20 CFR 404.1620(a); 20 CFR 416.1020(a)
DI 30001.001 Disability Determination Services (DDS) Quality Assurance System
20 CFR 404.1620(a);
20 CFR 416.1020(a)
Each state is responsible for providing an in-depth and substantive review of adjudicated claims for Social Security Disability and Supplemental Security Disability Income benefits. This subchapter provides state DDSs with discretionary guidelines for designing a Quality Assurance (QA) function to ensure that disability determinations are made accurately and promptly.
While end-of-line reviews help DDSs measure the effectiveness of procedures, practices, and training, a more comprehensive in-line review approach is needed to fully evaluate and maintain the quality of a DDS’s product. Experience has shown that a QA system involving the full range of QA activities is a valuable tool for ensuring accurate and timely disability determinations. To be most effective, QA should form a total system that includes review, analysis, and action.
B. Definition of quality assurance for the DDS
DDS Quality Assurance (QA) is a system designed to detect and correct errors or problems and to promote quality in all aspects of DDS claims processing. Quality includes both the accuracy and timeliness of the disability determination.
C. Meet regulatory requirements
The Code of Federal Regulations requires each state to have a quality assurance function. However, each state decides how to structure their quality assurance function and the scope of activities it performs.
2. Social Security Administration (SSAs) recommendations
SSA recommends that DDSs implement a QA system involving the full range of QA activities described in this subchapter.
3. Limitations on DDS QA reviews
State DDS quality assurance unit (QAU) reviews must be completed prior to the Federal QA and pre-effectuation review (PER) sample selection. QAU reviews must not be designed as a means of reviewing cases selected for QA review by SSA.