Common use of VERIFICATION PROCEDURES AND OPPORTUNITY TO CONTEST FINDINGS Clause in Contracts

VERIFICATION PROCEDURES AND OPPORTUNITY TO CONTEST FINDINGS. The Privacy Act at 5 U.S.C. §552a(o)(1)(E) requires that each CMA outline procedures for verifying information produced in the matching program, as required by 5 U.S.C. §552a(p). This requires agencies to independently verify the information produced by a matching program and to provide the affected individual an opportunity to contest the agency's findings, before taking an adverse action against the individual, as a result of the match. A. Verification Procedures 1. CMS will provide USCIS with the following identifying information about an Applicant or Enrollee for the purpose of obtaining verification from USCIS of the Applicant’s or Enrollee’s immigration status or naturalized/derived citizenship: date of birth, last name, first name, and middle name, and Alien Registration Number, I-94 number, and/or other identifiers as described in Section IV of this Agreement, as applicable. 2. If USCIS cannot verify immigration status on initial electronic verification (i.e., first step verification), the AE will be prompted to institute additional verification, at which time the AE may submit the case for second step verification or may upload an electronic copy of the Applicant's or Enrollee’s immigration document if done in accordance with the rules applicable to the AE for which the request is being made. If USCIS cannot verify immigration status on additional verification, the AE will be prompted to submit the verification request for third level verification. If third level verification is required, the AE will facilitate the transfer of the Applicant's or Enrollee's immigration documentation to USCIS. The SAVE Program requires copies of immigration documentation in order to conduct third-level verification. The AE must submit such documentation electronically. Submission of paper documentation by mail as an attachment to Form G-845 is no longer a submission option. 3. If an AE is unable to comply with the prompts through the Hub, the AE may implement an approved alternative verification method to verify documents that demonstrate the Applicants' or Enrollee’s immigration status. Alternative verification methods should use the AE's independent SAVE access methods to verify immigration and naturalized or derived citizenship status. Alternative access methods that do not use SAVE as an access method to verify immigration and naturalized or derived citizenship status cannot be considered to have received a determination from DHS as to whether the Applicant's information is consistent with information in DHS records. CMS agrees to provide USCIS with written descriptions of any alternative verification procedures, as appropriate, used by AEs. 4. CMS and AEs may not deny an application based on a verification response that fails to verify applicant information with USCIS records unless the AE completes all SAVE prompts returned to the Hub, including submitting the verification request for additional verification or resubmitting the case when prompted by SAVE, or completes an alternate verification procedure. 5. CMS and AEs may not suspend, terminate, reduce, or make a final denial regarding the federal benefit program eligibility of an Applicant or Enrollee under the PPACA based upon a SAVE verification response status, or a response received through an approved alternative method, or take other adverse action against such individual as a result of information produced by the matching program, without first providing the Applicant or Enrollee the opportunity to provide additional information to verify their citizenship or immigration status in accordance with 45 CFR §155.315(f) or 42 CFR §§435.952 and 457.380. See the “additional verification procedures" described in the DHS-USCIS SAVE Program Guide, which procedures are incorporated into this Agreement by reference, including any subsequent amendments or revisions, to the extent that such procedures are consistent with applicable law. B. Opportunity to Contest Findings 1. CMS and AEs may not suspend, terminate, reduce, or make a final denial regarding federal benefit program eligibility of an Applicant or Enrollee, or take other adverse action against such individual as a result of information produced by this matching program, unless: (A) the individual has received notice from CMS containing a statement of the findings of the immigration status check; and (B) until the subsequent expiration of any notice period provided by such program's law or regulations. Such opportunity to contest may be satisfied by the notice, hearing, and appeal rights governing the federal benefit program if the Applicant has been provided the opportunity to refute any adverse status information as a result of the matching program. 2. Information created by CMS regarding any individual which becomes part of the ▇▇▇ system of records can be contested by contacting CMS. 3. Because CMS is not the owner of the USCIS records used for verification, information provided to CMS by USCIS cannot be contested by contacting CMS. An individual seeking to contest the content of USCIS information must contact USCIS or the record’s owner. CMS, in its role as operator of the FFE, will provide guidance to the individual concerning how to contest the content of information provided by DHS. C. Additional Verification and Contest Procedures Applicable to QHPs, APTC and CSRs

