Resolving Disputes Module 8 January 2007 Resolving Disputes Learning Objectives Describe the process for resolving disputes between Employment Networks (EN) or State Vocational Rehabilitation (VR) Agencies, and MAXIMUS Describe the process for resolving disputes between beneficiaries and ENs Describe the process for resolving disputes between ENs and State VR Agencies Learning Objectives Describe the process for resolving disputes between beneficiaries and State VR Agencies Describe the process for resolving payment disputes between ENs and the Social Security Administration Disputes Between Employment Networks or State Vocational Rehabilitation Agencies and MAXIMUS MAXIMUS Dispute Resolution Process ENs and VRs can use MAXIMUS internal procedures to resolve disputes If process does not result in a mutually agreeable solution, dispute is forwarded to the Social Security Administration within 20 days of receiving the following: Description of disputed issue Summary of EN's/VR's and MAXIMUS position Description of solutions proposed by both parties MAXIMUS Dispute Resolution Process Once referred to the Social Security Administration, their decision is final Process does not apply to disputes involving payment requests or reimbursements State VR Agency serving beneficiaries under the the traditional cost reimbursement system will be resolved under existing regulations governing payment request disputes Disputes Between Beneficiaries and ENs EN Dispute Process Requirements EN is required to provide copy to Beneficiary each time an IWP is signed Process should inform the beneficiary of the following: The right to refer a dispute to MAXIMUS The right to refer a dispute to the Social Security Administration, if MAXIMUS resolution is dissatisfactory The availability of assistance from the State Protection & Advocacy (P&A) system Steps in the EN and Beneficiary Dispute Resolution Process Beneficiary seeks solution through ENs internal grievance process If unresolved, the beneficiary or the EN may seek resolution from MAXIMUS If still unresolved, the beneficiary or the EN may seek resolution from the Social Security Administration MAXIMUS Role in Resolving EN or Beneficiary Disputes When escalating an issue to MAXIMUS for review, the EN has 10 business days to submit all relevant information A full review will be conducted by MAXIMUS with recommendation for a resolution A written recommendation is provided by MAXIMUS to the EN and beneficiary within 20 working days Either party that is dissatisfied with the results can request a review by the Social Security Administration Office of Employment Support Programs Required Elements of the Request to MAXIMUS Description of disputed issues; Summary of the beneficiary's position related to each disputed issue, prepared by the beneficiary or his/her designee Summary of the EN's position related to each disputed issue, prepared by the EN; Description of any solutions proposed by the EN , including why the beneficiary rejected the solutions Social Security Administration's Role in Resolving EN and Beneficiary Disputes Request for Social Security Administration's review must be in writing and forwarded to MAXIMUS within 15 days of receipt of MAXIMUS recommendation Within in 10 working days, MAXIMUS must forward the request to the Social Security Administration The Social Security Administration's recommendation is final If either party is dissatisfied with the final recommendation, either party has the right to terminate the relationship with the other party Required Elements of the Request to the Social Security Administration Copy of the beneficiary IWP; Information on the disputed issue; Any relevant evidence; Detailed discussion of the facts, evidence, and other issues related to the dispute; Supporting documentation for MAXIMUS recommendation including statements from parties and excerpts from relevant statutes or regulations; and Conclusions and recommendations from MAXIMUS Disputes Between Employment Networks and State VR Agencies Steps in the EN and VR Agency Dispute Resolution Process Agreement between both entities should include procedures for dispute resolution If no procedures listed in agreement, resolution should follow procedures as addressed under state law or administrative procedures If state law or administrative procedures do not address issue, either party may contact MAXIMUS for a suggested resolution Required Elements of the Request to MAXIMUS The request should be in writing and include the following elements: Copy of the agreement, Information regarding dispute, and Information regarding the position of both the EN and the State VR Agency MAXIMUS' Role in Resolving EN and State VR Agency Disputes Following receipt of request, MAXIMUS has 20 calendar days to recommend a resolution to the dispute If either party is disagrees with the MAXIMUS recommendation, then either entity may contact the Social Security Administration within 30 calendar days after receiving MAXIMUS recommendation for another review Disputes Between Beneficiaries and State VR Agencies Rehabilitation Act of 1973 Procedures in the Rehabilitation Act of 1973, as amended, apply to any Ticket-holder assigned to the State VR Agency Requires State VR Agency to provide description of services provided through Client Assistance Program (CAP) Provides opportunity to resolve disputes using formal mediation services or impartial hearing process Payment Disputes Between EN or State VR Agency Functioning as EN and the Social Security Administration EN Payment Dispute Resolution with Social Security Administration If an EN, other than a State VR Agency, has a payment dispute, it is resolved through dispute resolution process in ENs Agreement (the Request for Proposal) If State VR Agency, functioning as an EN, has payment dispute under EN payment system, the State VR Agency may make a written request for reconsideration within 60 days of receiving notice of the Social Security Administration's decision The State VR Agency Functioning as EN Payment Dispute Process State VR Agency sends the request to MAXIMUS Then MAXIMUS forwards the request to the Social Security Administration for reconsideration and recommendation The Social Security Administration makes decision and notifies the State VR Agency of its decision in writing There can be no appeal of any Social Security Administration decision that affects a beneficiary's entitlement or eligibility for benefits, despite the decision's effect on the ENs payment Appeals to the Social Security Administration Payment Decision Only the beneficiary or his representative can appeal the decision However, the EN can provide evidence that might support a change in the Social Security Administration MAXIMUS Role in the Dispute Resolution Process Ensure that discrete and comprehensive records are maintained by the panel of Ticket staff to mediate disputes Provide assistance to the Social Security Administration in the investigation and resolution of issues Update the MAXSTAR(tm) system with detailed information about disputes between parties Maintain complete records of all payment history, correspondence, telephone contact, and other communications with each EN Resolving Disputes Module 8 January 2007