Identification Number:
EM-20023 REV
Intended Audience:All RCs/ARCs/ODD/DPU/DPB/OHO/DDS
Originating Office:DCO ODD
Title:Framework for Resuming In-person Consultative Examinations (CEs) – Coronavirus Disease 2019 (COVID-19) Pandemic – One Time Instruction- REV
Type:EM - Emergency Messages
Program:All Programs
Link To Reference:
Retention Date: 09/30/2021

      · Remove Section F: Failure to Attend a CE and Whereabouts Unknown since the information is obsolete and the current instructions are located in EM-20010 SEN REV 7, section F 3 and EM-20019 SEN REV 3, section D.
        · Extend Retention Date to 9/30/2021.

    This EM replaces instructions in Disability Determination Services Administrators’ Letter No.998, released on March 30, 2020; and, EM-20019 SEN REV 3, section D. Consultative Examinations, released on May 8, 2020.

    A. Purpose

    This EM provides a framework for State Disability Determinations Services (DDS) and Extended Service Teams (EST) to resume in-person CEs on a voluntary basis, while taking appropriate action to minimize risk to claimants, beneficiaries and CE providers.

    B. Background

    Effective March 17, 2020, due to the COVID-19 national public health emergency, we suspended public-facing, in-person operations to minimize exposure risk. Additionally, we postponed in-person CEs that we had already scheduled and suspended scheduling new CEs based on Centers for Disease Control and Prevention (CDC) guidelines. Below we set forth a framework for DDS-managed and locally executed guidance for resuming in-person CEs.

    C. General Instructions

    Understanding that the effects of COVID-19 vary across communities, each State DDS will determine and manage its reinstatement of in-person CEs, until further notice. In doing so, each DDS will make decisions based on the CDC, State, tribal, local, and territorial government guidelines regarding non-essential medical appointments and social distancing requirements.

    The health, safety, and privacy of the public we serve remains a top priority. Prior to resuming in-person CEs, DDSs should discuss with CE providers the safety procedures they have implemented at each of their locations.

    As the national public health emergency continues, DDSs must continue to balance the need to provide service with the need to minimize risk to claimants and beneficiaries. DDSs also must:

                  · prepare to rapidly respond to an increase or resurgence in COVID-19 cases in the community, including again suspending in-person CEs;

                  · provide service in accordance with government guidance for COVID-19 preventative measures; and

                  · consider gradually expanding services

    In addition, DDSs should consider working with CE providers to adjust appointment times to allow for an extra 15-30 minutes between appointments to help minimize contact as claimants arrive and depart the office space, and also to provide the CE provider time to sanitize the office space in between appointments.

    D. CE Provider Readiness:

    Once CDC, State, tribal, local, and territorial government guidelines support resuming non-essential medical examinations, the DDS should discuss with CE providers whether they are willing to conduct CE appointments and have implemented appropriate health and safety measures.

    CE provider readiness considerations may include:

                  · Availability of preventative or personal protective equipment;

                  · Availability of hand sanitizer and disinfecting wipes and procedures for provider, employee and patient use;

                  · Appropriate facility cleaning; and

                  · Space alterations to assist in appropriate physical distancing in waiting and examination rooms

                  · Other government or professional guidance, including guidance for medical providers.

    Other potential precautionary actions for CE provider consideration include:
                  · Contacting individual claimants or beneficiaries the day prior to the scheduled CE appointment to screen for signs of illness or exposure to COVID-19.

                  · Advise CE providers not to see or permit claimants or beneficiaries to enter the facility if they fail screening processes. If the claimant or beneficiary fails screening, the CE provider should recommend the claimant or beneficiary contact his or her primary care provider for further guidance and contact the DDS to have the CE appointment rescheduled.

                  · Advising claimants or beneficiaries to remain in their vehicles or outside the facility, if possible or advisable, until called for their scheduled appointment.

                  · Advising claimants or beneficiaries not to remain in the facility longer than necessary after their appointment.

                  · Requiring individuals to wear face coverings over their mouths and noses before entering the building.

                  · Advise people who accompany claimants or beneficiaries to an appointment to wait in their vehicle or outside of the office rather than entering the office, when possible.

                  · Limit unnecessary contact, such as shaking hands.

                  · Have supplies available for claimants or beneficiaries (tissues, waste receptacles, alcohol-based hand sanitizer).

                  · Sanitize all testing items, equipment, pens, and pencils with disinfectant as appropriate in between appointments, or discard difficult-to-sanitize items after one-time use.

                  · Provide visual alerts (signs, posters) at entrances and in strategic places providing instruction on hand hygiene, respiratory hygiene, social distancing, and cough etiquette.

      E. Notification

      DDSs must notify claimants and beneficiaries that they may request to postpone their CE without penalty, if a claimant or beneficiary has concerns with COVID-19 exposure.

      When the DDS begins to schedule in-person CEs, all CE notices to claimants and beneficiaries must contain the following language:

                      This provider can provide you with information about the steps it is taking to prevent the spread of COVID-19. If you are concerned about COVID-19 exposure, you may contact us to postpone the examination.

                      Please be aware that asking us to postpone the examination will delay your determination.

                      If you ask for a postponement, we will hold your claim until we can reschedule your examination at a future date or until we receive adequate evidence to make a determination.

      EM-20023 REV - Framework for Resuming In-person Consultative Examinations (CEs) – Coronavirus Disease 2019 (COVID-19) Pandemic – One Time Instruction- REV - 04/23/2021