Master Beneficiary Record (MBR) query

CO MSG1 line will include information about the type of Clark relief that the beneficiary is due.

Confirm that the special message data line states: “CLARK COURT ORDER — CASE SELECTED FOR CLARK REVIEW.”

If the Class Member may qualify for Medicare relief, the CO MSG1 will state: “CLARK COURT ORDER — CASE SELECTED FOR CLARK RELIEF AND MEDICARE REVIEW.”

FUGITIVE line will show warrant information.

Check the data entries in this data field to determine for each warrant the:

Warrant date and Originating Agency Indicator,

warrant type: Felon Status = VIOLATION, and

current warrant status.

If the warrant is actionable (i.e., not satisfied), there is no MBR WARRANT SATISFY field. If the warrant is closed, there are data entries in the WARRANT SATISFY and SATISFIED RSN fields.

NOTE: If the beneficiary is deceased (i.e., LAF T1) or in terminated status (e.g., T4, T6, etc.), the WARRANT SATISFY date entry and SATISFIED RSN entry will remain blank. Do not closeout the warrant as “satisfied” when the beneficiary’s status terminates. For information on multiple warrant processing, see GN 02615.120C in this section.

O/U PAY line shows the most recent overpayment occurrence on the record and the reason for the overpayment.

Check the data line to confirm a PPV suspension overpayment.

The Due Process Overpayment Type (DPOT) T2 FF/SUS/VIO, (Type of Event (TOE 74), will show if this is a PPV overpayment. The Due Process Overpayment Amount (DPO) should be identical to the amount that appears on the ROAR record PPV overpayment event.

NOTE: In some instances, Beneficiary Overpayment/Underpayment Data (BOUD) may not show a TOE 74 even though there is a TOE 74 event on ROAR. If the BOUD TOE is not 74 or your estimate of the PPV suspension overpayment amount does not equal the overpayment posted in BOUD, check ROAR to see if BOUD may contain multiple overpayments.

HISTORY line will reflect a history of payment changes to the record.

Check the data entries in this line to determine the S9 period(s) with an HRFST of FUGFEL between 01/05 – present.

Check the following fields in the HISTORY data line:

STATUS CODE--Position 3, Benefit Paid Designation (BPD) of this entry shows if the monthly benefit was paid, code “1;” or, not paid, code “0.”

Reason for Suspension or Termination (SUS/TERM)--The code will be “9” with an HRFST of “FUGFEL.”

Monthly Benefit Credited (MBC) – MBC is the monthly title II benefit due after any appropriate dollar rounding (considering a deductible of supplementary medical insurance (SMI) premium), but prior to the actual collection of any obligation of the beneficiary (including SMI premium). Determine any overpayment or underpayment amount and check amount based on the MBC amount.

Recovery Overpayment Accounting Record (ROAR)

BENEFIT line

Identify the total current balance due for all overpayments for the beneficiary stated on the BBAL-$$$$$ data line.

EVENT line

Find the Event Identifier (EI) for the PPV overpayment (e.g., 01, 02, etc.).

Find the Type of Event (TOE) for the PPV overpayment on the EVENT data line, (e.g., T2 FF SUS/VIO WAR, T2 FF SUS/FEL WAR, PRIS SUS NON-MENT, OTHER OR CONSOLIDATED LDO, etc.).

Find the STATUS for the PPV overpayment. Determine from the STATUS code entry the current PPV overpayment recovery effort (e.g., BEN ADJ, DUE PROCESS, etc.).

HISTORY line

Identify the entries in the data line to determine when ROAR established the PPV overpayment amount.

RUN DATE

TRAN

AMOUNT

NOTE: If the PPV suspension caused an overpayment, the ROAR HISTORY RUN DATE entry for the PPV overpayment event establishment is important when determining the initial determination date for applying Clark relief. The establishment event transaction code (TC) is generally a TC12, but sometimes ROAR establishes the event as a TC 10.

Fugitive Felon System Control File (FFSCF)

Fugitive Felon Warrant Data (FFWQ) Screen

Review the following data fields on this screen to determine if you need to distinguish the suspension for this warrant from other warrants that the beneficiary may have.

