Removal of Alternate Participant Program, 62455-62463 [2018-26231]

Agencies

• Social Security Administration

[Federal Register Volume 83, Number 233 (Tuesday, December 4, 2018)]
[Rules and Regulations]
[Pages 62455-62463]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2018-26231]


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SOCIAL SECURITY ADMINISTRATION

20 CFR Parts 404, 411 and 416

[Docket No. SSA-2017-0071]
RIN 0960-AI24


Removal of Alternate Participant Program

AGENCY: Social Security Administration.

ACTION: Final rule.

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SUMMARY: We are removing from the Code of Federal Regulations (CFR) our 
``Alternate Participant Program'' rules because they are obsolete. We 
are removing these rules in accordance with the requirements of 
Executive Order (E.O.) 13777.

DATES: Effective Date: December 4, 2018.

FOR FURTHER INFORMATION CONTACT: Cara Caplan, Social Security 
Administration, 6401 Security Boulevard, Baltimore, MD 21235-6401, 410-
966-0586. For information on eligibility or filing for benefits, call 
our national toll-free number, 1-800-772-1213 or TTY 1-800-325-0778, or 
visit our internet site, Social Security Online, at https://www.socialsecurity.gov.

SUPPLEMENTARY INFORMATION: We are removing our Alternate Participant 
Program rules in accordance with E.O. 13777 (``Enforcing the Regulatory 
Reform Agenda'').\1\ The E.O. requires agencies to identify rules that, 
among other things, are outdated or unnecessary, and repeal, replace, 
or modify them, consistent with applicable law. These rules, found in 
20 CFR Chapter III Part 411, Subpart J, describe how the Alternate 
Participant Program was affected by the Ticket to Work and Self-
Sufficiency Program (Ticket Program),\2\ and procedures related to 
phasing it out.
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    \1\ 82 FR 12285 (March 1, 2017).
    \2\ 66 FR 67369 (December 28, 2001).
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    Under the Social Security Act (Act), the Commissioner of Social 
Security is authorized to reimburse States for reasonable and necessary 
costs of vocational rehabilitation (VR) services furnished to certain 
disabled individuals under a State VR plan that meets specific 
requirements.\3\ If a State is unwilling to participate or does not 
have a plan meeting the specified requirements, we can enter into 
agreements or contracts with alternative VR service providers under the 
same conditions that apply to a State VR agency.\4\ In 1994, we created 
the Alternate Participant Program, which was intended to provide more 
VR service options to beneficiaries.\5\ These alternate VR service 
providers, referred to as ``alternate participants,'' could be 
organizations, institutions, individuals, or other public or private 
agencies.
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    \3\ Section 222(d)(1) of the Act, 42 U.S.C. 422(d)(1).
    \4\ Section 222(d)(2) of the Act, 42 U.S.C. 422(d)(2).
    \5\ 59 FR 11899 (March 15, 1994).
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    Our procedures changed when we published final rules implementing 
the Ticket Program \6\ in 2001. The Ticket Program, authorized by the 
Ticket to Work and Work Incentives Improvement Act of 1999 (TWWIIA),\7\ 
expanded the universe of service providers available to beneficiaries 
with disabilities who are seeking employment services, VR services, and 
other support services. Under the Ticket Program, beneficiaries have 
the option of obtaining services from providers known as employment 
networks (ENs). As we implemented the Ticket Program and began using 
ENs, we phased out the use of alternate participants, as authorized by 
section 101(d)(5) of the TWWIIA.\8\
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    \6\ 66 FR 67369 (December 28, 2001).
    \7\ Public Law 106-170, 113 Stat. 1860.
    \8\ Section 105(d)(5) of Public Law 106-170, 113 Stat. 1860, 
1877.
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    Under current rules, we cannot pay an alternate participant for 
services provided after December 31, 2003. There are no outstanding 
Alternate Participant Program payments and no entity could become 
eligible for these payments in the future. Because we no longer use the 
Alternate Participant Program, the rules associated with that program 
are obsolete and no longer necessary. In alignment with this rule 
removal, we are also removing references to the program found in 
Subparts A and E of 20 CFR part 411, sections in Subparts A and V of 20 
CFR part 404, and sections in Subpart A and V of 20 CFR part 416.

Regulatory Procedures

Justification for Issuing a Final Rule Without Notice and Comment

    We follow the Administrative Procedure Act (APA) rulemaking 
procedures specified in 5 U.S.C. 553 when we develop regulations. 
Generally, the APA requires that an agency provide prior notice and 
opportunity for public comment before issuing a final rule. The APA 
provides exceptions to its notice and public comment procedures when an 
agency finds there is good cause for dispensing with such procedures 
because they are impracticable, unnecessary, or contrary to the public 
interest.
    We find that there is good cause under 5 U.S.C. 553(b)(B) to issue 
this regulatory change as a final rule without prior notice or public 
comment. We find that prior notice and public comment are unnecessary 
because this final rule only removes from the CFR obsolete and 
unnecessary rules that do not affect any current beneficiaries.
    In addition, we find good cause for dispensing with the 30-day 
delay in the effective date of this rule provided for in 5 U.S.C. 
553(d)(3). For the reasons stated above, we find it unnecessary to 
delay the effective date of the changes we are making in this final 
rule. Accordingly, we are making them effective upon publication.

Executive Order 12866 as Supplemented by Executive Order 13563

    We consulted with the Office of Management and Budget (OMB) and 
determined that this final rule does not meet the criteria for a 
significant regulatory action under E.O. 12866, as supplemented by E.O. 
13563. Thus, OMB did not review the final rule.

Executive Order 13132 (Federalism)

    We analyzed this final rule in accordance with the principles and 
criteria established by Executive Order 13132 and determined that the 
rule will not have sufficient Federalism implications to warrant the 
preparation of a Federalism assessment. We also determined that this 
rule will not preempt any State law or State regulation or affect the 
States' abilities to discharge traditional State governmental 
functions.

