I-5-4-46.Jones v. Shalala
|Definition of Class|
|Processing and Adjudication|
|- Jones v. Shalala Order Filed With the Clerk of the District Court on May 10, 1994|
|- POMS SI 02005.006, Exception to Transitional Computation Procedures for Ninth Circuit Cases, Dated November 1994|
|- Route Slip for Current Claim(s) at OHA|
|- Route Slip for Class Member Inquiry and Evidence|
ISSUED: May 5, 1995
This Temporary Instruction (TI) is being issued to provide OHA adjudicators with instructions for implementing the relief ordered by the district court in the Jones v. Shalala class action. Jones involves the Secretary's application of the retrospective monthly accounting (RMA) method of calculating Supplemental Security Income (SSI) payments for the first three months of eligibility or reeligibility in nonrecurring income fact situations. This instruction also incorporates into HALLEX the substance of the Associate Commissioner's July 28, 1994 memorandum.
Adjudicators throughout the country must be familiar with this TI because Jones class members who now reside outside of the Ninth Circuit (Alaska, Arizona, California, Guam, Hawaii, Idaho, Montana, Nevada, Northern Mariana Islands, Oregon and Washington) must have their cases processed in accordance with the requirements of the court order.
The RMA statute of the Social Security Act (the Act) contains an exception (codified as 42 U.S.C. § 1382(c)(2)), which operates prospectively and provides that, for the first month of eligibility or reeligibility (and the second month if the Secretary chooses), the Secretary will determine SSI benefit amounts on the basis of the income of the individual (and on the basis of the income of the eligible spouse of the individual, if any) and other relevant circumstances in such month(s). An additional exception to the RMA provision (codified at 42 U.S.C. § 1382(c)(4)(A)) provides, in part, that if the Secretary determines that “reliable information” is currently available with respect to the income and other circumstances of an individual for a particular month, the benefit amount of the individual for such month may be determined on the basis of such information. As applied in accordance with the regulation at 20 CFR § 416.420(b) and the Program Operations Manual System (POMS) instructions at §§ SI 02005.060 through SI 02005.065, the RMA method sometimes results in the triple deduction of one-time, nonrecurring income received during the first month of SSI eligibility or reeligibility.
On April 3, 1992, plaintiffs filed a complaint in the United States District Court for the Eastern District of California challenging the Secretary's regulation and policy implementing the RMA method of calculating SSI payments for recipients who had received nonrecurring income in the first month of eligibility or reeligibility. On December 23, 1992, the court certified a class of all SSI recipients who resided in or had resided in the Ninth Circuit and who had or would have their SSI eligibility or benefit amount for any month determined pursuant to the Secretary's policy under the RMA provisions. Class membership is further restricted to individuals who receive nonrecurring income during the first month of eligibility or reeligibility.¹ Even though the court certified a class, it granted the Secretary's cross-motion for summary judgment because it concluded that neither the plain language of the statute nor Congress' intent unambiguously requires the Secretary to consider the nonrecurring nature of income as a relevant circumstance.
The district court also concluded that the challenged regulation and policies are not arbitrary, capricious or manifestly contrary to the statute.
On September 23, 1993, the United States Court of Appeals for the Ninth Circuit reversed the district court's grant of the Secretary's cross-motion for summary judgment. The court of appeals held that the Secretary's “triple-deduction” violates the Act because it does not take into account the nonrecurring nature of income received in the first month of eligibility as a relevant circumstance. The court of appeals stated that it need not review the Secretary's interpretation of the Act under the “arbitrary and capricious” standard because the congressional intent underlying the Act is clear and unambiguous. Therefore, the court of appeals held that, in keeping with the humanitarian purpose of the Act, the Secretary must deduct nonrecurring income only once. Jones v. Shalala, 5 F.3d 447 (9th Cir. 1993).
On May 9, 1994, the district court signed an order that the parties negotiated to implement the Ninth Circuit's decision and the order was filed with the clerk of the court on May 10 (Attachment 1).
¹ In the subsequent negotiated settlement that the district court approved and filed with the clerk of the court on May 10, 1994, the parties redefined the class definition so that it would be consistent with a separate, unpublished September 23, 1993 circuit court memorandum that affirmed the district court's certification and scope of the class. See Part IV., below, for the precise class definition.
