TN 6 (04-16)

GN 04410.040 Protesting Deficiency Citations- Rebuttals Title II

A. Introduction to protesting deficiency citations

The Office of Quality Review (OQR) uses the SSA-93 Quality Review Feedback Report to notify the field office (FO), processing center (PC), the Office of the Regional Commissioner (ORC), and the Associate Commissioner (AC) of the Office of Central Operations (OCO) (for PC 7 and 8) of findings that identify payment errors and informational items which require corrective action but do not affect the sample payment.

The purpose of the rebuttal process is to resolve case-related disagreements between OQR and operating components. This process ensures that issues are resolved systematically and objectively and that affected beneficiaries receive a correct benefit payment. Informal communications between OQR and the operating components are encouraged to expedite resolution.

B. Protesting a deficiency citation

The FO or PC may rebut a cited deficiency only if it meets the criteria for a rebuttable issue outlined in GN 04410.040C in this section.

Use the SSA-93 Quality Review website to submit a rebuttal to the reviewing OQR field site within 45 days of the date OQR transmitted the SSA-93.

  • Select “Rebuttal Request Sent to OQR” in the “Respond to SSA-93 Review” area of the detail screen on the SSA-93 website,

  • use the Comments box to explain the issue, and

  • scan all supporting material into the electronic folder and clearly indicate the location in the Comments box.

The SSA-93 website notifies the ORC/AC of OCO of the rebuttal request once submitted.

Delay corrective action only on contested deficiencies pending final resolution. Correct all non-disputed deficiencies cited on the case.

C. Criteria for a rebuttable issue

Only dollar deficiencies that affect the sample period’s payment cited by OQR are subject to the formal rebuttal process.

D. Issues not subject to rebuttal

OQR identifies non-payment and informational items on the SSA-93. Informally resolve questions related to non-payment and informational items via email or telephone contact. The FO or PC should reconcile any item where a policy misinterpretation is involved. If necessary, OQR revises the quality review database to reflect an informal resolution. The FO or PC must document the case when the decision is that corrective action is unnecessary or one that differs from the original OQR findings.

Deficiencies cited by OQR not rebutted by the FO or PC under the rebuttal process described in this section are:

  • Non-payment deficiencies,

  • evidentiary deficiencies, and

  • all informational items.

E. Operational component rebuttal process

If the FO or PC disagrees with a deficiency, follow the rebuttal process described in this section. Resolution of a rebuttal is possible at any level in this process. When all SSA components involved reach an agreement, the rebuttal is resolved. Encourage informal communications via telephone or email to expedite problem resolution. The FO or PC and OQR record the rebuttal decision on the SSA-93 Quality Review website.

F. Level I rebuttal process

If the PC or FO disagrees with a rebuttable deficiency finding, the PC or FO contacts the reviewing OQR office within 45 calendar days of the date of transmission of the SSA-93 feedback report to the SSA-93 Quality Review website.

If attempts to resolve the issue informally fail, the PC feedback coordinator or FO should use the SSA-93 website to submit a formal rebuttal as described in GN 04410.040B in this section.

To prevent the PC from initiating corrective action on FO caused errors in the rebuttal process, the FO should

  • contact the PC feedback coordinator via telephone or email;

  • inform the PC of their disagreement with OQR's findings; and

  • instruct the PC not to take action on the protested deficiency pending a resolution.

The SSA-93 website will automatically notify the appropriate ORC/AC of OCO of the first level rebuttal once submitted.

You can find contact information for OQR Field sites (AIPQBs) at OQR Field Sites.

1. OQR field site reverses their decision

If the AIPQB director agrees with the FO rebuttal (i.e., disagrees with the original position of OQR), OQR removes the deficiency from the OQR database. OQR notifies the PC feedback coordinator and the FO (if they initiated the rebuttal) of the decision. The PC feedback coordinator notifies all operational components.

If the AIPQB director believes an interpretation of policy is involved, the AIPQB will consult with Division of Title II Quality and Special Studies (DT2QSS) in central office to determine if a policy submittal to the Office of Income Security Programs (OISP) is appropriate before responding. Notify the PC feedback coordinator and the FO of the possible delay in responding pending a reply from OISP.

