TN 10 (02-11)

DI 30005.115 High and Low Impact Grace Periods

A. Definition of a grace period

A grace period is the time between the date when new, revised, or clarified policy or procedure or type of quality review becomes effective, and the date when group I deficiencies involving the new policy or procedure in initial quality assurance (QA) cases are cited to the adjudicating component and counted in the adjudicating component’s performance accuracy statistics. A grace period only covers initial QA sample cases. There are no grace period provisions for reconsideration or continuing disability review QA sample cases or for preeffectuation review sample cases or other miscellaneous sample cases such as Targeted Denial Reviews, etc.

B. Purpose of the grace period

The purpose of the grace period is to allow the adjudicating component time to become familiar with new, revised, or clarified policies or procedures before cited deficiencies based on them are included in the computation of the adjudicating component’s performance accuracy. For an explanation of the adjudicating component’s performance accuracy, see GN 04440.003.

C. Types of grace periods

There are two types of grace periods:

  • A high-impact grace period, and

  • A low-impact grace period.

We establish a high-impact grace period when we expect the new, clarified, or changed policy or procedure to affect a large workload.

We establish a low-impact grace period when we do not expect the new, clarified, or changed policy or procedure to affect a large workload.

Both types of grace periods apply only to initial QA sample cases. In a high-impact grace period, we remove all grace period cases from performance accuracy calculations. In a low-impact grace period, we include all grace period cases with a group I deficiency in calculating performance accuracy, but we count them as deficiency-free cases. The Office of Quality Review (OQR) determines which type of grace period to establish.

For a detailed description of the two types of grace periods, see DI 30005.115C.1. and DI 30005.115C.2. in this section.

1. High-impact grace period

When we expect a new, revised, or clarified policy or procedure to affect a large workload, e.g., when there has been a major revision to one of the widely applied listings, we exclude all grace period cases from performance accuracy statistics and do not report them in the normal QA process. Instead, we track grace period cases separately, and maintain separate data. We augment the initial QA sample to replace the grace period cases to maintain statistical precision in the reported accuracy rates.

For additional information on sample augmentation, see GN 04440.123D.4.

2. Low-impact grace period

When we do not expect a new, revised, or clarified policy or procedure to affect a large workload, we do not exclude grace period cases from adjudicating component performance accuracy statistics. However, we treat initial QA cases that fall under the grace period and contain a group I deficiency as deficiency-free cases for performance accuracy calculations. We apply the grace period only to initial QA cases.

For a detailed description of the two types of grace period and how they are applied, see GN 04440.123D. and GN 04440.123E.

D. Process for grace period cases

The review component reviews the cases in the usual manner, including medical review, and returns deficient cases to the adjudicating component for corrective action. The review component annotates the deficiency return transmittal Form SSA-1774-U5 (Request for Corrective Action) with either of the following remarks, depending on the type of grace period in effect:

  • High-Impact – Case Excluded From Performance Accuracy Calculations - Informational Only or,

  • Low-Impact - Informational Only. Group I Deficiency Not Counted in Performance Accuracy Calculations.

E. Policy on grace periods

1. Authority for grace period

OQR establishes grace periods in consultation with the Office of Disability Programs.

2. Length of grace period

The grace period for implementing instructions provided in the Program Operations Manual System transmittals (TN), teletypes, and emergency messages (EM) is two full calendar months following the effective date of the issuance.

The date the adjudicating co