Background

This transmittal amends the title of chapter I-5-6 to “Redeterminations Under Sections 205(u) and 1631(e)(7) of the Social Security Act.” It also amends section I-5-6-3 of the Hearings, Appeals and Litigation Law (HALLEX) manual to update instructions for processing redeterminations under sections 205(u) and 1631(e)(7) of the Social Security Act for certain cases adjudicated in New York.

Explanation of Content and Changes

We made the following changes to HALLEX I-5-6:

I-5-6 – We changed the title of the chapter to “Redeterminations Under Sections 205(u) and 1631(e)(7) of the Social Security Act.”

I-5-6-3 – To more clearly distinguish the differences between cases that are pending and cases we are redetermining under sections 205(u) and 1631(e)(7) of the Social Security Act, we removed all instructions relating to pending cases and added the pending case instructions in new HALLEX I-5-6-3 A. We made numbering changes to correspond with the removal of this information. We made minor technical corrections and edits throughout the section. We updated the instructions due to a change in circumstance, namely the receipt of plea agreements and the resulting conviction of the facilitators of the scheme. We added hearing level instructions for developing evidence, when appropriate, and for handling subsequent applications, consistent with other fraud or similar fault redetermination instructions. We also clarified that an administrative law judge (ALJ) must issue a new decision, even when a beneficiary does not appear at the time and place of the scheduled hearing and circumstances would generally warrant a dismissal action. We also added a new subsection to address how an ALJ handles representative fee issues when redetermining a claim for fraud or similar fault.

Date: November 16, 2015