2. OQR field site affirms or amends their decision

When the AIPQB affirms all or part of the error findings, the AIPQB provides an explanation of the decision and information about supporting documentation in the Comments box and transfers jurisdiction back to the FO or PC. The decision will explain the additional corrective actions the FO or PC needs to take.

G. Level II rebuttal process

If the FO or PC agrees with the AIPQB rebuttal decision, the FO or PC annotates the SSA-93 Quality Review website after all corrections are complete.

If the FO or PC disagrees with the AIPQB rebuttal decision, the FO or PC must update the SSA-93 website within 15 days to request a second level rebuttal. The rationale for the second level rebuttal request is required in the Comments box. The SSA-93 website sends an automated email to the RO with the rebuttal request and comments.

1. ORC/AC of OCO agrees with the deficiency

If, after review of the material, the ORC/AC of OCO agrees with the decision of the AIPQB they will explain the decision in the Comments box. The SSA-93 website sends an automated email to the FO or PC. The decision is final and the FO or PC must complete the corrective action. The follow-up process resumes until the FO or PC updates the SSA-93 website to show all actions are complete.

2. ORC/AC of OCO disagrees with the deficiency

If the ORC/AC of OCO disagrees with the position of the AIPQB, the ORC/AC of OCO must submit a second level rebuttal on the SSA-93 website within 10 days. The ORC/AC or OCO must provide the rationale for the disagreement in the Comments box. The SSA-93 website sends an automated email to OQR headquarters (HQ) with the request and rationale for review.

a. OQR HQ disagrees with the OQR field site decision (reversal or modification)

If OQR HQ agrees with the rebuttal (i.e., disagrees with the original position of the AIPQB), OQR HQ will post the decision and rationale to the SSA-93 website, and an automated email is sent to the FO or PC, and the RO. OQR will take action to remove the error from the eQA Quality Review database.

b. OQR HQ agrees with the OQR field site decision (affirmation)

If OQR HQ upholds the original decision, OQR HQ posts the decision and rationale to the SSA-93 website, which sends an automated email to the FO or PC and RO within 15 calendar days of the date of the second level rebuttal request.

The OQR HQ decision is final. If OQR HQ affirms or amends the deficiency, the FO or PC must take the corrective action. The case will return to the follow-up process until the FO or PC completes all corrections and updates the SSA-93 website.

H. Rebuttal conclusion

After resolution of all rebuttal actions, the FO or PC takes corrective action within 90 days and updates the SSA-93 Quality Review website. The ORC/AC of OCO is responsible for ensuring that corrective actions are completed.

I. List of ORC/AC of OCO and PC contacts

Refer to the chart for ORC/AC of OCO and PC addresses:

ORC, PC, and AC of OCO Contacts

ORC

E-mail Address

Phone

Boston

||BOS CPS RSI SSI

617-565-2882

New York

||NY CPS

212-264-8355

Philadelphia

||PHI MOS CTR PROG SYSTS

215-597-1251

Atlanta

||ATL MOS CPS

404-562-1301

Chicago

||CHI ARC MOS CRSI SSI

312-575-4240

Dallas

||DA RO TAR Feedback Reports

214-767-4224

Kansas City

||KC CPS

816-936-5640

Denver

^DENVER TAR

303-844-0763

San Francisco

||SF MOS Programs Support Center

510-970-8251

Seattle

||SEA CPS RPST

206-615-2175

Processing Center

E-mail Address

Phone

NEPSC

||NY ARC PCO OAS NEPC

718-557-3735

MATPSC

||PHI ARC PCO OSB OAS

215-597-3552

SEPSC

||SEPSC FEEDBACK

205-801-2287

GLPSC

||CHI ARC PCO OSB

312-575-4250

WNPSC

||SF WNPSC OAS

510-970-1427

MAMPSC

||KC OAS

816-936-5880

ODO

^OCO OQA TAR SSA93

410-966-4481

OIO