WARRANT DATE

OFFENSE CODE (PPV warrants =5011, 5012, 8101, or 8102)

OFFENSE CHARGE SYMBOL (PROBATION/PAROLE VIOLATION)

WARRANT NUMBER

NCIC NUMBER

WARRANT FILE REPORT DATE

NOTE: For specific PPV warrant data codes applicable to Clark class members, see GN 02615.100B.1.

Fugitive Felon Warrant Status (FFSQ) Screen

Review the OIG SUBJECT STATUS DATE. If it is blank, it means that the Office of the Inspector General (OIG) did not verify the warrant nor refer it for PPV suspension.

Payment History Update Query (PHUS)

TRANS line

The PHUS retains the entire Transaction line as a permanent record of actual payment history. Review the transaction on PHUS to see what we actually paid the beneficiary.

If you need more information on the TRANS data line of the PHUS query, see SM 00545.275.

1

Review the PPV warrant on FFSCF. Go to the Fugitive Felon Warrant Status Query (FFSQ) screen and find the OIG SUBJECT STATUS DATE: MM/DD/CCYY. This data represents the date that OIG referred the PPV warrant to us for review and suspension processing. Use this date as the beginning reference point for searching for the PPV suspension determination date. Benefit suspension always occurs after this date, if appropriate. Go to step 2.

If there is no OIG subject status date, search the Online Retrieval System (ORS) for title II PPV initial suspension and or overpayment determination notices dated 01/01/05 and later.

2

After determining the FFSQ beginning month and year reference point, review the MBR HISTORY PPV period of S9 FUGFEL. Find the posted MBR PPV suspension processing transaction. Use this date to search ORS for the notice, go to step 3.

If this warrant does not have a MBR PPV suspension processing transaction, stop. Go back to step 1 and start over with the next warrant.

NOTE: If the PPV suspension caused an overpayment, review the ROAR HISTORY data line. Check the ROAR PPV suspension overpayment posting date (i.e., RUN DATE and TC12 T2 FF/SUS/VIO). The ROAR PPV overpayment posting date corresponds with the POS FFEL or MACADE/MADCAP action date that processed the PPV suspension. Use this date to search for the notice on ORS, go to step 3.

3

Locate the beneficiary’s ORS PPV initial suspension notice and any related overpayment notice. Obtain the mailing date of the beneficiary’s PPV initial suspension and any overpayment determination notice, and go to step 5.

If the PPV suspension and any overpayment notice is not in ORS, go to step 4.

4

If you cannot find the beneficiary’s ORS PPV suspension and overpayment notice, recheck the beneficiary’s MBR and locate the MADCAP/MACADE PPV suspension action. This processing action will provide the beneficiary’s notice information that we included on the PPV suspension and overpayment notice. Add five days to the processing date and use this date as the PPV suspension and overpayment initial determination date, and go to step 5.

If MACADE/MADCAP did not process the PPV suspension, go to the MBR DED/ADD line and review the transactions to locate the system that processed the PPV suspension. Find the UPDATED field for the transaction and use the UPDATED date entry plus 5 working days as the initial PPV suspension determination date, and go to step 5.

5

If the initial PPV suspension determination is 10/24/2006 or later, the PPV warrant qualifies for Clark relief, process the reinstatement action. For reinstatement instructions, see GN 02615.120E.2 in this section.

NOTE: The title II PPV suspension and related overpayment determinations are contained in the same initial determination notice.

If the initial PPV suspension determination is earlier than 10/24/2006, the PPV warrant does not qualify for reinstatement unless the beneficiary has a pending administrative appeal. This warrant requires no further action. Go to step 1 to review the next warrant until you review all of the beneficiary’s PPV warrants.

If there is a 10/24/2006 pending administrative appeal on the PPV suspension or overpayment action on the record, process the record following instructions in GN 02615.130.

1

Remove or reduce the current PPV overpayment balance TOE 74-T2 FF SUS/FEL/VIO event on the ROAR/BOUD overpayment record using the DEBT MANAGEMENT SYSTEM (DMS) screens as instructed below:

Civil Action Screen (DRCA),

Choose “6” Debt Management from the SSA Main Menu screen.

Choose “2” Debt Resolution from the Debt Management Menu (DMMU). Enter the Social Security number (SSN) and beneficiary identification code (BIC).

On the Debt Resolution Menu (DRMU) enter the Debt Number. Enter “1” in SELECT for “Establish” mode. Then enter “20” for “Civil Action” in the SELECT THE DESIRED FUNCTION field.