E.O. 13771

    This regulation codifies legislative changes that already took 
place. Accordingly, the regulation does not have any financial impact 
on the public, and as such is an exempt regulatory action under E.O. 
13771.

Regulatory Flexibility Act

    We certify that this final rule will not have a significant 
economic impact on a substantial number of small entities because there 
are no current participants of the Alternate Participant Program. 
Therefore, the Regulatory Flexibility Act, as amended, does not require 
us to prepare a regulatory flexibility analysis.

[[Page 62456]]

Paperwork Reduction Act

    This rule does not create any new or affect any existing 
collections and, therefore, does not require Office of Management and 
Budget approval under the Paperwork Reduction Act.

(Catalog of Federal Domestic Assistance Program Social Security--
Retirement Insurance; and 96.004, Social Security--Survivors 
Insurance)

List of Subjects

 20 CFR Part 404

    Administrative practice and procedure, Blind, Disability benefits, 
Old-age, Survivors, and Disability Insurance, Reporting and 
recordkeeping requirements, Social Security.

20 CFR Part 411

    Administrative practice and procedure, Blind, Disability benefits, 
Public assistance programs, Reporting and recordkeeping requirements, 
Social Security, Supplemental Security Income (SSI), Vocational 
rehabilitation.

20 CFR Part 416

    Administrative practice and procedure, Alcoholism, Drug abuse, 
Investigations, Medicaid, Penalties, Reporting and recordkeeping 
requirements, Social Security, Supplemental Security Income (SSI), 
Travel and transportation expenses, Vocational rehabilitation.

Nancy A. Berryhill,
Acting Commissioner of Social Security.

    For the reasons set out in the preamble, we amend 20 CFR parts 404, 
411, and 416 as set forth below:

PART 404--FEDERAL OLD AGE, SURVIVORS AND DISABILITY INSURANCE 
(1950- )

Subpart A--Introduction, General Provisions and Definitions

0
1. The authority citation for subpart A of part 404 continues to read 
as follows:

    Authority: Secs. 203, 205(a), 216(j), and 702(a)(5) of the 
Social Security Act (42 U.S.C. 403, 405(a), 416(j), and 902(a)(5)) 
and 48 U.S.C. 1801.


0
2. Amend Sec.  404.1 by revising paragraph (v) to read as follows:


Sec.  404.1  Introduction

* * * * *
    (v) Subpart V relates to payments to State vocational 
rehabilitative agencies for vocational rehabilitation services.

Subpart V--Payments for Vocational Rehabilitation Services

0
3. The authority citation for subpart V of part 404 continues to read 
as follows:

     Authority: Secs. 205(a), 222, and 702(a)(5) of the Social 
Security Act (42 U.S.C. 405(a), 422, and 902(a)(5)).


0
4. Amend Sec.  404.2102 as follows:
0
a. Remove and reserve paragraphs (c) and (j);
0
b. Revise the introductory text and paragraphs (b), (d), (f), and (k).
    The revisions read as follows:


Sec.  404.2102   Purpose and scope.

    This subpart describes the rules under which the Commissioner will 
pay the State VR agencies for VR services. Payment will be provided for 
VR services provided on behalf of disabled individuals under one or 
more of the provisions discussed in Sec.  404.2101.
* * * * *
    (b) Section 404.2104 explains how State VR agencies may participate 
in the payment program under this subpart.
    (c) [Reserved]
    (d) Sections 404.2108 through 404.2109 describe the requirements 
and conditions under which we will pay a State VR agency under this 
subpart.
* * * * *
    (f) Section 404.2112 describes when payment will be made to a VR 
agency because an individual's disability benefits are continued based 
on his or her participation in a VR program which we have determined 
will increase the likelihood that he or she will not return to the 
disability rolls.
* * * * *
    (j) [Reserved]
    (k) Section 404.2119 describes how we will make payment to State VR 
agencies for rehabilitation services.
* * * * *


Sec.  404.2103  [Amended]

0
5. Amend Sec.  404.2103 by removing the definition of Alternate 
participants.

0
6. Amend Sec.  404.2104 as follows:
0
a. Remove paragraphs (b)(3) and (f);
0
b. Remove and reserve paragraph (e)(2); and
0
c. Revise the heading of the section and paragraphs (a), (b)(2), 
(c)(2), and (e)(3).
    The revisions read as follows:


Sec.  404.2104   Participation by State VR agencies.

    (a) General. In order to participate in the payment program under 
this subpart through its VR agency(ies), a State must have a plan which 
meets the requirements of title I of the Rehabilitation Act of 1973, as 
amended.
    (b) * * *
    (2) A State with one or more approved VR agencies may choose to 
limit participation of those agencies to a certain class(es) of 
disability beneficiaries. For example, a State with separate VR 
agencies for the blind and disabled may choose to limit participation 
to the VR agency for the blind. In such a case, we would give the 
State, through its VR agency for the blind, the opportunity to 
participate with respect to blind disability beneficiaries in the State 
in accordance with paragraph (d) of this section. A State that chooses 
to limit participation of its VR agency(ies) must notify us in advance 
under paragraph (e)(1) of this section of its decision to limit such 
participation.
* * * * *
    (c) * * *
    (2)(i) In order for the State to participate with respect to a 
disability beneficiary whom we referred to a State VR agency, the State 
VR agency must notify the appropriate Regional Commissioner (SSA) in 
writing or through electronic notification of its decision either to 
accept the beneficiary as a client for VR services or to place the 
beneficiary into an extended evaluation process. The notice must be 
received by the appropriate Regional Commissioner (SSA) no later than 
the close of the fourth month following the month in which we referred 
the beneficiary to the State VR agency.
    (ii) In any case in which a State VR agency notifies the 
appropriate Regional Commissioner (SSA) in writing within the stated 
time period under paragraph (c)(2)(i) of this section of its decision 
to place the beneficiary into an extended evaluation process, the State 
VR agency also must notify that Regional Commissioner in writing upon 
completion of the evaluation of its decision whether or not to accept 
the beneficiary as a client for VR services. If we receive a notice of 
a decision by the State VR agency to accept the beneficiary as a client 
for VR services following the completion of the extended evaluation, 
the State may continue to participate with respect to such beneficiary.
* * * * *
    (e) * * *
    (2) [Reserved]
    (3) A State which has decided not to participate or to limit 
participation may participate later through its VR agency(ies) in 
accordance with paragraph (c) of this section. A State which decides to 
resume participation under paragraph (c) of this section must provide 
advance written notice of that

