If an EN disputes a milestone or outcome payment decision, SSA will handle the dispute according to the procedures in the EN's Ticket Program Agreement (TPA).

SSA does not have contracts with State VR agencies. If a State VR agency serving a beneficiary/recipient as an EN disputes a milestone or outcome payment decision:

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  The State VR agency must send a written request for reconsideration to the TPM within 60 days of receiving the written payment decision notice from SSA.

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  The TPM must review the issue in dispute, make a recommendation, and forward it along with the reconsideration request to SSA.

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  SSA will review the issue in dispute and the TPM's recommendation and issue a written decision.

  NOTE: Staff in ORDES will issue the SSA written decision. Payment disputes will not be referred to the Dispute Resolution Board.

Determinations that SSA makes about an individual's right to benefits may:

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  affect an EN's (including a State VR agency's) eligibility for a milestone or outcome payment;

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  cause a milestone or outcome payment already made to be incorrect, resulting in an overpayment; or

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  cause a denial of a request for a milestone or outcome payment to be incorrect, resulting in an underpayment.

Although an EN (including a State VR agency) cannot appeal a determination that SSA makes about an individual's right to benefits, the EN (or State VR agency) may furnish any evidence it has that relates to the issues to be decided. Such issues could involve determinations that benefits should be suspended, terminated, continued, denied, or stopped or started on a different date than alleged.