions, Hospital and Supplemental Insurance (HI/SMI) entitlement, non-claim questions and questions on existing POMS instructions. Consider issues involving more than one claim general policy questions.

NOTE: Refer all Medicare coverage issues to the Medicare Carrier or Intermediary.

B. Process for requests for policy interpretation

The ARC and MOS staff has access to other applicable policy components within the Central Office, which provides support when needed. Do not call the Office of General Counsel (OGC), the Regional Chief Counsel (RCC), the Office of Operations Support (OPSOS) or any other policy component directly unless other established instructions ask to do so. If the issue cannot be resolved, follow the applicable instructions for initiating a precedent in GN 01010.810 thru GN 01010.820.

C. Procedure for requests for policy interpretation

1. FO

Immediately contact the appropriate ARC, MOS if policy interpretation is needed on a provision of the Social Security Act or a technical question arises on a procedural instruction contained in the POMS. The ARC, MOS will decide the issue and reply directly to the originating office. Their replies are limited to the application of current policy guidelines to a specific claim therefore do not use it as precedents or as revised instructions of general applicability.

2. ARC, MOS

Review the issue and reply directly to the originating office. If the issue conflicts with another region or it may have major or national program implications, ensure that all possible adjudicative actions are completed and subsequently submit the question to the components listed below.

• RSI/SSI Issue - ODISP, OPB in CO

• Disability Issue - ODISP, OD in CO

• HI/SMI Eligibility/Enrollment Issue - DCO, OPSOS in CO

NOTE: Do not contact the CMS Regional Administrator or specific CMS contacts in CO directly unless other instructions permit.