[[Page 62457]]

decision to the appropriate Regional Commissioner (SSA). A decision of 
a State to resume participation under paragraph (c) of this section 
will be effective beginning with the third month following the month in 
which the notice of the decision is received by the appropriate 
Regional Commissioner (SSA) or, if later, with a month specified by the 
State. The notice of the State decision must be submitted by an 
official authorized to act for the State as explained in paragraph 
(e)(1) of this section.
* * * * *


Sec.  404.2106  [Removed and Reserved]

0
7. Remove and reserve Sec.  404.2106.

0
8. Amend Sec.  404.2108 by revising paragraphs (a), (d), and (f) to 
read as follows:


Sec.  404.2108  Requirements for payment.

    (a) The State VR agency must file a claim for payment in each 
individual case within the time periods specified in Sec.  404.2116;
* * * * *
    (d) The VR services for which payment is being requested must have 
been provided under a State plan for VR services approved under title I 
of the Rehabilitation Act of 1973, as amended, and must be services 
that are described in Sec.  404.2114;
* * * * *
    (f) The State VR agency must maintain, and provide as we may 
require, adequate documentation of all services and costs for all 
disability beneficiaries with respect to whom a State VR agency could 
potentially request payment for services and costs under this subpart; 
and
* * * * *

0
9. Amend Sec.  404.2111 by revising the introductory text and 
paragraphs (b)(1)(i) and (b)(2) to read as follows:


Sec.  404.2111   Criteria for determining when VR services will be 
considered to have contributed to a continuous period of 9 months.

    The State VR agency may be paid for VR services if such services 
contribute to the individual's performance of a continuous 9-month 
period of SGA. The following criteria apply to individuals who received 
more than just evaluation services. If a State VR agency claims payment 
for services to an individual who received only evaluation services, it 
must establish that the individual's continuous period or medical 
recovery (if medical recovery occurred before completion of a 
continuous period) would not have occurred without the services 
provided. In applying the criteria below, we will consider services 
described in Sec.  404.2114 that were initiated, coordinated or 
provided, including services before October 1, 1981.
* * * * *
    (b) * * *
    (1) * * *
    (i) The individualized written rehabilitation program (IWRP) 
included medical services; and
* * * * *
    (2) In some instances, the State VR agency will not have provided, 
initiated, or coordinated medical services. If this happens, payment 
for VR services may still be possible under paragraph (a) of this 
section if:
    (i) The medical recovery was not expected by us; and
    (ii) The individual's impairment is determined by us to be of such 
a nature that any medical services provided would not ordinarily have 
resulted in, or contributed to, the medical cessation.

0
10. Revise Sec.  404.2112 to read as follows:


Sec.  404.2112   Payment for VR services in a case where an individual 
continues to receive disability payments based on participation in an 
approved VR program.

    Sections 404.1586(g), 404.316(c), 404.337(c), and 404.352(c) 
explain the criteria we will use in determining if an individual whose 
disability has ceased should continue to receive disability benefits 
from us because of his or her continued participation in a VR program. 
A VR agency can be paid for the cost of VR services provided to an 
individual if the individual was receiving benefits in a month or 
months, after October 1984, based on Sec.  404.316(c), Sec.  
404.337(c), or Sec.  404.352(c). If this requirement is met, a VR 
agency can be paid for the costs of VR services provided within the 
period specified in Sec.  404.2115, subject to the other payment and 
administrative provisions of this subpart.

0
11. Amend Sec.  404.2114 by revising paragraphs (a) introductory text, 
(a)(2), and (b)(4) to read as follows:


Sec.  404.2114   Services for which payment may be made.

    (a) General. Payment may be made for VR services provided by a 
State VR agency in accordance with title I of the Rehabilitation Act of 
1973, as amended, subject to the limitations and conditions in this 
subpart. VR services for which payment may be made under this subpart 
include only those services described in paragraph (b) of this section 
which are--
* * * * *
    (2) Provided by a State VR agency under an IWRP, but only if the 
services could reasonably be expected to motivate or assist the 
individual in returning to, or continuing in, SGA.
    (b) * * *
    (4) Vocational and other training services, including personal and 
vocational adjustment, books, tools, and other training materials, 
except that training or training services in institutions of higher 
education will be covered under this section only if maximum efforts 
have been made by the State VR agency to secure grant assistance in 
whole or in part from other sources;
* * * * *

0
12. Amend Sec.  404.2115 by revising paragraphs (a) introductory text 
and (b) to read as follows:


Sec.  404.2115   When services must have been provided.

    (a) In order for the VR agency to be paid, the services must have 
been provided--
* * * * *
    (b) If an individual who is entitled to disability benefits under 
this part also is or has been receiving disability or blindness 
benefits under part 416 of this chapter, the determination as to when 
services must have been provided may be made under this section or 
Sec.  416.2215 of this chapter, whichever is advantageous to the State 
VR agency that is participating in both VR programs.

