TN 13 (08-97)

DI 12015.002 Background - Disability Redesign Tests

The Full Process Model (FPM) is one of several disability redesign models which the Social Security Administration (SSA) will test as part of its initiative to create a new disability claim process. These disability redesign models evolved from the initial disability models and were described in the notice of proposed rulemaking (NPRM) entitled “Testing Modifications to the Disability Determination Procedures” which was published in the Federal Register on October 22, 1993. Since these models were proposed, SSA set out a proposal to redesign the initial and administrative appeals system for determining an individual's entitlement to Social Security and SSI disability payments. The final rules, which describe the revised models and establish SSA's authority to test them, were based on the NPRM, the comments received on it and the Commissioner's acceptance of the redesign plan and are found at 20 CFR§§404.906 and 416.1406. The models are:

• The disability claim manager (DCM) model which establishes a process whereby the DCM assumes the primary responsibility for the processing of an initial disability claim;

• The single decisionmaker (SDM) model which (except in cases where medical or psychological consultant input is required by statute) allows a SDM to make the initial determination of disability without requiring the medical or psychological consultant (MC) to sign the disability determination forms that we use to have the State agency certify the determination of disability;

• The predecision interview (PDI) model which provides a claimant with the opportunity to submit further evidence and have an interview with the decisionmaker if the evidence in the file does not support a fully favorable determination; and

• The reconsideration elimination (RE) model which eliminates the reconsideration step of the administrative review process for disability issues.

  Under the authority of separate rules found at 20 CFR§§ 404.943 and 416.1443, SSA is also testing:

• The adjudication officer (AO) model, in which an AO becomes the focal point of the prehearing process. The AO familiarizes the claimant with the hearing process, arranges the hearing, develops evidence, identifies the issues in dispute and prepares proposed written agreements for the approval of the ALJ regarding those issues which are not in dispute and those issues proposed for the hearing, conducts informal conferences, and possibly makes a “wholly favorable” decision prior to the hearing, if the evidence so warrants.

  The AO model is already being tested by itself and may be tested in combination with other models.

  SSA intends to test, under the authority of another rule currently proposed at 20 CFR §§404.966 and 416.1466:

• Appeals Council Review Elimination which, for some FPM claims, eliminates the right to request Appeals Council review of the ALJ decision. In those cases, the ALJ's decision will be the final decision that may be appealed by filing an action in Federal District Court. Testing will commence once the final rule is published in the Federal Register.