Quality review components must use the procedures outlined below when clarification of disability program or quality review policy is necessary, at any time, during the quality review process.

If policy and procedural guidelines or Program Operations Manual System (POMS) instructions do not clarify the disability program or quality review policy issue requiring resolution, quality review components must refer the case to the Division of Disability Quality (DDQ), in the Office of Quality Review (OQR), using the process described below.

NOTE: Under no circumstances should a quality review component submit policy issue referrals directly to the Office of Disability Policy (ODP) or any other central office component.

When a quality review component needs to request policy or procedure clarification, the quality review component will submit their question(s) using the Policy Clarification and Field Site Assistance Form located on the Office of Quality Review (OQR) Field Site Home SharePoint.

The information needed to submit a question includes:

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  the subject or topic of the question,

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  the primary requestor's contact information,

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  the type and level of the case associated with the question,

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  the social security number associated with the case,

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  the specific policy issue or question,

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  the proposed resolution, and

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  any applicable policy or procedure references.

Once a quality review component submits a question using the designated submission form, a notification e-mail will automatically be sent to the ^DCARO OQR Policy Questions mailbox.

The mailbox leads in DDQ will assign the question to a DDQ staff member(s) and change the status on the submission form to "Assigned".

NOTE: The individual designated as the "Primary Requestor", and all other individuals listed in the "Notify Other Users" field on the submission form, will receive automatic e-mail notifications upon initial submission of a question, when a question is referred to another component, and when the response to the question is completed by DDQ staff members.

For pending cases, the assigned DDQ staff member(s) will respond to the submitted question in:

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  two business days, if the question can be answered with DDQ input alone, or

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  seven business days, if the question requires multi-component collaboration and input.

For closed cases, the assigned DDQ staff member(s) will respond to the submitted question in:

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  five business days, if the question can be answered with DDQ input alone, or

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  fourteen business days, if the question requires multi-component collaboration and input.

If the assigned DDQ staff member(s) is unable to provide a response within the allotted time, that staff member will provide a status update, via e-mail, to all of the quality review component staff designated on the original submission form and send a copy of the e-mail to the ^DCARO OQR Policy Questions mailbox.

When a quality review component disagrees with a response provided by a DDQ staff member(s), and the policy at issue is owned by OQR, the quality review component will send an e-mail to the ^DCARO OQR Policy Questions mailbox with a detailed explanation of the disagreement.

To ensure proper routing and expedite the resolution process, the subject line of the e-mail should include:

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  the word "disagreement",

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  the Request ID # associated with the initial question, and

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  any other pertinent information that may assist in the resolution process (e.g., case status, additional relevant POMS, new developments, etc.).

Upon receipt of the quality review component's disagreement e-mail, the question will be assigned to a different DDQ staff member(s), who did not participate in the initial response, for resolution and to help ensure that additional input is impartial. The newly assigned DDQ staff member will send a "Reply All" response to the submitting quality review component's disagreement e-mail, within one business day, to acknowledge receipt.

The DDQ time frames for resolving disagreements are as follows:

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  two business days for pending cases and

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  five business days for closed cases.

If the assigned DDQ staff member(s) is unable to provide a response within the allotted time, that staff member will provide a status update, via e-mail, to all of the quality review component staff designated on the original submission form and send a copy of the e-mail to the ^DCARO OQR Policy Questions mailbox.

Once the disagreement is resolved, the assigned DDQ staff member(s) will forward a draft response, via e-mail, to the Quality Review Policy and Procedures Branch Chief for review, approval, and final release to the involved quality review component.

When a quality review component disagrees with a response provided by a component outside of OQR, and the policy at issue is owned by the outside component, the quality review component will send an e-mail to the ^DCARO OQR Policy Questions mailbox with a detailed explanation of the disagreement.

To ensure proper routing and expedite the resolution process, the subject line of the e-mail should include:

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  the word "disagreement",

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  the Request ID # associated with the initial question, and

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  any other pertinent information that may assist in the resolution process (e.g., case status, additional relevant POMS, new developments, etc.).

Upon receipt of the quality review component's disagreement e-mail, the question will be assigned to the same DDQ staff member(s), who participated in the initial response, for resolution. The DDQ staff member(s) will send a "Reply All" response to the submitting quality review component's disagreement e-mail, within one business day, to acknowledge receipt.

The DDQ time frames for resolving disagreements are as follows:

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  seven business days for pending cases and

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  fourteen business days for closed cases.

If the assigned DDQ staff member(s) is unable to provide a response within the allotted time, that staff member will provide a status, via e-mail, to all of the quality review component staff designated on the original submission form and send a copy of the e-mail to the ^DCARO OQR Policy Questions mailbox.

Once policy clarification is received from the outside component, the assigned DDQ staff member(s) will prepare a response to the involved quality review component and update the resolution in the Policy and Procedure Clarification and Field Site Assistance Request Form.