Assess whether work-requirement hours are documentable (bef939)

SITUATION Issuance file-control totals that will not balance arrived with a provider billing full-time care during school hours for disability continuing-eligibility reviewer. That is a Public Benefits Compliance and Integrity Operations decision on work-requirement hours are documentable in a disability unit facing a backlog of CDRs.

DECISION Disability continuing-eligibility reviewer in a disability unit facing a backlog of CDRs must choose Pay or continue / Recoup / Deny / Hold using issuance file-control totals that will not balance after a provider billing full-time care during school hours.

HYPOTHESES TO TEST 1. The population in issuance file-control totals that will not balance is the one a provider billing full-time care during school hours named, so Pay or continue follows for this Compliance and Integrity Operations file. 2. The population in issuance file-control totals that will not balance is adjacent only to a provider billing full-time care during school hours; Recoup is the honest Public Benefits call. 3. A disability unit facing a backlog of CDRs already contained a provider billing full-time care during school hours before issuance file-control totals that will not balance arrived; no new Compliance and Integrity Operations path. 4. Provenance on issuance file-control totals that will not balance after a provider billing full-time care during school hours is broken; do not pick Pay or continue or Recoup yet.

ANALYSIS REQUIRED 1. Quantify overpayment if work-requirement hours are documentable is wrong. 2. Separate a case-level error from a program-design failure in a disability unit facing a backlog of CDRs. 3. Match household facts in issuance file-control totals that will not balance to the rule that pays the benefit. 4. For this Public Benefits Compliance and Integrity Operations file, read issuance file-control totals that will not balance against a provider billing full-time care during school hours and write the one fact that would move work-requirement hours are documentable for disability continuing-eligibility reviewer.

RECOMMENDATION Choose Pay or continue / Recoup / Deny / Hold on this Public Benefits / Compliance and Integrity Operations packet (issuance file-control totals that will not balance after a provider billing full-time care during school hours). If issuance file-control totals that will not balance cannot force a Public Benefits label under Compliance and Integrity Operations, stop. If issuance file-control totals that will not balance after a provider billing full-time care during school hours 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.