Identification Number:
DI 30005 TN 22
Intended Audience:See Transmittal Sheet
Originating Office:OARO Office of Quality Review
Title:Adjudicating Component Actions on Deficient Cases
Type:POMS Transmittals
Program:Disability
Link To Reference:
 

PROGRAM OPERATIONS MANUAL SYSTEM
Part DI – Disability Insurance
Chapter 300 – Quality Assurance
Subchapter 05 – Adjudicating Component Actions on Deficient Cases
Transmittal No. 22, 07/01/2019

Audience

PSC: DE, DEC;
OCO-OEIO: CR, FDE, RECONE;
DQB: DE, PA, PL, TL;
OCO-ODO: DC, DE, DS, RECONE;
ODD-DDS: ADJ, DHU;

Originating Component

OQR

Effective Date

Upon Receipt

Background

This is a Quick Action Transmittal. These revisions do not change or introduce new policy or procedure.

Summary of Changes

DI 30005.115 High and Low Impact Grace Periods

The trasmittal is part of an ongoing activity by the Office of Quality Review (OQR) to update POMS. This update does not change policy.

We made the following revisiions to all sections:

  • followed plain language guidlines;

  • provided clear and detailed section titles and subsection headings;

  • made minor changes to clarify content;

  • rearranged sections to make it easier to follow and apply the POMS;

  • shortened sentences, where possible.

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 are cited to the adjudicating component and counted in the adjudicating component’s performance accuracy statistics. A grace period ONLY applies to initial QA sample cases.

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.

C. Types of grace periods

There are two types of grace periods:

  • high-impact grace period, and

  • low-impact grace period.

The Office of Quality Review (OQR) determines which type of grace period to establish.:

We establish a high-impact grace period when we expect the new, clarified, or changed policy or procedure to affect a large workload. In a high-impact grace period, we remove all grace period cases from performance accuracy calculations.

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. 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

.

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 component disability examiner signs the SSA-831-C3 or SSA-831-U3 (Disability Determination and Transmittal) determines when and whether the grace period applies.


DI 30005 TN 22 - Adjudicating Component Actions on Deficient Cases - 7/01/2019