On the Civil Action screen (DRCA), DECISION TYPE and DECISION REASON enter “2” – CLARK. Enter the APPROVAL AMOUNT that you previously determined from your review of our payment records based on the instructions in GN 02615.120B in this section and press enter.

An informational message will notify you that you must complete the Review Civil Action (DRWA) screen (you must do this for every case input on the DRCA). Press enter again.

Move the case to the selected reviewer’s paperless queue designated by your office to authorize the input action.

2

The designated approving reviewer will log into the Personal Communications software (PCOM) with a different personal identification number (PIN) than the one used to input the DRCA screen. If the reviewer is satisfied with the proposed ROAR transaction, process the approval as follows:

On the DRWA Screen,

Choose “6” for Debt Management from the SSA Main Menu.

Choose “2” for Debt Resolution from the DMMU screen. Enter the SSN and BIC.

On the Debt Resolution Menu (DRMU), enter the Debt Number. Enter “2” in SELECT for “Update” mode. Then enter “21” Review Civil Action in the SELECT THE DESIRED FUNCTION field.

On the DRWA screen, the DRCA information propagates to DRWA screen. Put a “Y” in the APPROVED BY REVIEWER FIELD and then press enter.

3

DMS sends an automated beneficiary notice to explain the PPV overpayment removal or reduction. For an illustration of the caption and paragraph that will appear on the notice, see GN 02615.160B.3.

NOTE: If the beneficiary is deceased (i.e., LAF T1), DMS will only send a PPV overpayment removal or reduction notice if the beneficiary had a representative payee on his or her record at the time of death. If a deceased beneficiary does not have a representative payee, that notice is not used. For information on processing Clark relief for a deceased beneficiary, see GN 02615.135A.4.

4

Reprocess the PPV overpayment Debt Management input exceptions using the screens in the DMS. For instructions for resolving debt management exceptions, see SM 00610.410 through SM 00610.420.

5

Add the MBR SP MSG: CLARK COURT ORDER—CLARK RELIEF PROCESSED to annotate that you completed your review and processing of the case.

If the record has the CO MSG: CLARK COURT ORDER—CASE SELECTED FOR CLARK RELIEF AND MEDICARE REVIEW, do not add the SP MSG to the MBR. Next, process a Medicare review following instructions in GN 02615.140.

1

Determine if the PPV warrant and the accompanying suspension period are eligible for Clark relief. For instructions on determining the initial PPV suspension and overpayment decision date, see GN 02615.120A.4 in this section.

You must review and evaluate each PPV warrant independently, go to step 2.

2

After review of each PPV warrant, review the beneficiary’s payment records following instructions in GN 02615.120A.3 in this section.

Go to step 3.

3

If your payment review reveals,

A 10/24/2006 or later pending administrative appeal on either PPV suspension or overpayment:

• For reconsideration, process following instructions in GN 02615.130B

• For Administrative Law Judge (ALJ) and Appeals Counsel (AC) appeals, refer the pending PPV administrative appeal to the Office of Hearings Operations (OHO). Do not continue processing Clark relief for any of the other PPV warrants. OHO must decide the pending administrative appeal issue before we process the Clark relief. For instructions on processing administrative appeals, see GN 02615.130.

or,

The PPV suspension and overpayment are eligible for Clark relief, but the beneficiary has an overpayment that prohibits the system from automatically calculating paid versus payable correctly without manual review and processing, go to step 4.

or,

The warrant and the PPV suspension and overpayment are not eligible for Clark relief, stop. You do not need to take further action on the warrant. Continue to process each actionable PPV warrant.

4

For instructions on processing relief for cases where you must review and process the PPV overpayment manually, see GN 02615.120B in this section.

1

Use MADCAP/MACADE to reinstate benefits. (For systems FFEL screen processing instructions, see MSOM COMMON 005.035.)

From the FFSCF:

Annotate the new warrant disposition to the PPV WARRANT DUE PROCESS/GOOD CAUSE (FFDG) screen.

In the update mode, enter the mandatory entries and then enter the: GOOD CAUSE DETERMINATION section of the screen:

GOOD CAUSE ESTABLISHED(Y/N): Y

IF YES, GOOD CAUSE REASON: CRT

GOOD CAUSE DECISION DATE (mmddccyy): 99999999 (place the current date in this date field)

REMARKS: CLARK COURT ORDER—CLARK RELIEF PROCESSED or CLARK RELIEF AND MEDICARE RELIEF PROCESSED, if your reinstatement action also includes processing Medicare relief.

