Reconsideration Policy Clarification

On the January 14 All VR Call, SSA announced a change in the policy for VR payment reconsiderations, limiting VRs to one reconsideration request per claim. This message is to clarify the policy and the intent behind the change. Effective February 1, SSA will only accept and address one reconsideration request per claim if the denial is due to earnings. If a VR agency has already received a reconsideration decision on a claim, it is final and VR agencies should not resubmit the decision because it will automatically be denied. This policy aligns with how reconsiderations are handled in other agencies and within SSA.

This new policy is not designed to withhold payments from VR agencies, but to make sure that VRs hold claims until they are ready. An analysis of denials shows that overall, agencies are not waiting to make sure that the necessary earnings are available, but are submitting cases when it looks like there might be enough earnings and waiting for the denial from SSA to resubmit. This practice prevents agencies that do their due diligence to ensure that claims are submitted properly from receiving their payments in a timely manner.

The new reconsideration policy is an effort to manage the claims workload. SSA is currently processing 150-day old cases and has a backlog of over 10,000 cases, an all-time high. The VR team has seen a reduction in staff and we do not have the ability to hire replacements for the foreseeable future. The current team is working at capacity, but cannot keep up with new cases as they come in if they are spending all of their time re-reviewing claims that are not ready for payment.

Guidance to Help Submit Claims Properly

A claim is ready for payment when there are proven earnings for 9 out of 12 consecutive months at Substantial Gainful Activity (SGA) level or above. As a reminder, our earnings policy, effective November 1, 2019, states that all VRs must submit proof of earnings documentation with every claim. Acceptable earnings documentation includes, but is not limited to:

• The Work Number
• Pay Stubs
• Employer Signed Statement with FICA withholdings
• SSA supplied Quarterly VR Client Earnings Report (VRCER)
• Quarterly Office of Child Support and Enforcement (OCSE) National Directory of New Hire (NDNH) data

If you are unsure of whether you have the necessary documentation to submit the case, we recommend you contact our helpdesk (VR.Helpdesk@ssa.gov). If you need training, please contact the helpdesk and let us know.

In addition, SSA is performing data analysis at a statewide level and plans to start sharing this information with all VR agencies. VR agencies will have an opportunity to improve their allowance rate. If rates improve, then SSA will consider further modification to the reconsideration policy. If VR agencies do not improve, SSA may institute a triage system where lower performing states will have claims processed behind higher performing states.

This policy change will be updated in the VR Provider Handbook. For any questions, please contact the VR Help Desk (VR.Helpdesk@ssa.gov).