DI 39518.065 Administrative Provisions for Assuring that Mental Impairment Cases are Evaluated by Qualified Professionals


Social Security Disability Benefits Reform Act of 1984;
Regulations 20 CFR 404.1624 and 416.1024

A. Policy principle

SSA must make every reasonable effort to ensure that a qualified psychiatrist or psychologist completes the medical portion of the case review and any needed assessment of residual functional capacity in initial mental impairment cases before an unfavorable decision is made.

B. Background

1. CO responsibilities

CO is responsible for monitoring national compliance with the statutory requirements and intent of Congress by:

  1. a. 

    identifying problems requiring new or revised instructions, guides or regulations;

  2. b. 

    developing mental caseload estimates, where necessary;

  3. c. 

    budgeting for program costs;

  4. d. 

    providing clarification on a case-by-case basis of what circumstances warrant a finding that “every reasonable effort” has been made to obtain necessary specialist staff; and

  5. e. 

    issuing guidelines on the nature and extent of Federal resources that may be applied in securing specialist services.

NOTE: Use of Federal resources, including contracting out for psychiatrist and psychological services, will be considered only where the States are unable, despite every reasonable effort, to obtain the specialist services required.

2. RO responsibilities

The RO is responsible for assuring every reasonable effort is made to obtain specialist reviews by:

  1. a. 

    providing State agency with caseload estimates and other information for use in determining the extent of staff needed;

  2. b. 

    working with the State agency to develop strategies for meeting the required effort, and/or undertaking actions needed to eliminate impediments to the State's obtaining and maintaining the required staff;

  3. c. 

    budgeting for approved acquisition of additional staff or for increases in payment rates for professionals;

  4. d. 

    monitoring State agency performance in completing plans and providing the necessary reviews;

  5. e. 

    determining for the State agency:

    • the circumstances under which the State may release mental impairment cases that have not been reviewed by a specialist,

    • the number and types of cases that may be released, and

    • the period of time that such releases may continue;

  6. f. 

    determining when alternative Federal resources, including contracting out, are needed and how these resources will be provided;

  7. g. 

    obtaining the necessary Federal resources and coordinating these resources within the State agency, RO and CO structure; and

  8. h. 

    requesting CO assistance as needed.

C. Operating policy

1. Specialist review

SSA's goal is to have specialist, i.e., qualified psychiatrists or psychologists, review all mental impairment cases.

2. Every reasonable effort

The responsibility to ensure that every reasonable effort is made to obtain specialist reviews in mental impairment cases is the responsibility of all State agencies and regional and central offices.

D. Operating procedures

1. Staff levels

Determine whether the current staff is sufficient to provide specialist reviews.

2. Less than full time

Develop a plan to overcome less than full and continuous coverage. Include:

  1. a. 

    The delays, caseload and/or anticipated number of days, specialist case reviews are pending;

  2. b. 

    Planned recruitment initiatives and contacts to be made.

    EXAMPLE: The following actions can be taken:

    • Increase existing staff hours;

    • Contact other State agencies for qualified staff willing to participate or for other recruitment leads;

    • Contact medical schools/universities;

    • Contact State/national specialist societies and associations; and

    • Advertise in professional publications.

3. Fee schedule

Develop a strategy to update inadequate fee/payment rates if revisions are needed to obtain qualified specialists.

4. Reports

  1. a. 

    Report to the RO within 45 days after specialist shortage is determined.

  2. b. 

    Submit subsequent reports as specialty staff changes occur.

  3. c. 

    Include in the report:

    • the status of recruitment efforts,

    • shortages still existing,

    • impediments to recruitment,

    • status of efforts to alleviate impediments, and

    • the level/degree of State (parent agency) cooperation.

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DI 39518.065 - Administrative Provisions for Assuring that Mental Impairment Cases are Evaluated by Qualified Professionals - 06/07/1999
Batch run: 03/25/2020