0
13. Amend Sec.  404.2116 by revising the introductory text and 
paragraphs (b)(1) and (b)(2) to read as follows:


Sec.  404.2116   When claims for payment for VR services must be made 
(filing deadlines).

    The State VR agency must file a claim for payment in each 
individual case within the following time periods:
* * * * *
    (b) * * *
    (1) If a written notice requesting that a claim be filed was sent 
to the State VR agency, a claim must be filed within 90 days following 
the month in which VR services end, or if later, within 90 days after 
receipt of the notice.
    (2) If no written notice was sent to the State VR agency, a claim 
must be filed within 12 months after the month in which VR services 
end.

0
14. Amend Sec.  404.2117 by revising the introductory text and 
paragraphs (a), (b), (c)(1) introductory text, (c)(2), (d), and (e) to 
read as follows:


Sec.  404.2117   What costs will be paid.

    In accordance with section 222(d) of the Social Security Act, the

[[Page 62458]]

Commissioner will pay the State VR agency for the VR services described 
in Sec.  404.2114 which were provided during the period described in 
Sec.  404.2115 and which meet the criteria in Sec.  404.2111 or Sec.  
404.2112, but subject to the following limitations:
    (a) The cost must have been incurred by the State VR agency;
    (b) The cost must not have been paid or be payable from some other 
source. For this purpose, State VR agencies will be required to seek 
payment or services from other sources in accordance with the ``similar 
benefit'' provisions under 34 CFR part 361, including making maximum 
efforts to secure grant assistance in whole or part from other sources 
for training or training services in institutions of higher education.
    (c)(1) The cost must be reasonable and necessary, in that it 
complies with the written cost-containment policies of the State VR 
agency. A cost which complies with these policies will be considered 
necessary only if the cost is for a VR service described in Sec.  
404.2114. The State VR agency must maintain and use these cost-
containment policies, including any reasonable and appropriate fee 
schedules, to govern the costs incurred for all VR services, including 
the rates of payment for all purchased services, for which payment will 
be requested under this subpart. For the purpose of this subpart, the 
written cost-containment policies must provide guidelines designed to 
ensure--
* * * * *
    (2) The State VR agency shall submit to us before the end of the 
first calendar quarter of each year a written statement certifying that 
cost-containment policies are in effect and are adhered to in procuring 
and providing goods and services for which the State VR agency requests 
payment under this subpart. Such certification must be signed by the 
State's chief financial official or the head of the VR agency. Each 
certification must specify the basis upon which it is made, e.g., a 
recent audit by an authorized State, Federal or private auditor (or 
other independent compliance review) and the date of such audit (or 
compliance review). We may request the State VR agency to submit to us 
a copy(ies) of its specific written cost-containment policies and 
procedures (e.g., any guidelines and fee schedules for a given year) if 
we determine that such additional information is necessary to ensure 
compliance with the requirements of this subpart. The State VR agency 
must provide such information when requested by us.
    (d) The total payment in each case, including any prior payments 
related to earlier continuous 9-month periods of SGA made under this 
subpart, must not be so high as to preclude a ``net saving'' to the 
trust funds (a ``net saving'' is the difference between the estimated 
saving to the trust funds, if disability benefits eventually terminate, 
and the total amount we pay to the State VR agency);
    (e) Any payment to the State VR agency for either direct or 
indirect VR expenses must be consistent with the cost principles 
described in OMB Circular No. A-87, as revised;
* * * * *


Sec.  404.2118  [Removed and Reserved]

0
15. Remove and reserve Sec.  404.2118.

0
16. Revise Sec.  404.2119 to read as follows:


Sec.  404.2119   Method of payment.

    Payment to the State VR agencies pursuant to this subpart will be 
made either by advancement of funds or by payment for services provided 
(with necessary adjustments for any overpayments and underpayments), as 
decided by the Commissioner.

0
17. Revise Sec.  404.2120 to read as follows:


Sec.  404.2120   Audits.

    (a) General. The State shall permit us and the Comptroller General 
of the United States (including duly authorized representatives) access 
to and the right to examine records relating to the services and costs 
for which payment was requested or made under these regulations. These 
records shall be retained by the State for the periods of time 
specified for retention of records in the Federal Acquisition 
Regulations (48 CFR part 4, subpart 4.7).
    (b) Audit basis. Auditing will be based on cost principles and 
written guidelines in effect at the time services were provided and 
costs were incurred. The State VR agency will be informed and given a 
full explanation of any questioned items. It will be given a reasonable 
time to explain questioned items. Any explanation furnished by the 
State VR agency will be given full consideration before a final 
determination is made on questioned items in the audit report.
    (c) Appeal of audit determinations. The appropriate SSA Regional 
Commissioner will notify the State VR agency in writing of his or her 
final determination on the audit report. If the State VR agency 
disagrees with that determination, it may request reconsideration in 
writing within 60 days after receiving the Regional Commissioner's 
notice of the determination. The Commissioner will make a determination 
and notify the State VR agency of that decision in writing, usually, no 
later than 45 days from the date of appeal. The decision by the 
Commissioner will be final and conclusive unless the State VR agency 
appeals that decision in writing in accordance with 45 CFR part 16 to 
the Department of Health and Human Services' Departmental Appeals Board 
within 30 days after receiving it.

0
18. Amend Sec.  404.2121 by revising paragraphs (a), (b)(3), (c), and 
(d) to read as follows:


Sec.  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. 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, 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 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 Sec.  
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 Sec.  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 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) * * *
    (3) To assess the need for additional validation reviews or 
additional documentation requirements for any State VR agency to ensure 
compliance

[[Page 62459]]

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 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 that we will make the 
appropriate adjustment.
    (d) Appeals. If the State VR agency disagrees with our 
determination under this section, it may appeal that determination in 
accordance with Sec.  404.2127. For purposes of this section, an appeal 
must be filed within 60 days after receiving the notice of our 
determination.

