SSA - POMS: DI 30007.155 - The Request for Program Consultation (RPC) Resolution and Post-Resolution Actions

A. Timeframe for issuing the RPC resolution

RPC’s goal is to issue a resolution within 14 calendar days of receipt of the DDS’s RPC submission. However, a variety of factors may affect this goal, including current caseloads, available staff, the size of the RPC case file, and whether there is a need for additional medical, vocational, or policy input.

B. The RPC resolution is SSA’s official response

The RPC resolution is the result of the three-member RPC panel discussion vote. The resolution is binding on both the DDS and the DQB involved. The components are required to take the actions identified in the RPC resolution.

The panel members base the decision to affirm or rescind a deficiency on whether the DDS’s development, documentation, and determination are reasonable in relation to program instructions. These are the same criteria discussed in Quality Review Process in QR 04440.008.

The DP RPC discussion panel member drafts the final RPC resolution document, sends it to RPC’s technical expert for editing and approval, and completes all remaining RPC tool screens.

Once approved, the DP RPC panel discussion member uploads the document into the RPC tool and submits the completed case for closure.

Upon closure, the RPC tool automatically emails notification to the involved DDS, DQB, and DC that the resolution is available online. The tool also automatically sends a copy of the resolution to the certified electronic folder, to become a part of the official claim file.

C. DDS actions after RPC resolution

If there are actions for the DDS, the DDS will immediately take the action(s) specified in the RPC resolution and finish processing the case. DDS will manage the case per their normal business processes.

D. DQB actions after RPC resolution

1.

If there are actions for the DQB, the DQB will immediately take the action(s) specified in the RPC resolution and finish processing the case. The DQB will manage the case per their normal business processes.
2.

The DQB will ensure that the DDS has completed all of the actions identified in the RPC resolution. If the corrected determination is not consistent with the RPC resolution and informal attempts to resolve the issue with the DDS are unsuccessful, DQB will email notification to RPC (include the RPC case number in the subject line) at “” to the attention of the Director.

E. Follow-up questions

Although the RPC resolution is final, components may submit questions to RPC for further clarification of an RPC resolution. Components should send follow-up questions to RPC (include the RPC case number in the subject line) using the mailbox “”

RPC will respond to the inquirer via email, cc’ing DA, QR and DC. RPC will also attach the question and response as an additional document to the case in the RPC Tool. In rare situations, a follow-up question indicates program instructions do not support the resolution. If this occurs, RPC will refer the case to the appropriate DP policy component for guidance. If the policy component determines that program instructions do not support the resolution, RPC will respond to the question, correct the RPC resolution in its response to the question and, if necessary, advise the DQB to reinstate or rescind the deficiency citation.

NOTE: RPC must receive follow-up question within 15 business days of the date of the RPC resolution.

F. RPC Audits

1. The DDS or the DQB identifies a case where they feel the other component has not completed all of the actions required by the resolution.

When this occurs, the DDS or the DQB may contact the other component to discuss and resolve the issue informally. If informal consultation does not resolve the issue, the DDS or the DQB may send an email to , (include the RPC case number in the subject line) cc’ing the DC, explaining the concern.

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An assigned RPC staff member reviews the resolution, the actions taken to date, and the issues presented in the audit request, to determine the need for any additional action.
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If, after reviewing the case, the RPC staff member determines all components completed all actions as directed, the RPC staff member will send a written explanation back to the originator of the audit request, explaining why the actions taken are sufficient.
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If the RPC staff member determines that not all actions identified in the resolution were completed, or the revised determination is incorrect, the RPC staff member emails either the DC or the DQB, cc’ing DA and QR on the message. The email will explain the facts of the case, the requirements of the resolution, and additional actions required. The RPC staff member will fax a copy of the email into the electronic folder using the RPC-DP document with annotation “RPC Audit”. The DC will work with the DDS to ensure they complete the additional actions.

2. RPC audits a case after resolution and finds the DQB needs to return the case to the DDS for additional corrective actions

The DQB will take the following actions:

a.

Prepare an informational Form SSA-1774 (Request for Corrective Action), or Form SSA-847 (Request for Case Action), instructing the DDS to refer to the “RPC Audit” document in the electronic folder for the necessary additional corrective action. If using an SSA-1774, annotate it “Informational Only—No Additional Deficiency Charged”;
b.

Return the case to the DDS; and
c.

Control the return.

3. RPC audits a case after resolution, and finds a party has not completed all actions identified in the resolution

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RPC will contact the DC or the DQB to discuss the case and the additional required action(s);
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RPC will instruct the DDS to reactivate the case and complete the necessary actions;
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RPC will instruct the DQB to return the case to the DDS to complete the necessary actions;
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RPC will monitor the case and ensure the necessary actions are completed.

Social Security

Program Operations Manual System (POMS)

DI 30007.155 The Request for Program Consultation (RPC) Resolution and Post-Resolution Actions