Steps for Waiver Determination under Section 1870(c) of the Act

50.10 – Steps for Waiver Determination under Section 1870(c) of the Act (Rev. 12438; Issued: 01-04-24; Effective: 02-06-24; Implementation: 02-06-24) a) Collect All Pertinent Data The MSP Contractor will collect all supporting documentation necessary for the waiver determination, including: i. Beneficiary procurement costs; ii. Accident-related out-of-pocket medical expenses incurred; and iii. Expenses and income information that demonstrate financial hardship (if the beneficiary is alleging financial hardship). b) Apply Waiver Criteria The MSP Contractor determines whether the beneficiary meets the criteria for waiver determinations under Section 1870(c) of the Act (see also 42 C.F.R. § 405.355 and 20 C.F.R. §§ 404.506-512). Section 1870(c) of the Act provides that CMS may waive all or part of its recovery in any case where an overpayment under Title XVIII of the Act has been made with respect to a beneficiary: i. Who is without fault, and/ ii. When adjustment or recovery would either: A. Defeat the purpose of title II or title XVIII of the Act, or B. Be against equity and good conscience. iii Based on the CMS application of the SSA definition of fault, found at 20 C.F.R. § 404.507, CMS deems that beneficiaries are without fault. c) Determine if a full or partial waiver is warranted.