0
19. Revise Sec.  404.2122 to read as follows:


Sec.  404.2122   Confidentiality of information and records.

    The State shall comply with the provisions for confidentiality of 
information, including the security of systems, and records 
requirements described in 20 CFR part 401 and pertinent written 
guidelines (see Sec.  404.2123).

0
20. Revise Sec.  404.2123 to read as follows:


Sec.  404.2123   Other Federal laws and regulations.

    Each State VR agency shall comply with the provisions of other 
Federal laws and regulations that directly affect its responsibilities 
in carrying out the vocational rehabilitation function.

0
21. Amend Sec.  404.2127 by revising paragraphs (a) and (c) to read as 
follows:


Sec.  404.2127   Resolution of disputes.

    (a) Disputes on the amount to be paid. The appropriate SSA official 
will notify the State VR agency in writing of his or her determination 
concerning the amount to be paid. If the State VR agency disagrees with 
that determination, the State VR agency may request reconsideration in 
writing within 60 days after receiving the notice of determination. The 
Commissioner will make a determination and notify the State VR agency 
of that decision in writing, usually no later than 45 days from the 
date of the State VR agency's appeal. The decision by the Commissioner 
will be final and conclusive upon the State VR agency unless the State 
VR agency appeals that decision in writing in accordance with 45 CFR 
part 16 to the Department of Health and Human Services' Departmental 
Appeals Board within 30 days after receiving the Commissioner's 
decision.
* * * * *
    (c) Disputes on determinations made by the Commissioner which 
affect a disability beneficiary's rights to benefits. Determinations 
made by the Commissioner which affect an individual's right to benefits 
(e.g., determinations that disability benefits should be terminated, 
denied, suspended, continued or begun at a different date than alleged) 
cannot be appealed by a State VR agency. Because these determinations 
are an integral part of the disability benefits claims process, they 
can only be appealed by the beneficiary or applicant whose rights are 
affected or by his or her authorized representative. However, if an 
appeal of an unfavorable determination is made by the individual and is 
successful, the new determination would also apply for purposes of this 
subpart. While a VR agency cannot appeal a determination made by the 
Commissioner which affects a beneficiary's or applicant's rights, the 
VR agency can furnish any evidence it may have which would support a 
revision of a determination.

PART 411--THE TICKET TO WORK AND SELF-SUFFICIENCY PROGRAM

0
22. The authority citation for part 411 continues to read as follows:

    Authority:  Secs. 702(a)(5) and 1148 of the Social Security Act 
(42 U.S.C. 902(a)(5) and 1320b-19); sec. 101(b)-(e), Public Law 106-
170, 113 Stat. 1860, 1873 (42 U.S.C. 1320b-19 note).

Subpart A--Introduction


Sec.  411.100  [Amended]

0
23. Amend Sec.  411.100 by removing paragraph (j).

0
24. Amend Sec.  411.115 by revising paragraph (f) to read as follows:


Sec.  411.115  Definitions of terms used in this part.

* * * * *
    (f) Employment plan means an individual work plan described in 
paragraph (i) of this section, or an individualized plan for employment 
described in paragraph (j) of this section.
* * * * *

Subpart E--Employment Networks


Sec.  411.305  [Amended]

0
25. Amend Sec.  411.305 by removing and reserving paragraph (d).

Subpart J--[Removed]

0
26. Remove subpart J, consisting of Sec. Sec.  411.700 through 411.730.

PART 416--SUPPLEMENTAL SECURITY INCOME FOR THE AGED, BLIND, AND 
DISABLED

Subpart A--Introduction, General Provisions and Definitions

0
27. The authority citation for subpart A of part 416 is revised to read 
as follows:

    Authority: Secs. 702(a)(5) and 1601-1635 of the Social Security 
Act (42 U.S.C. 902(a)(5) and 1381-1383d); sec. 212, Pub. L. 93-66, 
87 Stat. 155 (42 U.S.C. 1382 note); sec. 502(a), Pub. L. 94-241, 90 
Stat. 268 (48 U.S.C. 1681 note).


0
28. Amend Sec.  416.101 by revising paragraph (v) to read as follows:


Sec.  416.101  Introduction.

* * * * *
    (v) Subpart V of this part explains when payments are made to State 
vocational rehabilitation agencies for vocational rehabilitation 
services.

Subpart V--Payments for Vocational Rehabilitation Services

0
29. The authority citation for subpart V of part 416 continues to read 
as follows:

    Authority: Secs. 702(a)(5), 1615, 1631(d)(1) and (e), and 
1633(a) of the Social Security Act (42 U.S.C. 902(a)(5), 1382d, 
1383(d)(1) and (e), and 1383b(a)).


0
30. Amend Sec.  416.2201 introductory text to read as follows:


Sec.  416.2201  General.

    In general, sections 1615(d) and (e) of the Social Security Act 
(the Act) authorize payment from the general fund for the reasonable 
and necessary costs of vocational rehabilitation (VR) services provided 
certain disabled or blind individuals who are eligible for supplemental 
security income (SSI) benefits, special SSI eligibility status, or 
federally administered State supplementary payments. In this subpart, 
such benefits, status, or payments are referred to as disability or 
blindness benefits (see Sec.  416.2203). Subject to the provisions of 
this subpart, payment may be made for VR services provided an 
individual during a month(s) for which the individual is eligible for 
disability or blindness benefits, including the continuation of such 
benefits under section 1631(a)(6) of the Act, or for which the 
individual's disability or blindness benefits are suspended (see Sec.  
416.2215). Paragraphs (a) and (b) of this section describe the

[[Page 62460]]

cases in which the State VR agencies can be paid for the VR services 
provided such an individual under this subpart. The purpose of sections 
1615(d) and (e) of the Act is to make VR services more readily 
available to disabled or blind individuals and ensure that savings 
accrue to the general fund. Payment will be made for VR services 
provided on behalf of such an individual in cases where--
* * * * *

0
31. Amend Sec.  416.2202 as follows:
0
a. Remove and reserve paragraphs (c) and (j); and
0
b. Revise the introductory text and paragraphs (b), (d), (f), and (k).
    The revisions read as follows:


Sec.  416.2202  Purpose and scope.

