TN 14 (03-98)

A. Procedure - Title XVI Offset Cases

1. Adjusted Title II Income Changes SSI Determinations

a. Underpayments

An underpayment for a month caused by adjusting title II income will be paid only if a claimant/recipient is eligible for the month based on all factors of eligibility. (See SI 02006.005.) The computations, which the system can do if no limitations apply, follow the rules for SSI computations and differ from prior computations for the same months only because of the title II income change. Enter the changed title II income amounts as type W or type A income depending on the month involved. See 3. below for required notices.

• When an underpayment exists, decide if the system can process it. If manual computations are required, use RMA rules. Before entering data for payment, decide if no SSI payment was previously made and b. below applies.

b. SSI Development Previously Curtailed

• Development of eligibility factors may have been curtailed under the guidelines in SI 02006.005. If so, develop and fully resolve all eligibility factors before entering changed data for payment.

• In a denied claim for which anSSI payment was never made, send the underpayment caused by reopening the prior determinations to the State/County due interim assistance reimbursement (IAR) if the claimant authorized it. (The SSR would show either code N or R in the GRC field of the MPMT segment of the SSIRD (see SM 01601.865)). If the code is N, the system would pay the claimant rather than send the payment to the State/County. Refer to SM 01901.100 B.7. in the instructions for A-OTP that explains entry of address data that would be needed to pay the State/County. Refer to the regional instructions that provide the name and address of the State/County agency that corresponds to the code in the GRC field. If the code is R and no systems limitations apply, delete the existing offset and retrigger a new one using the adjusted title II amounts. The system will send the UP to the state or county.

c. Reduced Overpayment

A reduced overpayment for 1 or more months caused by adjusting the title II income can occur either as the only result of the FO's action or in addition to an underpayment for 1 or more other months. If no systems limitations apply, enter the appropriate title II income data to the SSR so that the system will compute the correct overpayment.

2. No Change Cases

Do not enter the changed title IItype A amounts. However, send a notice to the claimant with a copy to the representative (see 3 below.). (See the example in SI 02006.220 A.2.)

3. Notices

a. Requirements

Suppress any system-generated notices and manually prepare and send notices explaining the revised determination(s) and the results of underpayments and/ or reduced overpayments to both the SSI recipient and the representative. Also, notify each if the adjustment of the title II income made no difference in prior SSI determinations.

NOTE: Follow the special notice procedures in NL 01001.010 if the notice will be sent to a claimant, beneficiary, or representative payee who alleges being blind or visually impaired.

b. Types of Notices

Use an SSA-L8100-U2 (Notice of Revised Determination) to notify the recipient and the representative of an underpayment. Also, use an SSA-L8100-U2 to notify the recipient of a reduced overpayment when that is the only result. However, use the SSA-L8166-U2 (Supplemental Security Income Notice) to advise of a no-change situation. Use the paragraphs necessary for a complete notice (i.e., exclusion from counting as resources paragraphs, IAR paragraph, Medicaid paragraph, etc.) as appropriate per NL 00804.100 ff.

c. Language To Explain Changed Determinations

In underpayments and reduced overpayments, use the following paragraphs to explain the reasons for the change.

“You had monthly income which must be considered in figuring your payment as follows:

Your social security benefits (before deductions for Medicare medical insurance premiums) of $$$.00 for MM/YY, $$$.00 for MM/YY and/or $$$.00 for MM/YY through MM/YY.

In figuring your SSI before, we used $$$.00 for MM/YY, $$$.00 for MM/YY and $$$.00 for MM/YY, as your monthly social security income. These were the amounts before deductions for Medicare premiums, if any. However, fees of $$$.00 were approved to pay the representative in your social security claim. We subtract these fees from the social security income we count.”

If the SSI recipient has a representative payee, substitute for “you ” and “your” in the paragraph, the recipient's name, “he” or “she,” or “his” or “her,” as appropriate.

In the second paragraph, enter the amounts and the month(s) and year(s) that apply after subtraction of the fee. In the third paragraph, enter the prior amounts of title II income and the months and years they apply. In the third paragraph, enter the amount of the authorized fees.

B. Procedure - Title II Offset Cases

1. Adjusted Title II Income Changes Amounts in Offset Period

a. System Limitations Always Apply

Systems limitations apply when the title II retroactive benefits have been released per MBR/PHUS and offset applied. In these situations you cannot change the data in the system and have it pay the correct amounts.

• The unearned income data in the SSR UMIH segment will generally not include type A UM entries for the months before the last 2 months in the title II offset period. (The data may include type A UM entries if dual entitlement is involved or type W UM entries if the title II offset computation was automated.)

• Should the FO attempt to enter type A UM entries based on the adjusted title II income, the system would compute an overpayment rather than an underpayment for months in the title II offset period.

• Instead, manually compute the underpayment and use the A-OTP facility to make payment. See SI 02006.210 B.8.

b. A-OTP Payment

Refer to SM 01901.000 ff. for instructions on A-OTP. Refer to SM 01311.280 which provides instructions for use of the N TAC which is used to resolve erroneous systems-computed overpayments. When paying by A-OTP, the FO should enter N TAC data in the amount of the A-OTP to correct the increase in the overpayment amount in the system and prevent an alert.

2. Adjusted Title II Income is Type A for First Month of Title XVI Payment

a. Systems Capability Exists

The FO can use the system to help when the retroactive title II benefits are paid in 1 of the last 2 months of the extended offset period or later and the type A UM entry must be decreased. The FO can enter adjusted title II income for a month of receipt of retroactive title II as type A UM entries to compute and pay underpayments (or correct overpayments) through the system.

The automated system can compute the true overpayment/underpayment from PE changes in the offset period following an automated title II offset computation done after January 15, 1984, with some exceptions (see SM 01320.600). The WIN code indicates the necessary action for correctly reviewing, and processing PE events when title II offset applied (see SM 01320.021). If the WIN code is “F,” “I,” or “R,” the systems computations are always correct. This includes those for PE changes in type A UM for months, such as the last 2 months of an extended offset period, that have a zero (0) type W UM amount posted.

b. Both Systems Capability and Limitations Apply

If the adjusted title II income changes are both for months when data should not be entered and for months when they can be, the FO can use the A-OTP and the N TAC procedures for the earlier month and also correct the type A amounts for the later months.

3. Notices

See A.3. above.

C. MSSICS 4.4 Support for Attorney Fee Recomputation

Effective 5/27/97, in some cases, use MSSICS to trigger an automated windfall offset computation using type “W” amounts adjusted for the attorney fees. In situations in which the PSC/ODIO asks the FO to recalculate the offset amounts because the attorney fee plus the calculated FOA/SOA exceed the total retroactive title II benefits, use the CWIN screen and the ISSA screen to trigger an automated computation using the adjusted title II amounts.

This procedure can be used only if the following conditions exist:

• The title II retroactive benefits have not been released, (i.e., a 6W diary is present).

• There is an active MSSICS pending file.

• For MSSICS cases that were seeded, the windfall period cannot begin before the Seed Date.

D. References

• Completion of the ISSA Screen, MSOM MSSICS 015.013

• Computing the Adjusted Title II Amounts for use on the ISSA Screen, SI 02006.203 and SI 02006.210