20 CFR 404.2121 - Validation reviews.

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§ 404.2121 Validation reviews.
(a) General. We will conduct a validation review of a sample of the claims for payment filed by each State VR agency or alternate participant. We will conduct some of these reviews on a prepayment basis and some on a postpayment basis. We may review a specific claim, a sample of the claims, or all the claims filed by any State VR agency or alternate participant, if we determine that such review is necessary to ensure compliance with the requirements of this subpart. For each claim selected for review, the State VR agency or alternate participant must submit such records of the VR services and costs for which payment has been requested or made under this subpart, or copies of such records, as we may require to ensure that the services and costs meet the requirements for payment. For claims for cases described in § 404.2101(a), a clear explanation or existing documentation which demonstrates how the service contributed to the individual's performance of a continuous 9-month period of SGA must be provided. For claims for cases described in § 404.2101 (b) or (c), a clear explanation or existing documentation which demonstrates how the service was reasonably expected to motivate or assist the individual to return to or continue in SGA must be provided. If we find in any prepayment validation review, that the scope or content of the information is inadequate, we will request additional information and will withhold payment until adequate information has been provided. The State VR agency or alternate participant shall permit us (including duly authorized representatives) access to, and the right to examine, any records relating to such services and costs. Any review performed under this section will not be considered an audit for purposes of this subpart.
(b) Purpose. The primary purpose of these reviews is—
(1) To ensure that the VR services and costs meet the requirements for payment under this subpart;
(2) To assess the validity of our documentation requirements; and
(3) To assess the need for additional validation reviews or additional documentation requirements for any State VR agency or alternate participant to ensure compliance with the requirements under this subpart.
(c) Determinations. In any validation review, we will determine whether the VR services and costs meet the requirements for payment and determine the amount of payment. We will notify in writing the State VR agency or alternate participant of our determination. If we find in any postpayment validation review that more or less than the correct amount of payment was made for a claim, we will determine that an overpayment or underpayment has occurred and will notify the State VR agency or alternate participant that we will make the appropriate adjustment.
(d) Appeals. If the State VR agency or alternate participant disagrees with our determination under this section, it may appeal that determination in accordance with § 404.2127. For purposes of this section, an appeal must be filed within 60 days after receiving the notice of our determination.
[59 FR 11916, Mar. 15, 1994]

Title 20 published on 2012-04-01

The following are only the Rules published in the Federal Register after the published date of Title 20.

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  • 2014-03-03; vol. 79 # 41 - Monday, March 3, 2014
    1. 79 FR 11706 - Medicare Determinations and Income-Related Monthly Adjustment Amounts to Medicare Part B Premiums; Conforming Changes to Regulations
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      SOCIAL SECURITY ADMINISTRATION
      Final rule.
      The interim final rule with request for comments published on September 18, 2013, at 78 FR 57257, is confirmed as final, effective March 3, 2014.
      20 CFR Parts 404 and 418

This is a list of United States Code sections, Statutes at Large, Public Laws, and Presidential Documents, which provide rulemaking authority for this CFR Part.

This list is taken from the Parallel Table of Authorities and Rules provided by GPO [Government Printing Office].

It is not guaranteed to be accurate or up-to-date, though we do refresh the database weekly. More limitations on accuracy are described at the GPO site.


United States Code
U.S. Code: Title 31 - MONEY AND FINANCE
U.S. Code: Title 42 - THE PUBLIC HEALTH AND WELFARE

§ 401 - Trust Funds

§ 402 - Old-age and survivors insurance benefit payments

§ 403 - Reduction of insurance benefits

§ 404 - Overpayments and underpayments

§ 405 - Evidence, procedure, and certification for payments

§ 405 note - Evidence, procedure, and certification for payments

§ 406 - Representation of claimants before Commissioner

§ 409 - “Wages” defined

§ 410 - Definitions relating to employment

§ 410a - Transferred

§ 411 - Definitions relating to self-employment

§ 412 - Self-employment income credited to calendar years

§ 413 - Quarter and quarter of coverage

§ 414 - Insured status for purposes of old-age and survivors insurance benefits

§ 415 - Computation of primary insurance amount

§ 416 - Additional definitions

§ 417 - Benefits for veterans

§ 418 - Voluntary agreements for coverage of State and local employees

§ 418 note - Voluntary agreements for coverage of State and local employees

§ 421 - Disability determinations

§ 421 note - Disability determinations

§ 422 - Rehabilitation services

§ 423 - Disability insurance benefit payments

§ 424a - Reduction of disability benefits

§ 425 - Additional rules relating to benefits based on disability

§ 428 - Benefits at age 72 for certain uninsured individuals

§ 429 - Benefits in case of members of uniformed services

§ 430 - Adjustment of contribution and benefit base

§ 431 - Benefits for certain individuals interned by United States during World War II

§ 433 - International agreements

§ 902 - Commissioner; Deputy Commissioner; other officers

§ 902 note - Commissioner; Deputy Commissioner; other officers

§ 909 - Delivery of benefit checks

42 U.S. Code § 905, 905a - Transferred

42 U.S. Code § 1320a–8a - Administrative procedure for imposing penalties for false or misleading statements

42 U.S. Code § 905, 905a - Transferred

42 U.S. Code § 905, 905a - Transferred

U.S. Code: Title 48 - TERRITORIES AND INSULAR POSSESSIONS
Statutes at Large

Title 20 published on 2012-04-01

The following are ALL rules, proposed rules, and notices (chronologically) published in the Federal Register relating to 20 CFR 404 after this date.

  • 2014-05-01; vol. 79 # 84 - Thursday, May 1, 2014
    1. 79 FR 24634 - Revised Medical Criteria for Evaluating Neurological Disorders; Reopening of the Comment Period
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      SOCIAL SECURITY ADMINISTRATION
      Proposed rule; reopening of the comment period.
      The comment period for the notice of proposed rulemaking published on February 25, 2014 (79 FR 10636), is reopened. To ensure that your written comments are considered, we must receive them no later than June 2, 2014.
      20 CFR Part 404