    This subpart describes the rules under which the Commissioner will 
pay the State VR agencies for VR services. Payment will be provided for 
VR services provided on behalf of disabled or blind individuals under 
one or more of the provisions discussed in Sec.  416.2201.
* * * * *
    (b) Section 416.2204 explains how State VR agencies may participate 
in the payment program under this subpart.
    (c) [Reserved]
    (d) Sections 416.2208 through 416.2209 describe the requirements 
and conditions under which we will pay a State VR agency under this 
subpart.
* * * * *
    (f) Section 416.2212 describes when payment will be made to a VR 
agency because an individual's disability or blindness benefits are 
continued based on his or her participation in a VR program which we 
have determined will increase the likelihood that he or she will not 
return to the disability rolls.
* * * * *
    (j) [Reserved]
    (k) Section 416.2219 describes how we will make payment to State VR 
agencies for rehabilitation services.
* * * * *


Sec.  416.2203  [Amended]

0
32. Amend Sec.  416.2203 by removing the definition of Alternate 
participants.

0
33. Amend Sec.  416.2204 as follows:
0
a. Remove paragraphs (b)(3) and (f);
0
b. Remove and reserve paragraph (e)(2);
0
c. Revise the heading of the section and paragraphs (a), (b)(2), 
(c)(2), and (e)(3).
    The revisions read as follows:


Sec.  416.2204  Participation by State VR agencies.

    (a) General. In order to participate in the payment program under 
this subpart through its VR agency(ies), a State must have a plan which 
meets the requirements of title I of the Rehabilitation Act of 1973, as 
amended.
    (b) * * *
    (2) A State with one or more approved VR agencies may choose to 
limit participation of those agencies to a certain class(es) of 
disabled or blind recipients. For example, a State with separate VR 
agencies for the blind and disabled may choose to limit participation 
to the VR agency for the blind. In such a case, we would give the 
State, through its VR agency for the blind, the opportunity to 
participate with respect to blind recipients in the State in accordance 
with paragraph (d) of this section. A State that chooses to limit 
participation of its VR agency(ies) must notify us in advance under 
paragraph (e)(1) of this section of its decision to limit such 
participation.
* * * * *
    (c) * * *
    (2)(i) In order for the State to participate with respect to a 
disabled or blind recipient whom we referred to a State VR agency, the 
State VR agency must notify the appropriate Regional Commissioner (SSA) 
in writing or through electronic notification of its decision either to 
accept the recipient as a client for VR services or to place the 
recipient into an extended evaluation process. The notice must be 
received by the appropriate Regional Commissioner (SSA) no later than 
the close of the fourth month following the month in which we referred 
the recipient to the State VR agency.
    (ii) In any case in which a State VR agency notifies the 
appropriate Regional Commissioner (SSA) in writing within the stated 
time period under paragraph (c)(2)(i) of this section of its decision 
to place the recipient into an extended evaluation process, the State 
VR agency also must notify that Regional Commissioner in writing upon 
completion of the evaluation of its decision whether or not to accept 
the recipient as a client for VR services. If we receive a notice of a 
decision by the State VR agency to accept the recipient as a client for 
VR services following the completion of the extended evaluation, the 
State may continue to participate with respect to such recipient.
* * * * *
    (e) * * *
    (2) [Reserved]
    (3) A State which has decided not to participate or to limit 
participation may participate later through its VR agency(ies) in 
accordance with paragraph (c) of this section. A State that decides to 
resume participation under paragraph (c) of this section must provide 
advance written notice of that decision to the appropriate Regional 
Commissioner (SSA). A decision of a State to resume participation under 
paragraph (c) of this section will be effective beginning with the 
third month following the month in which the notice of the decision is 
received by the appropriate Regional Commissioner (SSA) or, if later, 
with a month specified by the State. The notice of the State decision 
must be submitted by an official authorized to act for the State as 
explained in paragraph (e)(1) of this section.
* * * * *


Sec.  416.2206  [Removed and Reserved]

0
34. Remove and reserve Sec.  416.2206.

0
35. Amend Sec.  416.2208 by revising paragraphs (a), (d), and (f) as 
follows:


Sec.  416.2208  Requirements for payment.

    (a) The State VR agency must file a claim for payment in each 
individual case within the time periods specified in Sec.  416.2216;
* * * * *
    (d) The VR services for which payment is being requested must have 
been provided under a State plan for VR services approved under title I 
of the Rehabilitation Act of 1973, as amended, and must be services 
that are described in Sec.  416.2214;
* * * * *
    (f) The State VR agency must maintain, and provide as we may 
require, adequate documentation of all services and costs for all 
disabled or blind recipients with respect to whom a State VR agency 
could potentially request payment for services and costs under this 
subpart; and
* * * * *

0
36. Amend Sec.  416.2211 by revising the introductory text and 
paragraphs (b)(1)(i), and (b)(2) to read as follows:


Sec.  416.2211   Criteria for determining when VR services will be 
considered to have contributed to a continuous period of 9 months.

