TN 15 (02-11)

GN 04440.320 Policy Issue Referrals

A. Introduction to policy issue referrals

Use the following procedures when clarification of disability program or quality review (QR) policy is necessary at any time during the QR process.

B. Procedure for disability program policy issues in certified electronic folder (CEF) cases

If policy and procedural guidelines or Program Operations Manual System (POMS) instructions do not clarify the disability program policy issue requiring resolution, refer the case as indicated in GN 04440.320B.1. or GN 04440.320B.2.

1. Review component referrals

The review component should prepare an e-mail to either the regional center for disability (CD) or the Director, Division of Disability Quality (DDQ) in the Office of Quality Review (OQR) explaining the issue(s) requiring resolution. Include in the e-mail:

  • the reasons why current guidelines do not resolve the issue;

  • proposed solutions;

  • a description of the workload impact;

  • acknowledgment of medical or vocational input, as appropriate; and,

  • an explanation of why the policy issue must be resolved before the case can be adjudicated accurately.

If the policy referral e-mail is submitted to the regional CD, include OQR, DDQ as a “cc:” and prepare a 30-calendar day diary to control the referral.

If the referral involves a non-QR policy question, DDQ will forward the policy referral to the appropriate component for resolution.

Under no circumstances should a review component policy referral be submitted directly to the Office of Disability Policy (ODP) or any other central office component.

2. Referrals from OQR Baltimore

Prepare an e-mail explaining the issue(s) requiring resolution and send it with the case to the Division Director, OQR, DDQ. Include in the e-mail:

  • the reasons why current guidelines do not resolve the issue;

  • proposed solutions;

  • a description of the workload impact;

  • acknowledgment of medical or vocational input, as appropriate;

  • the date you expect a response and the name of the contact person; and

  • explain why the policy issue must be resolved before the case can be adjudicated accurately.

If the referral involves a non-QR policy question, DDI will forward the policy referral to the appropriate component for resolution.

Under no circumstances should OQR Baltimore e-mail a disability program policy referral directly to the ODP or other central office component.

C. Procedure for disability program policy issues and QR policy issues in paper cases

If the policy issue that needs clarification involves a paper folder, refer the case to OQR, DDQ Division Director or the CD after any decisional input.

Follow these steps.

  1. Photocopy the case file.

  2. Effectuate the determination and route the paper case to the appropriate component.

  3. Prepare a memorandum explaining the QR policy issue to be clarified and route the memorandum and photocopied case file to the appropriate component (i.e., OQR, DDQ or CD).

  4. Control the referral with a 30-day diary.


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0204440320
GN 04440.320 - Policy Issue Referrals - 12/01/2014
Batch run: 12/01/2014
Rev:12/01/2014