GN 03960: Administrative Review of Determinations Under the Fee Agreement Process
TN 3 (03-95)
A. Policy - Favorable Decision Below the Hearing Level
In all cases favorably decided below the hearing level, responsibility for conducting administrative review is the same under both the fee agreement and the fee petition processes. See GN 03930.001 ff.; GN 03950.005B.1.; and, if necessary, GN 01050.055 ff. for PC jurisdiction. (PCs include the Program Service Centers (PSCs) and the Office of Central Operations (OCO).)
The chart below shows those employees delegated authority to conduct administrative review in all cases decided below the hearing level, including title XVI only cases.
| COMPONENT | REVIEWER |
|---|---|
| PSC | Special Case Review Analyst (or someone in an equivalent position) in the Center for Security and Integrity. |
| ODO | Disability Specialist in the Special Appeals and Class Action Section |
| OIO | Reconsideration Reviewer |
The Assistant Regional Commissioners for Management and Budget in the PSCs and the Director of the Office of Central Operations may delegate authority to others in equivalent positions, as necessary.
B. Policy - Favorable Decision at or Above the Hearing Level
In cases favorably decided at or above the hearing level, responsibility for conducting administrative review varies depending on the issue for review.
1. Review of the Disapproval of the Fee Agreement
When the issue for administrative review is a disapproval of the fee agreement, the identity of the decision maker controls who has authority to conduct the review. The chart below shows those delegated authority to conduct administrative review in all such cases decided at or above the hearing level, including title XVI only cases.
| DECISION MAKER | REVIEWER |
|---|---|
| ALJ | Regional Chief ALJ |
| Regional Chief ALJ | Deputy Chief ALJ |
| Deputy Chief ALJ | Chief ALJ |
| AAJ | Deputy Chair, Appeals Council |
| Deputy Chair, Appeals Council | Chair, Appeals Council |
2. Review of the Fee Amount
When the issue for administrative review is the amount of the fee under the fee agreement process, the identity of the requester controls who has authority to conduct the review.
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If the claimant, affected auxiliary beneficiary, or representative requested administrative review, those delegated authority to conduct administrative review in all such cases decided at or above the hearing level, including title XVI only cases, are as follows:
if the case is decided at the hearing level, then the reviewer is the ALJ;
if the case is decided at the Appeals Council level, then the reviewer is the Attorney Fee Officer, OARO.
If the decision maker requested administrative review, delegation of authority to conduct administrative review in all such cases decided at or above the hearing level, including title XVI cases, is the same as shown in GN 03960.005B.1.