III. Guiding Principles
The May 10 relief order specifically invalidates and enjoins the Secretary from applying 20 CFR § 416.420(b), POMS §§ SI 02005.060 through SI 02005.065 and “any other written or oral directives, guidelines, memoranda, etc.” having such effect in the Ninth Circuit.
The order, in part, required or requires the Secretary to:
redetermine the monthly SSI benefits and, within 15 working days after entry of the order, certify payment for the two remaining named plaintiffs;
within 20 working days after entry of the order, issue a teletype, which will apply to class member claims that are pending at any stage of the administrative process (“award letter, initial decisions, reconsideration, Administrative Law Judge, Appeals Council”), explaining that the policy, regulation and POMS instruction at issue have been enjoined in the Ninth Circuit;
within 240 days from the date that the order is issued, identify class members and issue retroactive benefits; and
allow individuals who are not identified by the Secretary as potential class members to self-identify.
IV. Definition of Class
The May 10, 1994 district court order redefines the class as:
All SSI recipients [who are past or present Ninth Circuit residents] who have had their benefit amount for SSI for any month determined pursuant to defendants' policy of retrospective monthly accounting (RMA) and, as a consequence of such determination, who have had nonrecurring income in their first month of eligibility or reeligibility used as the basis for their SSI benefit computation for the first three months of eligibility or reeligibility, and who either:
received a final decision . . . [on or after January 29, 1992, and before April 4, 1992]; or
had a request for administrative review pending [on or after January 29, 1992, and before April 4, 1992]; or
received a decision notice at some level of the administrative process (i.e., award letter, initial decision, reconsideration, or Administrative Law Judge decision) [on or after January 29, 1992, and before April 4, 1992], and whose period of limitations for timely seeking further administrative review therefore had not expired at the time the complaint was lodged;
and all [SSI recipients] . . . who received an award letter, initial determination or other notice of decision after [April 3, 1992] . . . , who have had nonrecurring income in their first month of eligibility or reeligibility used as the basis for their SSI benefit computation for the first three months of eligibility or reeligibility.
The certified class also includes individuals who receive a notice of overpayment on or after January 29, 1992 (sixty-five days prior to the filing of the complaint), because of the Secretary's method of considering nonrecurring income and calculating benefits for the first three months of eligibility or reeligibility. This includes individuals who had overpayment appeals pending as of January 29, 1992.
V. Processing and Adjudication
On June 9, 1994, the Office of Supplemental Security Income (OSSI) issued teletype instructions in compliance with ¶ 7 of the court order. Final POMS instructions were published in November 1994 (Attachment 2). These technical instructions involve the modification of SSI payment calculation procedures that are generally performed at the SSA field office (FO) level. The FOs have been provided with special computer software for performing RMA payment calculations.
OSSI developed computer specifications to generate a list of potential class members and forwarded class member alerts only to affected FOs.
The identification and recalculation aspects of the Jones relief will typically not occur at the OHA level of adjudication. However, infrequent instances may occur at the OHA level, e.g., when a claimant has self-identified as a Jones class member in an appeal of an overpayment determination, which will require an ALJ or the Appeals Council to forward a class member claim to an appropriate FO for a recalculation of SSI payments pursuant to Jones. In such instances, after ensuring that any necessary OHA-level adjudication has been completed, OHA adjudicators should forward any claims which have been identified as meeting the Jones class member criteria to the appropriate FO for the immediate application of the policy set forth in POMS SI 02005.006 (see Attachment 2). Similarly, if an individual contacts OHA regarding Jones class relief and OHA determines that the individual does not have an OHA-level claim pending, OHA personnel should take a statement from the claimant, and any evidence that the claimant offers in support of his or her statement, and refer the matter to the appropriate FO (see Attachment 4). Adjudicators should consider the class member's current place of residence as a basis for selecting the appropriate FO.
Hearing Office personnel should direct any questions to their Regional Office. Regional Office personnel should contact the Division of Field Practices and Procedures in the Office of the Chief Administrative Law Judge at (703) 305-0022. Headquarters personnel should direct questions to the Division of Litigation Analysis and Implementation at 305-0708.