Identification Number:
GN 04440 TN 121
Intended Audience:See Transmittal Sheet
Originating Office:OARO Office of Quality Review
Title:Federal Quality Review of Disability Determinations
Type:POMS Transmittals
Program:Disability
Link To Reference:
 

PROGRAM OPERATIONS MANUAL SYSTEM
Part GN – General
Chapter 044 – Quality Appraisal
Subchapter 40 – Federal Quality Review of Disability Determinations
Transmittal No. 121, 08/05/2020

Audience

PSC: DE, DEC;
OCO-OEIO: FDE;
OCO-ODO: DE, DEC, DS, RECONE;

Originating Component

OQR

Effective Date

Upon Receipt

Background

This is a Quick Action Transmittal. These revisions do not change or introduce new policy or procedures. This POMS is being revised to make minor grammar, punctuation, and technical corrections, to improve clarity, and to update obsolete POMS references.

Summary of Changes

GN 04440.015 Federal Quality Review of Certified Electronic Folder (CEF) Cases

In Section C., we:

Changed the capitalization of the word "Federal" to the lowercase "federal", as federal is only capitalized when used to refer to a proper noun.

Changed the third sentence in the second bullet from one sentence to two and made minor changes to the new second sentence to improve clarity.

Added the title of the POMS to the reference in the last sentence.

In Section D., we:

Changed the capitalization of the word "Federal" in the first sentence to the lowercase "federal", as federal is only capitalized when used to refer to a proper noun.

In Section D.1., we:

Added a comma after "PC7" in D.1.

In Section D.2., we:

Added a lead in sentence to better reflect what information was contained in this section.

Reworded both bullets to improve clarity.

Removed the obsolete POMS reference in the last sentence and replaced it with the updated POMS reference numbers and titles.

In Section D.3., we:

Changed "the review" to "a quality review" in the first sentence, as "the" refers to a specific review and "a" refers to reviews, in general.

Added parentheses around the POMS title in the second sentence to make the presentation of references consistent throughout this POMS.

In Section E., we:

Changed "redirected" to "directed", as "redirected" would not apply to both types of routing referenced in this section.

Removed the obsolete POMS reference (DI 81030.115) in the last sentence and changed the presentation of the remaining, still applicable, POMS to make it consistent with other POMS references in this section.

In Section G., we:

Added the word "guidance" after the word "the".

Removed the existing POMS reference and replaced it with a reference that provides information on both types of rebuttal processes an adjudicating component can use when they disagree with a deficiency cited by a review component.

GN 04440.015 Federal Quality Review of Certified Electronic Folder (CEF) Cases

A. Introduction to the federal quality review

The Office of Quality Review (OQR) conducts a federal quality review of disability cases in OQR review components located in the 10 regions and OQR Baltimore. The OQR review components were formerly called disability quality branches.

B. Official folder is a modular disability folder (MDF) or CEF

Federal quality review of adjudicating component disability determinations provides general quality review processing instructions for review components to use when returning or correcting deficient Certified Electronic Folder (CEF) cases.

C. Quality review sample selection

The automated sample selection process selects OQR’s quality review sample cases during the adjudicating component’s case closure process and prior to effectuation of the determination.

  • The adjudicating component receives an alert during the case closure process, via the National Disability Determination Services System (NDDSS), when a CEF case is selected for federal quality review.

  • Both NDDSS and eView display an indicator when the case has been selected for federal quality review. NDDSS only shows that the case has been selected for review and the original review component as the destination. Some CEF cases are automatically transferred to other review components. This transfer is only visible in eView. The only place to see where a case is being, or has been, reviewed, is in eView.

  • CEF cases selected for federal quality review are electronically transferred to the appropriate review component for quality review (e.g., quality assurance review, pre-effectuation review, special studies, etc.).

For information regarding eView, refer to DI 81005.005 (eView Overview).

D. Results of OQR quality review

Results of federal quality reviews are as follows:

1. Non-deficient (correct) cases:

The review component completes the quality review and case processing system coding and clears the CEF case to the field office (FO), program service center, National Records Center, or PC7, for effectuation of the determination.

2. Deficient cases:

If a case is found to be deficient, the review component will either:

  • route the CEF back to the adjudicating component for corrective action(s) or

  • complete the needed corrective action(s) and route the CEF to the FO to effectuate the determination.

For additional information regarding deficiencies,see GN 04440.202 (Group I Decisional Deficiencies), GN 04440.203 (Group I Documentation Deficiencies), and GN 04440.204 (Group II Deficiencies).

3. FO action needed:

The review component may request assistance from the FO for additional development (e.g., substantial gainful activity development) prior to completing a quality review. Refer to GN 04440.510 (Completing the SSA-5524-U3, Request for Assistance), for additional information regarding requesting FO assistance.

E. Process for federal quality review

For CEF cases, OQR quality reviews may be electronically directed to an “out-of-region” review component or the “home” review component.

For further information, refer to DI 81020.135 (Federal Quality Review (QR)).

F. Adjudicating component and review component disagreement when a paper MDF is the agency's official folder and no CEF exists

The adjudicating component follows OQR's established rebuttal process, as described in GN 04440.401 through GN 04440.425 and DI 30005.501 through DI 30005.550.

G. Adjudicating component and review component disagreement when the CEF is the agency's official folder

The adjudicating component follows the guidance in DI 30005.501 (Resolving Deficiency Disagreements --- Informal Resolution Request (IRR) and Request for Program Consultation (RPC)).


GN 04440 TN 121 - Federal Quality Review of Disability Determinations - 8/05/2020