TN 12 (09-16)

DI 30005.540 Policy Issue Referrals in Rebuttal Cases Using the Office of Quality Review (OQR) Rebuttal Process

  1. Policy clarification needed during the OQR rebuttal process

    • If, at any time during the rebuttal process, the issue being resolved appears to require policy clarification, refer the case to the Office of Disability Policy (ODP) or other SSA component to make a final policy ruling for clarification of medical or vocational program policy issues or OQR for clarification of quality review policy issues.

    • When a policy issue (which impacts the citation of a deficiency) requiring clarification is discovered in a rebuttal case, the resolution of the policy issue in question always takes precedence over completion of the rebuttal process.

    • If the policy referral on the rebuttal case requires mailing to another Social Security Administration (SSA) component for resolution, send the case to the component via an overnight courier.

    • A deficiency cited in a rebuttal case referred for policy clarification will only be rescinded when:

      • The policy issue has been resolved, and

      • The SSA component responsible for making a final policy ruling (i.e., ODP or OQR) determines that the policy clarification referral was indeed necessary before the case could be adjudicated accurately.

    • A rebuttal case requiring policy clarification is not effectuated until the policy issue is finally resolved.

  2. Procedure for the adjudicating component and the Center for Disability (CD) or Center for Disability and Program Support (CDPS) when policy clarification is necessary during the OQR rebuttal process

    • The adjudicating component will:

      • Prepare a letter or memorandum fully explaining the rebuttal of the deficiency and the policy issue(s) that requires resolution;

      • Submit the rebuttal case with the letter or memorandum to the CD or CDPS Director requesting support of the policy referral;

      • Use email to communicate the status of the policy issue resolution, if possible.

      If the CD or CDPS concurs with the adjudicating component that a policy issue requiring resolution exists, the CD or CDPS will prepare a cover letter or memorandum that includes the appropriate email addresses to be used for status updates and send the case (via an overnight courier) to the appropriate SSA component responsible for making a final policy ruling (i.e., ODP or OQR).

    • If the CD or CDPS does not concur with the adjudicating component that a policy issue requiring resolution exists, the CD or CDPS returns the case to the adjudicating component with a written response indicating their position.

  3. Procedure for the reviewing component when policy clarification is necessary during the OQR rebuttal process

    • Send the rebuttal case with the referral letter or memorandum to the appropriate SSA component responsible for making a final policy ruling.

    • The reviewing component forwards the rebuttal case with the referral letter or memorandum to:

      • CD or CDPS for resolution of medical or vocational program policy issues; or the CD of CDPS may decide to refer the policy issue case to ODP or other SSA component (via an overnight courier) for resolution and notify the reviewing component of their action; or

      • OQR, DDQ in Central Office for the resolution of quality review policy issues (via an overnight courier).

      NOTE: Include the appropriate email addresses for status updates in the referral letter or memorandum.

  4. Procedure after resolution of policy issues in rebuttal cases

    • After resolution of the policy issue, the review component will:

      • Take all actions to process the disability determination consistent with the resolution of the policy issue(s);

      • Prepare the rebuttal resolution;

      • Follow the instructions for the OQR rebuttal process in GN 04440.410; and

      • Forward the proposed resolution to the Director of OQR, Division of Disability Quality (DDQ) via an overnight courier.

      NOTE: Rescind the deficiency only if ODP, OQR, or other SSA component determines that policy clarification was indeed necessary before the case could be adjudicated accurately.