VERIFICATION PROCEDURES AND OPPORTUNITY TO CONTEST FINDINGS. The Privacy Act at 5 U.S.C. §Act’s subsection 552a(o)(1)(E) requires that each CMA outline procedures for verifying information produced in the matching program, as required by 5 U.S.C. §§ 552a(p). This subsection requires agencies to independently verify the information produced by a matching program and to provide the affected individual an opportunity to contest the agency's ’s findings, before taking an adverse action is taken against the individual, as a result of the match. A. Verification Procedures 1. CMS will provide USCIS with the following identifying information about an Applicant or Enrollee for the purpose of obtaining verification from USCIS of the Applicant’s or Enrollee’s immigration status or naturalized/derived citizenshipcitizenship verification: date of birth, last name, first name, and middle name, and Alien Registration Number, I-94 number, and/or or other identifiers as described defined in the Records Description in Section IV 4 of this Agreement, as applicable, of the Applicant or Enrollee seeking an Eligibility Determination. 2. If USCIS cannot verify immigration status on initial electronic verification (i.e., first step verification), the AE AEs will be prompted to institute additional verification, at which time the AE Administering Entity may submit the case for second step verification or may upload an electronic copy of the Applicant's or Enrolleeapplicant’s immigration document if done in accordance with the rules applicable to the AE for which the request is being made. If USCIS cannot verify immigration status on additional verification, the AE AEs will be prompted to submit the verification request for third level verification. If third level verification is required, the AE will facilitate the transfer of the Applicant's ’s or Enrollee's ’s immigration documentation to USCIS. The SAVE Program requires copies of immigration documentation in order to conduct third-level verification. The AE must submit such documentation electronically. Submission of paper documentation by mail as an attachment to Form G-845 is no longer a submission option, unless USCIS expressly requests submission in that format. 3. If an AE is unable to comply with the prompts through the Hub, the AE may implement an approved alternative verification method to verify documents that demonstrate the Applicants' or Enrollee’s applicants’ immigration status. Alternative verification methods should use the AE's ’s independent SAVE access methods to verify immigration and naturalized or derived citizenship status. Alternative access methods that do not use SAVE as an access method to verify immigration and naturalized or derived citizenship status cannot be considered to have received a determination from DHS as to whether the Applicant's applicant’s information is consistent with information in DHS records. CMS agrees to provide USCIS with written descriptions of any alternative verification procedures, as appropriate, used by AEs. 4. CMS and AEs may not to deny an application covered under this Agreement based on a verification response that fails upon the failure to verify applicant information with USCIS DHS records unless the an AE completes all SAVE prompts returned to the Hub, including submitting the verification request for additional verification or resubmitting the case when prompted by SAVE, or completes an alternate verification procedure. 5. CMS and AEs may not suspend, terminate, reduce, or make a final denial regarding the federal Federal benefit program eligibility of an Applicant or Enrollee Applicant/recipient under the PPACA ACA based upon a SAVE verification response status, or a response received through an approved alternative method, or take other adverse action against such individual as a result of information produced by the matching programMatching Program, without first providing the Applicant or Enrollee the opportunity to provide additional information to verify their citizenship or immigration status in accordance with 45 CFR §§ 155.315(f) or 42 CFR §§§ 435.952 and 457.380. See the Please see DHS-USCIS’ “additional verification procedures" ” as described in the DHS-USCIS its SAVE Program Guide, which procedures are is incorporated into this Agreement by reference, including any subsequent amendments or revisions, to the extent revisions provided that such additional verification procedures are consistent with applicable law. B. Opportunity to Contest Findings 16. Furthermore, CMS and AEs may not suspend, terminate, reduce, or make a final denial regarding federal the Federal benefit program eligibility of an Applicant or Enrolleeany individual described in the preceding paragraph, or take other adverse action against such individual as a result of information produced by this matching program, Matching Program unless: (A) the such individual has received notice from CMS containing a statement of the findings of the immigration status check; and (B) until the subsequent expiration of any notice period provided by such program's ’s law or regulations. Such opportunity to contest may be satisfied by the notice, hearing, and appeal rights governing the federal Federal benefit program if the Applicant applicant has been provided the opportunity to refute any adverse status information as a result of the matching programverification query. 27. Information created by CMS regarding any individual which becomes part of the ▇▇▇ system System of records Records can be contested by contacting CMS. 38. Because CMS is not the owner of the USCIS records used for verificationrecord, any information provided to CMS by USCIS DHS cannot be contested by contacting CMS. An individual seeking to contest the content of USCIS information must DHS provided for matching purposes should contact USCIS or the record’s ownerrelevant Party. CMS, in its role as operator of the Federally-facilitated Exchange (FFE), will provide guidance to the individual concerning how to contest the content of information provided by DHS. C. Additional Verification and Contest Procedures Applicable to QHPsB. Enrollment in a QHP through an Exchange, APTC and CSR 1. An Exchange will verify citizenship and immigration status in accordance with 45 CFR § 155.315(c). Pursuant to the verification process in 45 CFR § 155.315, the Exchange will provide notice to and an opportunity to resolve the inconsistency for the Applicant or Enrollee if there is an inconsistency between the Applicant/Enrollee’s attestation and the information provided by DHS/USCIS under this Agreement through the Hub in connection with Eligibility Determinations and Redeterminations for APTCs and CSRs. See also section 1411(e)(3)-(4) of the ACA. The Applicant/Enrollee will have 90 days from the date of notice of the inconsistency to resolve the inconsistency or to present satisfactory documentary evidence to the agency. 45 CFR § 155.315(f). 2. In addition, an Exchange will provide notice of appeals procedures with a notice of Eligibility Determination and Redetermination pursuant to 45 CFR §§ 155.230 and 155.355. An Applicant or Enrollee will be provided the opportunity to appeal denials of eligibility for APTCs and CSRs based upon contested determinations of citizenship or immigration status pursuant to section 1411(f)(1) of the ACA.