POMS Reference

HI 03040: Appeal of Medicare Part D Subsidy Determination

TN 1 (06-05)

A. Policy

OGC will act as liaison between the court and the Subsidy Appeal Unit (SAU). OGC will forward the court order to the SAU for effectuation and/or further development. The Management Analyst is responsible for certifying the case for the court. Certification includes ensuring all relevant documents are in place and properly assembled. The Management Analyst will use the following in his/her certification:

“The undersigned, as Management Analyst, Subsidy Appeal Unit, Social Security Administration, hereby certifies that the documents annexed hereto constitute a full and accurate transcript of the entire record of proceedings relating to the case.”

The certification is then signed by the Management Analyst.

If the court does not retain jurisdiction, after the administrative proceedings on remand have been completed, the case is closed. The notice(s) issued is the final decision of the Commissioner.

If the court retains jurisdiction, after the administrative proceedings on remand have been completed, SSA must file a copy of the new final decision with the court.

We will look to the court order and OGC to provide guidance as to whether the court retains jurisdiction.

B. Procedure

When OGC transfers the court remand to the SAU, the SDR will review the case based on instructions by the court and OGC. The SDR will undertake further development which may include a new hearing or case review and changes to eligibility criteria in MAPS. Any notices that are issued will come from DGS and the determination process, as appropriate. A hearing may not be necessary if the SDR can make a fully favorable decision, i.e., full subsidy.

The court is either going to retain jurisdiction (sentence 6) or not (sentence 4). If the court retains jurisdiction, the DGS notice will explain in the appeal paragraph that the individual has 10 days to let us know if he/she disagrees with the decision and we will then file a certified copy of the administrative record with the U.S. Attorney for filing with the court.

Where the court does not retain jurisdiction, the DGS notice will explain that the court order returning the case back to the Commissioner ends the court’s review. If the individual disagrees with the notice of decision issued by the SAU upon remand, he/she must file a new civil action.

There is a timeframe for continuing the appeal process. If the individual requests an extension of time, the SDR will determine whether the individual has good cause, document the reason(s), and send appropriate DGS notice.