    The State VR agency may be paid for VR services if such services 
contribute to the individual's performance of a continuous 9-month 
period of SGA. The following criteria apply to individuals who received 
more than just evaluation services. If a State VR agency claims payment 
for services to an individual who received only evaluation services, it 
must establish that the individual's continuous period or medical 
recovery (if medical recovery occurred before completion of a 
continuous period) would not have occurred without the

[[Page 62461]]

services provided. In applying the criteria below, we will consider 
services described in Sec.  416.2214 that were initiated, coordinated 
or provided, including services before October 1, 1981.
* * * * *
    (b) * * *
    (1) * * *
    (i) The individualized written rehabilitation program (IWRP), 
included medical services; and
* * * * *
    (2) In some instances, the State VR agency will not have provided, 
initiated, or coordinated medical services. If this happens, payment 
for VR services may still be possible under paragraph (a) of this 
section if:
    (i) The medical recovery was not expected by us; and
    (ii) The individual's impairment is determined by us to be of such 
a nature that any medical services provided would not ordinarily have 
resulted in, or contributed to, the medical cessation.

0
37. Revise Sec.  416.2212 to read as follows:


Sec.  416.2212   Payment for VR services in a case where an individual 
continues to receive disability or blindness benefits based on 
participation in an approved VR program.

    Section 1631(a)(6) of the Act contains the criteria we will use in 
determining if an individual whose disability or blindness has ceased 
should continue to receive disability or blindness benefits because of 
his or her continued participation in an approved VR program. A VR 
agency can be paid for the cost of VR services provided to an 
individual if the individual was receiving benefits based on this 
provision in a month(s) after October 1984 or, in the case of a 
blindness recipient, in a month(s) after March 1988. If this 
requirement is met, a VR agency can be paid for the costs of VR 
services provided within the period specified in Sec.  416.2215, 
subject to the other payment and administrative provisions of this 
subpart.

0
38. Amend Sec.  416.2214 by revising paragraph (a) introductory text, 
(a)(2), and (b)(4) to read as follows:


Sec.  416.2214   Services for which payment may be made.

    (a) General. Payment may be made for VR services provided by a 
State VR agency in accordance with title I of the Rehabilitation Act of 
1973, as amended, subject to the limitations and conditions in this 
subpart. VR services for which payment may be made under this subpart 
include only those services described in paragraph (b) of this section 
which are--
* * * * *
    (2) Provided by a State VR agency under an IWRP, but only if the 
services could reasonably be expected to motivate or assist the 
individual in returning to, or continuing in, SGA.
    (b) * * *
    (4) Vocational and other training services, including personal and 
vocational adjustment, books, tools, and other training materials, 
except that training or training services in institutions of higher 
education will be covered under this section only if maximum efforts 
have been made by the State VR agency to secure grant assistance in 
whole or in part from other sources;
* * * * *

0
39. Amend Sec.  416.2215 by revising paragraphs (a) introductory text 
and (b) to read as follows:


Sec.  416.2215   When services must have been provided.

    (a) In order for the VR agency to be paid, the services must have 
been provided--
* * * * *
    (b) If an individual who is receiving disability or blindness 
benefits under this part, or whose benefits under this part are 
suspended, also is entitled to disability benefits under part 404 of 
this chapter, the determination as to when services must have been 
provided may be made under this section or Sec.  404.2115 of this 
chapter, whichever is advantageous to the State VR agency that is 
participating in both VR programs.

0
40. Amend Sec.  416.2216 by revising the introductory text and 
paragraphs (b)(1) and (b)(2) to read as follows:


Sec.  416.2216   When claims for payment for VR services must be made 
(filing deadlines).

    The State VR agency must file a claim for payment in each 
individual case within the following time periods:
* * * * *
    (b) * * *
    (1) If a written notice requesting that a claim be filed was sent 
to the State VR agency, a claim must be filed within 90 days following 
the month in which VR services end, or if later, within 90 days after 
receipt of the notice.
    (2) If no written notice was sent to the State VR agency, a claim 
must be filed within 12 months after the month in which VR services 
end.

0
41. Amend Sec.  416.2217 by revising the introductory text and 
paragraphs (a), (b), (c)(1) introductory text, (c)(2), (d), and (e) as 
follows:


Sec.  416.2217   What costs will be paid.

    In accordance with section 1615(d) and (e) of the Social Security 
Act, the Commissioner will pay the State VR agency for the VR services 
described in Sec.  416.2214 which were provided during the period 
described in Sec.  416.2215 and which meet the criteria in Sec.  
416.2211 or Sec.  416.2212, but subject to the following limitations:
    (a) The cost must have been incurred by the State VR agency;
    (b) The cost must not have been paid or be payable from some other 
source. For this purpose, State VR agencies will be required to seek 
payment or services from other sources in accordance with the ``similar 
benefit'' provisions under 34 CFR part 361, including making maximum 
efforts to secure grant assistance in whole or part from other sources 
for training or training services in institutions of higher education.
    (c)(1) The cost must be reasonable and necessary, in that it 
complies with the written cost-containment policies of the State VR 
agency. A cost which complies with these policies will be considered 
necessary only if the cost is for a VR service described in Sec.  
416.2214. The State VR agency must maintain and use these cost-
containment policies, including any reasonable and appropriate fee 
schedules, to govern the costs incurred for all VR services, including 
the rates of payment for all purchased services, for which payment will 
be requested under this subpart. For the purpose of this subpart, the 
written cost-containment policies must provide guidelines designed to 
ensure--
* * * * *
    (2) The State VR agency shall submit to us before the end of the 
first calendar quarter of each year a written statement certifying that 
cost-containment policies are in effect and are adhered to in procuring 
and providing goods and services for which the State VR agency requests 
payment under this subpart. Such certification must be signed by the 
State's chief financial official or the head of the VR agency. Each 
certification must specify the basis upon which it is made, e.g., a 
recent audit by an authorized State, Federal or private auditor (or 
other independent compliance review) and the date of such audit (or 
compliance review). We may request the State VR agency to submit to us 
a copy(ies) of its specific written cost-containment policies and 
procedures (e.g., any guidelines and fee schedules for a given year), 
if we determine that such additional information is necessary to ensure 
compliance with the requirements of this subpart. The State VR agency 
shall