NOTE: You must update the FFDG screen to avoid a processing exception of the FFEL reinstatement input. Instructions for updating the FFSCF are in PRISON 006.001.

2

From the MACADE path:

Select #6 (ENTITLEMENT AND ELIGIBILITY MENU) on the TRANS-TO MENU and select #31 FUGITIVE FELON (FFEL) on the ENTITLEMENT AND ELIGIBILITY MENU, or

Enter ENT in the TRANS- TO field and select #31 (FFEL).

3

On the MACADE FFEL screen:

a. LAF S9 FUGFEL status

In the update mode, enter the mandatory entries and then enter on the

RESUMPTION OF BENEFITS section the following:

RESUME BENEFITS EFFECTIVE WITH FIRST SUSPENSION MONTH: Y

ENTER RESUMPTION REQUEST REASON: 3 GOOD CAUSE

IF RESUMPTION REQUESTED FOR GOOD CAUSE, ENTER GOOD CAUSE REASON: CRT

b. Closed period suspension

Remove from the FFEL screen, the existing “WARRANT SATISFIED” date and “SATISFIED REASON” entries.

Enter on the RESUMPTION OF BENEFITS section the following:

RESUME BENEFITS EFFECTIVE WITH FIRST SUSPENSION MONTH: Y

ENTER RESUMPTION REQUEST REASON: 3 GOOD CAUSE

IF RESUMPTION REQUESTED FOR GOOD CAUSE, ENTER GOOD CAUSE REASON: CRT

4

Add a Payment History (HST) screen to the MACADE/MADCAP action to release the benefits that were in S9 FUGFEL for the PPV suspension period and to start continuing monthly benefit payment, if appropriate. For information on the summarization rules for post-adjudicative actions, see SM 00848.010B.2.

5

If the beneficiary is eligible for Medicare relief, see the instructions in GN 02615.140 for additional MACADE/MADCAP coding that is necessary for completion of this processing action.

6

Add additional notice information to the MADCAP notice regarding the Clark Class Order to the notice. Include paragraph FUG118 to the notice. For an exhibit of the Clark Court Order relief language, see GN 02615.160B. For information on processing requests for special notices for blind or visually impaired claimants, beneficiaries, and representative payees, see TC 00101.021.

Steps

Actions

1

Check the PPV warrant data on the FUGITIVE data line on the MBR and on the FFSCF to determine the closed suspension period.

For a closed PPV warrant, the MBR FUGITIVE warrant entries contain the following:

WARRANT DATE = date the law enforcement agency (LEA) issued the PPV warrant

FELON STATUS = VIOLATION

WARRANT SATISFY= date the PPV warrant was satisfied

SATISFIED RSN – Apprehended or Dismissed

For a closed PPV warrant, the FFSCF Fugitive Felon Warrant Status (FFSQ) screen warrant entries contain the following:

WARRANT DATE = date the law enforcement agency (LEA) issued the PPV warrant

WARRANT STATUS = CLOSED

IF WARRANT CLOSED, WARRANT END DATE= date the warrant was satisfied

WARRANT ENDED REASON = Warrant Dismissed or Felon Apprehended

WARRANT SATISFIED INPUT DATE = date the FO or PC keyed the warrant satisfied action

2

After reviewing the MBR and FFSCF warrant data, determine the closed PPV warrant period. The period begins with the WARRANT DATE or 01/01/2005 if later than the WARRANT DATE, and ends with the MBR WARRANT SATISFY/WARRANT ENDED DATE entry.

NOTE: For computing the PPV closed period, remember that the earliest warrant date you can have is 01/01/2005 regardless of the actual PPV warrant date on FFSCF.

EXAMPLE:

Date of initial determination = 08/31/2008

MBR FUGITIVE line

DATE OF WARRANT = 02/05/2004 FELON STATUS = Violation

WARRANT SATISFY= 07/21/2008

SATISFIED RSN = Dismissed

The closed period for this example = 01/01/2005 through 07/21/2008.

3

Determine the PPV suspension and overpayment initial determination date and if the PPV closed period warrant is eligible for Clark relief following instructions in GN 02615.120A.4 in this section.