When OQR expects a new or revised policy or procedure to affect a large workload, e.g., when there has been a major revision to a widely applied listing(s), OQR excludes all grace period cases from adjudicating component's performance accuracy statistics and does not report them in the normal QA process. Instead, OQR tracks grace period cases separately and maintains separate data for these cases. OQR augments the initial QA sample, to replace the grace period cases, to maintain statistical precision in the reported accuracy rates of adjudicating components.

For additional information on sample augmentation, see GN 04440.123D.4.

A high-impact grace period case is any initial QA case in which a new or revised policy or procedure is a factor in the adjudication of the case, regardless of whether the case contains a deficiency.

To preclude distortion of performance accuracy data and prevent artificial inflation of adjudicating component's accuracy rates, OQR central office (CO) systems staff exclude all initial QA sample cases, that fall under a high-impact grace period, from adjudicating component's performance accuracy calculations. This exclusion applies to both deficient and non-deficient cases.

Since OQR excludes all high-impact grace period cases, regardless of whether they contain a deficiency, from adjudicating component's performance accuracy calculations, additional "non-grace period" sample cases are selected for quality review while a grace period is in effect. This means that a larger number of randomly chosen cases for the initial QA sample is selected from each adjudicating component. This number is approximately equal to the number of cases in each adjudicating component that involve a grace period issue. OQR does this to maintain the required statistical precision and validity of the initial QA sample, i.e., to ensure review of a sufficient number of cases.

For a detailed description of the two types of grace periods and how they are applied, see GN 04440.123D and GN 04440.123E.

When OQR does not expect a new or revised policy or procedure to affect a large workload, OQR does not exclude grace period cases from adjudicating component's performance accuracy statistics. However, OQR treats initial QA cases that fall under a grace period, and contain a group I deficiency, as deficiency-free cases with regard to performance accuracy calculations.

A low-impact grace period case is any initial QA case in which a new or revised policy or procedure is a factor in the adjudication of the case, regardless of whether the case contains a deficiency.

OQR establishes grace periods in consultation with the Office of Disability Programs.

The grace period for adjudicating components to implement use of new or revised policy or procedures, as provided in Program Operations Manual System (POMS) transmittals (TN) and emergency messages (EM), is two full calendar months after the effective date of the issuance. For example, if the POMS transmittal is effective 6/28, the grace period would continue through 8/31.

The date an adjudicating component disability examiner signs the SSA-831-C3/U3 (Disability Determination and Transmittal) determines when and whether the grace period applies.

Quality reviewers will review grace period cases in the usual manner, including obtaining medical or psychological contractor review, if applicable, and return deficient cases to the adjudicating component for corrective action.

High-impact grace period cases

If the grace period in effect is a high-impact grace period, the quality reviewer will enter the assigned grace period code in the "Grace Period" field on the QA Initial Allowance tab in OQR’s case processing system for any case that falls under the grace period, regardless of whether the case contains a deficiency, i.e., all initial QA sample cases in which the new or revised policy or procedure is a factor in the adjudication of the case. Quality reviewers will code group I or group II deficiencies, if applicable, in the usual manner in the "Med/Voc Deficiency" field under the QA Initial Allowance tab in OQR’s case processing system.

OQR CO systems staff remove all initial QA sample cases that are coded as grace period cases from the adjudicating component's accuracy computations, i.e., OQR CO systems staff remove all cases coded as grace period cases from the QA database.

Low-impact grace period cases

If the grace period in effect is a low-impact grace period, the quality reviewer will enter the assigned grace period code in the “Grace Period” field on the QA Initial Allowance tab in OQR’s case processing system only if there is a group I deficiency in the grace period case that is directly related to the new or revised policy or procedure.

Quality reviewers will code group I deficiencies in the usual manner in the “Med/Voc Deficiency” field under the QA Initial Allowance tab in OQR’s case processing system.

When a quality reviewer identifies a deficiency in a case, that is related to a new or revised policy or procedure covered by a grace period, the quality reviewer will cite the deficiency and return the deficient case to the adjudicating component for correction. The quality reviewer will annotate the SSA-1774-U5 (Request for Corrective Action) with either of the following remarks, depending on the type of grace period in effect:

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  High-Impact - Case Excluded From Performance Accuracy Calculations - Informational Only or

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  Low-Impact - Informational Only. Group I Deficiency Not Counted in Performance Accuracy Calculations.

NOTE: When a quality reviewer identifies a deficiency in a case, that is NOT related to a new or revised policy or procedure covered by a grace period, the quality reviewer will cite and record the deficiency following the standard quality review process.