32 Miss. Code. R. § 22-3.18.2 - Social Security Reimbursement Program

I. Overview

Under the Social Security Administration/Vocational Rehabilitation Reimbursement Program, the Agency has a formal agreement with SSA that allows the Agency to receive incentive payments from SSA on all SSDI/SSI clients (receiving benefits based on disability) who receive services resulting in the client working at least nine months out of 12 continuous months at the Substantial Gainful Activity (SGA) level. The 2011 SGA amount is $1000 per month for all disabilities except blindness and $1640 for individuals who are blind. Because the Agency is entitled to incentive payments from SSA based on the period a client receives SSDI/SSI during the rehabilitation process, care should be taken in properly coding and updating cases. In addition, care should be taken to properly code disability-based SSDI/SSI cases since the Agency is not entitled to incentive payments on those cases receiving retirement, childhood, widows, and other non-disability-based benefits.

Claims for reimbursement must be filed within 12 months after the month in which the client completes nine months of SGA. For example, if the individual completed a period of 9 months of SGA in April 2008, the claim must be filed for reimbursement before May 2009. Therefore, all rehabilitated cases considered for reimbursement are pulled by the Ticket Unit approximately one year after closure since cases are normally closed 90 days following the date the client is successfully employed. However, should there be a situation where a client reaches the SGA threshold amount during the time the case is in open status, the Ticket Unit should be notified at 601-853-5351 so that a reimbursement claim can be filed within the allotted 12-month period.

II. Reimbursement Process

The Ticket Unit verifies receipt of SSDI/SSI benefits during the VR service period by means of SSA queries. Wage verification documentation is secured by the Ticket Unit on cases receiving VR services while in SSDI/SSI benefit status through an agreement with the Mississippi Department of Employment Security. The Ticket Unit searches for nine months of SGA within a continuous twelve-month period.

When wage verification is not available through this process, the Ticket Unit will explore AACE seeking documentation of employment at SGA. If qualifying criteria is identified, the Ticket Unit will forward a Wage Verification Letter to the counselor who closed the case. The counselor will contact the previously served client in an effort to obtain written verification of wages. The signed Wage Verification Letter or an explanation of inability to secure cooperation from the previously served client will be forwarded back to the Ticket Unit.

Good Provider Claims, Form SSA-199, are then submitted to the SSA Claims Processing Unit for consideration of reimbursement for direct costs, administrative costs, and tracking costs. Required documentation to accompany the SSA-199 is usually pulled from AACE.

Requests for all signed authorizations for direct costs for services provided prior to implementation of the AACE System in October 1999 will be forwarded to the counselors from the Ticket Unit. Counselors will make copies of the signed authorizations and return to the Ticket Unit.

Upon receiving the SSA-199 with attachments, SSA can also request Payment Validation Reviews (PVRs) on a sample of cases for which they may request all signed authorizations and a copy of the IPE. These requests will be forwarded to the counselors who will copy the requested documents and return to the Ticket Unit. After reviewing submitted claims, SSA will forward notice of approval or denial to the Ticket Unit.

Notes

32 Miss. Code. R. § 22-3.18.2