Assess whether continuing disability review supports cessation (9c5220)

SITUATION A CDR where treating-source evidence conflicts with a CE put TANF work-hours that cannot be corroborated in front of disability continuing-eligibility reviewer in a disability unit facing a backlog of CDRs. This Public Benefits / Compliance and Integrity Operations close is continuing disability review supports from TANF work-hours that cannot be corroborated, and the live options are Pay or continue, Recoup, Deny.

DECISION Disability continuing-eligibility reviewer in a disability unit facing a backlog of CDRs must choose Pay or continue / Recoup / Deny / Hold using TANF work-hours that cannot be corroborated after a CDR where treating-source evidence conflicts with a CE.

HYPOTHESES TO TEST 1. TANF work-hours that cannot be corroborated reads as Pay or continue once a CDR where treating-source evidence conflicts with a CE is lined up to the same Public Benefits population. 2. TANF work-hours that cannot be corroborated is closer to Recoup after a CDR where treating-source evidence conflicts with a CE; Pay or continue would over-claim this Compliance and Integrity Operations extract. 3. Deny is still live in TANF work-hours that cannot be corroborated for disability continuing-eligibility reviewer in a disability unit facing a backlog of CDRs. 4. TANF work-hours that cannot be corroborated is missing the fact disability continuing-eligibility reviewer needs after a CDR where treating-source evidence conflicts with a CE; stop this Public Benefits close.

ANALYSIS REQUIRED 1. Test eligibility, recoupment, and improper-payment facts in TANF work-hours that cannot be corroborated after a CDR where treating-source evidence conflicts with a CE. 2. Quantify overpayment if continuing disability review supports is wrong. 3. Separate a case-level error from a program-design failure in a disability unit facing a backlog of CDRs. 4. For this Public Benefits Compliance and Integrity Operations file, read TANF work-hours that cannot be corroborated against a CDR where treating-source evidence conflicts with a CE and write the one fact that would move continuing disability review supports for disability continuing-eligibility reviewer.

RECOMMENDATION Choose Pay or continue / Recoup / Deny / Hold on this Public Benefits / Compliance and Integrity Operations packet (TANF work-hours that cannot be corroborated after a CDR where treating-source evidence conflicts with a CE). If TANF work-hours that cannot be corroborated cannot force a Public Benefits label under Compliance and Integrity Operations, stop. If TANF work-hours that cannot be corroborated after a CDR where treating-source evidence conflicts with a CE cannot support Pay or continue versus Recoup on this Public Benefits Compliance and Integrity Operations close, disability continuing-eligibility reviewer must do not pay, recoup, or deny beyond the eligibility record.