TN 2 (12-88)

SI 01403.005 Monitoring and Noncompliance for Pass Along

A. Operating Procedures

The Regional Commissioner (RC) has the primary responsibility for monitoring State compliance with passalong procedures.

1. OBTAIN WRITTEN CONFIRMATION

Within 30 days from the end of a relevent 12-month period, the RC will obtain written confirmation from each State as to whether it plans to:

  • Maintain all of its OSS and MMSS payments at least at the required levels;

  • Reduce some payments below the required levels and rely on compliance through the maintenance of total expenditures; or

  • Not comply (by reducing one or more of its supplementary payments below the required levels and not maintaining its total expenditures as required).

2. ACTION TAKEN AFTER RECEIVING RESPONSE

Upon receipt of each State’s response, the RC will take the following actions as necessary to monitor State compliance:

  • Obtain an agreement modification showing the new payment levels for federally administered State supplementary payments for those States that plan to maintain all their supplementary payments at least at the required levels.

  • Inform any State not electing to maintain all of its State supplementary payments at the required levels (as provided by section 1618 of the Social Security Act (the Act)) that in order to avoid a finding of noncompliance, it will have to meet the total expenditures test.

3. CONTINUED MONITORING

During the course of a fiscal year, the RC will continue to monitor the States as follows:

  • Review State procedures to verify that a State which has elected to do so is maintaining all its supplementary payments at least at the required levels. Case reviews should be needed only when there is reason to believe that established procedures were not followed.

  • Review State expenditures to date at least twice in the first 9 months of a 12-month period in order to determine whether it appears that a State which has elected not to maintain all of its supplementary payments at the required level(s) will meet the total expenditures test. This will be accomplished by review of either State expenditure reports when a State administers its own supplementary payment program(s), or SSA-8700’s (Financial Accountability Statement) when SSA administers the State supplementary payment program(s).

B. Process - Out of Compliance Findings

These charts explain what actions SSA will take when a State is found out of compliance for the reasons mentioned in SI 01403.001 B.4.

1. CHART #1

State’s failure to have an agreement in effect or State has terminated the agreement.

IFTHEN

RC Determines the Situation in SI 01403.001 B.4.a. has Occurred

He/she will:

  • Inform the State agency; and

  • Notify the Associate Commissioner (AC), SSI.

AC, SSI, Is Notified

He/she will inform Commissioner:

  • That the State made supplementary payments as described in section 1616(a) of the Act and/or pursuant to an agreement entered into under section 212(a) of P.L. 93-66 on or after June 30, 1977;

  • That a model pass-along agreement was offered to the State;

  • That negotiations were entered into with the State;

  • That the negotiations failed to result in the execution of an agreement;

  • If the agreement was executed but subsequently terminated, the date of its termination;

  • That presently there is no agreement binding the State to pass along FBR increases as required by section 1618 of the Act; and

  • The efforts, if any, to execute a new agreement.

Commissioner Agrees With The Findings

He/she will:

  • Forward an agreement form to the State together with a notice that SSA is planning to submit a proposed finding for the Secretary’s signature that the State does not have in effect an agreement with the Secretary as required, giving the State 30 days to execute such an agreement; and

  • Forward a copy of the notice sent to the State to the Secretary through the appropriate department officials, including CMS.

Commissioner Does Not Agree With The Findings

He/she will:

  • Take no further action against the State agency; and

  • Notify the RC that the State is not out of compliance and should be so informed.

State Fails To Act On The Agreement Sent By The Commissioner

He/she will:

  • Forward a notice to the State that he/she is submitting a proposed finding for the Secretary’s signature that the State has no agreement in effect with the Secretary as required;

  • Forward a copy of the notice to the State to CMS; and

  • Forward the proposed finding of noncompliance specifying the elements in this section for the Secretary’s signature through appropriate department officials.

Secretary Agrees With Finding

He/she will:

  • Forward a notice to the State of that finding specifying the elements in this section; and

  • Forward a notice to CMS directing that title XIX matching funds be withheld.

Secretary Does Not Agree With the Finding

He/she will:

  • Take no further action against the State agency; and

  • Notify the Commissioner that the State is not out of compliance and should be so informed.

Secretary Notifies CMS

CMS will:

  • Suspend title XIX expenditures for next quarter;

  • Undertake action to recoup expenditures for all other quarters beginning with the first quarter of the State’s noncompliance as shown in the Secretary’s determination; and

  • Inform the State of the rights of review and appeal provided for as in other title XIX reimbursement disallowances.

NOTE: The regulations at 45 CFR Part 16, Departmental Grant Appeals Process, provide the procedures for States to request reconsideration of the decision to withhold Federal financial participation in title XIX funding.

2. CHART #2

State’s failure to maintain required supplementary payment levels or meet total expenditures test.

IFTHEN

RC Determines The Situation in SI 01403.001B.4.b. Has Occurred

Within 45 days of the end of the relevant 12-month period he/she will:

  • Inform the State agency; and

  • Notify the AC, SSI.

AC, SSI, Is Notified

Within 90 days of the end of the relevant 12-month period he/she will inform the State that:

  • Methods are available for achieving compliance; and

  • Failure to act could result in finding of noncompliance.

State Fails To Act

AC, SSI, will inform the Commissioner:

  • That the State has not maintained one or more of its supplementary payment levels; or

  • That the State has not satisfied the total expenditures test, nor agreed to take the necessary corrective action within 12 months following the relevant 12 month period; and

  • That he/she recommends that the State be determined to be out of compliance.

Commissioner Concurs

He/she will:

  • Send a notice to the State that the RC is planning to submit a proposed finding for the Secretary’s signature that the State is out of compliance for failure to meet the passalong requirements and give the State 30 days to provide evidence to the contrary; and

  • Forward a copy of the notice sent to the State to the Secretary through the appropriate department officials, including CMS.

Commissioner Does Not Concur

He/she will:

  • Take no further action against the State agency; and

  • Notify the RC that the State is not out of compliance and should be so informed.

State Does Not Take Corrective Action

Commissioner will submit:

  • The proposed finding of noncompliance specifying the elements of noncompliance for the Secretary’s signature through the appropriate department officials;

  • A notice to the State that he/she has submitted a proposed finding of noncompliance for the Secretary’s signature; and

  • A copy of the notice sent to the State and CMS.

Secretary Concurs

He/she will:

  • Send a notice to the State of that finding specifying the elements of noncompliance; and

  • Forward a notice to CMS directing that title XIX reimbursement funds be disallowed for the calendar quarters specified.

Secretary Does Not Concur

He/she will:

  • Take no further action against the State agency; and

  • Notify the Commissioner that the State is not out of compliance and should be so informed.

Secretary Notifies CMS

CMS will:

  • Notify State that title XIX expenditures will be disallowed;

  • Undertake actions to recoup expenditures for all other quarters beginning with the quarter of the State’s noncompliance as shown in the Secretary’s determination; and

  • Inform the State of the rights of review and appeal provided for as in other title XIX reimbursement disallowances.

NOTE: The regulations at 45 CFR Part 16, Departmental Grant Appeals Process, provide the procedures for States to request reconsideration of the decision to withhold Federal financial participation in title XIX funding.


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http://policy.ssa.gov/poms.nsf/lnx/0501403005
SI 01403.005 - Monitoring and Noncompliance for Pass Along - 07/08/2011
Batch run: 07/08/2011
Rev:07/08/2011