[[Page 62462]]

provide such information when requested by us.
    (d) The total payment in each case, including any prior payments 
related to earlier continuous 9-month periods of SGA made under this 
subpart, must not be so high as to preclude a ``net saving'' to the 
general funds (a ``net saving'' is the difference between the estimated 
savings to the general fund, if payments for disability or blindness 
remain reduced or eventually terminate, and the total amount we pay to 
the State VR agency);
    (e) Any payment to the State VR agency for either direct or 
indirect VR expenses must be consistent with the cost principles 
described in OMB Circular No. A-87, as revised;
* * * * *


Sec.  416.2218  [Removed and Reserved]

0
42. Remove and reserve Sec.  416.2218.

0
43. Revise Sec.  416.2219 to read as follows:


Sec.  416.2219   Method of payment.

    Payment to the State VR agencies pursuant to this subpart will be 
made either by advancement of funds or by payment for services provided 
(with necessary adjustments for any overpayments and underpayments), as 
decided by the Commissioner.

0
44. Revise Sec.  416.2220 to read as follows:


Sec.  416.2220   Audits.

    (a) General. The State shall permit us and the Comptroller General 
of the United States (including duly authorized representatives) access 
to and the right to examine records relating to the services and costs 
for which payment was requested or made under these regulations. These 
records shall be retained by the State for the periods of time 
specified for retention of records in the Federal Acquisition 
Regulations (48 CFR part 4, subpart 4.7).
    (b) Audit basis. Auditing will be based on cost principles and 
written guidelines in effect at the time services were provided and 
costs were incurred. The State VR agency will be informed and given a 
full explanation of any questioned items. They will be given a 
reasonable time to explain questioned items. Any explanation furnished 
by the State VR agency will be given full consideration before a final 
determination is made on questioned items in the audit report.
    (c) Appeal of audit determinations. The appropriate SSA Regional 
Commissioner will notify the State VR agency in writing of his or her 
final determination on the audit report. If the State VR agency 
disagrees with that determination, it may request reconsideration in 
writing within 60 days after receiving the Regional Commissioner's 
notice of the determination. The Commissioner will make a determination 
and notify the State VR agency of that decision in writing, usually, no 
later than 45 days from the date of the appeal. The decision by the 
Commissioner will be final and conclusive unless the State VR agency 
appeals that decision in writing in accordance with 45 CFR part 16 to 
the Department of Health and Human Services' Departmental Appeals Board 
within 30 days after receiving it.

0
45. Amend Sec.  416.2221 by revising paragraphs (a), (b)(3), (c), and 
(d) to read as follows:


Sec.  416.2221   Validation reviews.

    (a) General. We will conduct a validation review of a sample of the 
claims for payment filed by each State VR agency. 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, 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 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 Sec.  
416.2201(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 Sec.  416.2201(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 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) * * *
    (3) To assess the need for additional validation reviews or 
additional documentation requirements for any State VR agency 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 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 that we will make the 
appropriate adjustment.
    (d) Appeals. If the State VR agency disagrees with our 
determination under this section, it may appeal that determination in 
accordance with Sec.  416.2227. For purposes of this section, an appeal 
must be filed within 60 days after receiving the notice of our 
determination.

0
46. Revise Sec.  416.2222 to read as follows:


Sec.  416.2222   Confidentiality of information and records.

    The State shall comply with the provisions for confidentiality of 
information, including the security of systems, and records 
requirements described in 20 CFR part 401 and pertinent written 
guidelines (see Sec.  416.2223).

0
47. Revise Sec.  416.2223 to read as follows:


Sec.  416.2223   Other Federal laws and regulations.

    Each State VR agency shall comply with the provisions of other 
Federal laws and regulations that directly affect its responsibilities 
in carrying out the vocational rehabilitation function.

0
48. Amend Sec.  416.2227 by revising paragraphs (a) and (c) to read as 
follows:


Sec.  416.2227   Resolution of disputes.

    (a) Disputes on the amount to be paid. The appropriate SSA official 
will notify the State VR agency in writing of his or her determination 
concerning the amount to be paid. If the State VR agency disagrees with 
that determination, the State VR agency may request reconsideration in 
writing within 60 days after receiving the notice of determination. The 
Commissioner will make a determination and notify the State VR agency 
of that decision in writing, usually, no later than 45 days

[[Page 62463]]

from the date of the State VR agency's appeal. The decision by the 
Commissioner will be final and conclusive upon the State VR agency 
unless the State VR agency appeals that decision in writing in 
accordance with 45 CFR part 16 to the Department of Health and Human 
Services' Departmental Appeals Board within 30 days after receiving the 
Commissioner's decision.
* * * * *
    (c) Disputes on determinations made by the Commissioner which 
affect a disabled or blind beneficiary's rights to benefits. 
Determinations made by the Commissioner which affect an individual's 
right to benefits (e.g., determinations that disability or blindness 
benefits should be terminated, denied, suspended, continued or begun at 
a different date than alleged) cannot be appealed by a State VR agency. 
Because these determinations are an integral part of the disability or 
blindness benefits claims process, they can only be appealed by the 
beneficiary or applicant whose rights are affected or by his or her 
authorized representative. However, if an appeal of an unfavorable 
determination is made by the individual and is successful, the new 
determination would also apply for purposes of this subpart. While a VR 
agency cannot appeal a determination made by the Commissioner which 
affects a beneficiary's or applicant's rights, the VR agency can 
furnish any evidence it may have which would support a revision of a 
determination.

[FR Doc. 2018-26231 Filed 12-3-18; 8:45 am]
 BILLING CODE 4191-02-P