DI 39563.210 Non-SSA Program Work
Some State DDS agencies receive requests from various other agencies within the State to make disability determinations for claims not related to SSA benefits, claims commonly known as “Non-SSA Program” claims and primarily involving various categories of nonpayment Medicaid-only cases. Most of these requests come from State welfare agencies, particularly in States where the DDS is contained within a parent or “umbrella” agency of the State welfare department. In a few States, the DDS has been asked to make disability determinations by other agencies, such as those administering teachers' retirement systems, State employees' retirement systems, and State homestead acts.
The DDS's must ensure that the non-SSA program work does not hamper the ability of the DDS to fulfill its obligations under SSA regulations. Where such work is assigned to the DDS, it is to be predicated upon (1) the recognition and payment of all costs by the State, direct and indirect, in accordance with State and Federal laws; (2) assurance to the regional commissioner that no delay in SSA claims will result; and (3) assurance to the regional commissioner that the funding and reporting system is consistent with the guidelines outlined below.
B. Effect of workload
Experience has indicated that the workload for non-SSA program work has been such that in only a few cases is it large enough to warrant a completely separate unit for its administration. In those cases, although the DDS has been called upon to set up the unit and furnish a staffing cadre, the funding, and staffing are the responsibility of the “other” agency, presenting no problem to the DDS administration.
In most cases, however, the workload does not warrant setting up a separate, independent work group. Instead, the staffing and other resources must be shared and allocated between the SSA program work and the non-SSA program work. This requires that all the costs of the non-SSA program work be clearly identified to provide accurate cost allocations.
C. Legal requirement
The Social Security Act and the regulations providing for the administration of the disability programs permit appropriate funds to be used only for the purposes specified in titles II and XVI of the Act.
Separate Unit Funding--This legal requirement poses no problem in the financial relationship between the independent unit and the DDS since the funding of the independent unit is completely outside the DDS budget.
Concurrent Funding of a Single Unit--The funding and staffing of the joint operation, however, does present some difficulties. A split operation ordinarily brings with it inherent problems in estimating costs; apportioning costs; and maintaining accurate, reliable records for data accumulation, monitoring, and management purposes. Moreover, the addition of a concurrent payment system compounds the complexities of the financial management system. In some States, obtaining funding authority and drawing appropriated funds are processes sometimes protracted even beyond the limits permitted by operating needs.
The Cash Flow System--Nevertheless, in the joint operation, the regulatory constraints make it necessary for the State to draw concurrently upon the resources provided by both the Federal government and the State government for the payment of the costs shared in doing the SSA work and the non-SSA program work. Reimbursement after the fact would constitute use of appropriated funds, albeit temporary, for purposes not authorized by the Social Security Act or the Federal-State regulations.
A satisfactory cash flow system then, is one which provides a fund of working capital and establishes a system for paying the costs of doing the work as the costs are incurred. Thus, the State will need to (1) merge the funds appropriated for this work with those of the DDS and (2) integrate procedures to provide for payment of shared costs.
1. Considerations-establishing the system
a. “Memorandum of Understanding”
Although all of the following conditions may not be completely met at any one time, the status of the DDS should clearly indicate its ability to assume the responsibilities of processing the additional workload. The assessment of the situation will be critical since inadequate operational readiness will adversely affect not only SSA claims, but the additional State workloads as well.
A memorandum of understanding should be worked out between the State and the regional commissioner, outlining the arrangements that have been made to absorb the additional workload and stating specifically how this additional responsibility will affect SSA workload responsibilities. The memorandum of understanding should include a statement to the effect that the assumption of the non-SSA program workload should not interfere with the prompt and effective completion of SSA-related claims.
b. Workload management
The current weeks' work pending and percentage of aged cases should not be substantially greater than the national norm. If the DDS is not meeting or approaching the norm in these areas, prospects need to be good for achieving this level in the near future.
The regional office should be informed of the size and type of the addtional workload. The basis for the estimated size should be reviewed and the description of the extent of the DDS involvement should be clear, i.e., whether it will be expected to process such items as CDR's, appeals, and notices and to conduct, where appropriate, face-to-face evidentiary hearings. As far as possible, the involvement should be limited only to making the determinations of disability on initial, reconsidered, appealed, and CDR claims leaving the notification of decision, processing of appeals, controlling of CDR's, storge of completed cases, and other administrative matters to the requesting agency. The requesting agencies should be asked to spell out precisely what they expect the DDS to do and what they themselves will do in each of the above areas.
There should be sufficient lead time to prepare and train existing personnel. If additional personnel are required, they should be authorized by the State prior to accepting new workloads. Adequate training facilities and qualified trainers should be available so that individuals newly hired or requiring additional training may receive timely, meaningful instruction. Supervision and administration should be adequate, including the agency's ability to determine the costs of the non-SSA program workloads. Medical resources, both within and outside the agency, should be adequate for the existing and added programs. Overtime, preferably paid, should be available for both clerical and professional staff to absorb the increased workload. Individuals engaged in quality assurance, vocational evaluation, and other nonproduction activities should remain fully committed to their assigned functions and not be deployed to process non-SSA program disability workloads at the expense of their SSA specialities.
d. Space and equipment
Space and equipment should be adequate for current needs. Contiguous space should be available if expansion is necessary. If contiguous space is not available, the agency should be in a position to move. Equipment must be readily available through State resources, rentals, or by borrowing from other agencies in the State.
Controls must be adequate to cope with the additional workload. Workflow must be sufficiently streamlined to absorb the additional workloads without causing bottlenecks. The capability must exist for prompt development and followups.
The non-SSA program workloads should be processed at a pace that does not seriously interfere with handling the SSA-related workloads and with the State's ability to meet performance levels prescribed by regulation.
The State should make available sufficient funds to the DDS to finance all the direct and indirect costs of doing the non-SSA program work for a reasonable period. This period should cover at least the time required to process and make available to the DDS an amount sufficient to finance the next ensuing segment of the non-SSA program workload. The amounts made available to the DDS should be based upon the most recent estimate of the cost per case of doing such work. Where appropriate to the amount of work involved, recent average case costs for title II or title XVI cases may be used tentatively. The case cost estimate should be revised periodically to reflect changing experience. At reasonable intervals, preferably quarterly, the amounts already made available to the DDS should be adjusted to the actual costs for the period and the next amount to be made available should be increased or reduced by any difference.
3. Retention of records
Documents containing such pertinent information as the method of determining case costs of non-SSA program work should be retained according to the guidelines in OMB Circular No. A-102 (Uniform Administrative Requirements for Grants--In--Aid to State and Local Governments).
4. Considerations-existing system
Where the payment system for non-SSA program work deviates from the principles stated above, State agencies should take steps as soon as possible to establish a case flow system which will meet the requirements of this standard.
If necessary, the regional office may provide assistance in implementing these procedures.