TN 15 (02-95)

A. Introduction

Recipients have the right to advance notice under GK procedures before SSA corrects erroneous payments. Payment continuation may apply in certain cases, but not at the PPL. SSA does not restore erroneous payments.

B. Definitions

These definitions are only for identifying erroneous payments and determining how payment continuation may apply.

1. Erroneous payment

An erroneous payment is a multiple payment or a payment which is over the payment ceiling.

2. Intervening changes

Intervening changes are changes which occurred in the month before erroneous payments began over the payment ceiling.

3. Multiple payment

A multiple payment is a regular monthly SSI payment which SSA issued in addition to another regular monthly SSI payment for the same period and for the same recipient. Multiple payments can occur because of applications on different SSNs, records established on pseudo numbers and processing errors.

4. Payment ceiling

The payment ceiling is the highest possible SSI payment that a recipient can receive for a period. The payment ceiling is:

• the Federal benefit rate (FBR) for an individual or couple ($446/ $669 in 1994) or the reduced SSI benefit rate for an individual or couple ($30/$60 in 1994), plus

• the highest rate for any SSA administered State supplementary payments (based on category on the SSR), plus

• any essential person increment.

NOTE: The State living arrangement (L/A) codes on the SSR indicate the supplement category for aged, blind and disabled individuals and couples. The Federal and State L/A codes appear in the Computation History (CMPH) segment. Essential person flags appear in the Case Miscellaneous Data (CMSC) segment. To compute payment ceilings, use the Federal benefit rates and essential person increments in SI 02001.020 and the State supplement rates in SI 01415.001.

EXAMPLE: Mary Perez is a disabled individual living in Los Angeles, California. Her record on the SSR for 1993 shows that she is living in a public shelter for January and February, she is living in the household of another for March and April, and she is in a Medicaid facility for May and continuing. These are the Federal and State L/A codes and the payment ceilings for each month:

C. Policy

1. Appeal rights

A determination to correct an erroneous payment which reduces the total SSI payment is an initial determination with appeal rights. Payment continuation applies only in certain cases, but not at the PPL.

2. How payment continuation applies

a. Multiple payment case

Payment continuation applies in a multiple payment case at the higher of these amounts:

• the highest multiple payment that was in effect (subject to the payment ceiling), or

• the correct amount due.

b. Payment ceiling case

Payment continuation applies in a payment ceiling case at the highest of these amounts:

• the amount paid in the month before erroneous payments began (subject to intervening changes, if higher), or

• the amount SSA was attempting to pay the month in which erroneous payments began, or

• the correct amount due.

3. When payment continuation does not apply

Payment continuation does not apply in a payment ceiling case when:

• the record was in nonpay status (eligibility suspension) in the month before erroneous payments began, and

• the suspension was also proper for the month in which erroneous payments began, and

• the recipient did not regain eligibility.

4. Qualifying for payment continuation

When payment continuation applies, recipients must still qualify to receive it until there is a decision on the first level of appeal. They may also waive it and later request it any time before the first appeal decision. These policies and procedures are in SI 02301.310 above.

CAUTION: Do not use an SSA-94 for appeal or an SSA-263-U2 for waiver of payment continuation in erroneous payment cases.

5. Manual notice requirements

To correct erroneous payments, FOs issue a manual GK notice which explains:

• the erroneous payments that SSA made,

• the payments that SSA should have made,

• the correct amount due and when it will begin, and

• appeal rights.

D. Procedure — correcting multiple payment cases

1. Correct payments

Follow these steps to stop multiple payments and pay the correct amount:

2. Issue a manual GK notice

Follow manual GK notice procedures in SI 02301.307 above and issue an SSA-L8165-U2. Also:

• Use paragraph GBKM06 (NL 00804.225) under the caption “Your Payment Is Based On These Facts.”

• Use paragraph GBKM08 (NL 00804.225) for the appeal language. Complete fill-ins 1 and 2 with the payment continuation amount; follow instructions immediately below.

3. Determine payment continuation

Follow these steps to determine the payment continuation amount:

E. Procedure — correcting payment ceiling cases

1. Correct Payments

Follow these steps to correct payments over the payment ceiling:

2. Issue a manual GK notice

Follow manual GK notice procedures in SI 02301.307 above and issue an SSA-L8165-U2. Also:

• Use paragraph GBKM07 (NL 00804.225) under the caption “Your Payment Is Based On These Facts.”

• Use paragraph GBKM08 (NL 00804.225) for the appeal language. Do not use the caption and language for payment continuation if it does not apply (see below).

3. Determine payment continuation

Follow these steps to determine if payment continuation applies and, if so, the amount:

F. Process — continuing payments during appeals

This chart describes how recipients receive payment continuation until the appeal decision in a multiple payment or payment ceiling case.

G. Examples

1. Example 1

Multiple Payment Case/Payment Over the Payment Ceiling

In July 1993, the FO discovers that Randy Yates is receiving SSI payments on three different SSNs. He is receiving monthly payments of $74, $434 (FBR), and a payment of $1000 which is over the payment ceiling. The FO determines that Mr. Yates is entitled only to the monthly payment of $74 which he is receiving on the correct SSN. On July 10, the FO inputs T20 to the incorrect records to terminate the erroneous payments for the following month, and issues a manual SSA-L8165-U2. The notice explains that SSA will send only one monthly payment of $74 beginning August and offers payment continuation at $434.

NOTE: The FO offers payment continuation at $434 since it is the highest payment within the payment ceiling. Since it is higher than the correct amount on the record, the FO would have to pay by A-OTP an additional $360 each month to provide payment continuation until the appeal decision. For a sample notice, see NL 00804.700, notice number 4.

2. Example 2

Payment Ceiling Case

In July 1993, the FO discovers continuing SSI payments over the payment ceiling for Lamar Candy of $1289.34 since March 1993. The FO attempted to pay $289.34 beginning March, but a transmission error resulted in the erroneous payments on the M02 record. Mr. Candy is due $289.34 for March and $254 for April and continuing. On July 5, the FO inputs to reduce the payment and issues a manual SSA-L8165-U2. The notice explains the reduction to $254 beginning August and offers payment continuation at $289.34.

NOTE: The FO must offer payment continuation at $289.34 because it is the amount that the FO attempted to pay for the first month of erroneous payments and because it is higher than the correct amount due. For a sample notice, see NL 00804.700, notice number 5.