Identification Number:
GN 04440 TN 74
Intended Audience:See Transmittal Sheet
Originating Office:OARO Office of Quality Review
Title:Federal Quality Review of Disability Determinations
Type:POMS Transmittals
Program:All Programs
Link To Reference:
 

PROGRAM OPERATIONS MANUAL SYSTEM
Part GN – General
Chapter 044 – Quality Appraisal
Subchapter 40 – Federal Quality Review of Disability Determinations
Transmittal No. 74, 08/08/2019

Audience

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

Originating Component

OQR

Effective Date

Upon Receipt

Background

The Office of Quality Review (OQR) is making editorial changes and completing updates throughout the quality review sections of the POMS to improve readability, add clarity, and ensure conformance with Plain Language Guidelines. Currently, the information regarding assuming jurisdiction is contained in two POMS sections, GN 04440.244 and GN 04440.245. We are incorporating the information from these sections into GN 04440.244 Assuming Jurisdiction.

Summary of Changes

GN 04440.244 Policy Requirements for Assuming Jurisdiction

We revised the section title

Subsection A:

This section explains OQRs authority to conduct reviews and what actions OQR will take when it finds a deficiency or a technical corrective action is needed. It further explains what it means to assume jurisdiction of a case and how this is beneficial for claimants and beneficiaries.

Subsection B:

We define specific situations when we will assume jurisdiction of a case and make the necessary corrections. These situations are: medical assessment form technical corrective actions (TCAs) (see GN 04440.232 for more information), regulation basis code TCAs (see GN 04440.231 for more information), mental impairment TCAs (see GN 04440.232 for more information), and second returns (see GN 04440.203 for more information).

We provide policy references for these situations for more specific information.

We provide a note explaining assuming jurisdiction is not required if the incorrect regulation basis code is due to an obvious typographical error.

Subsection C:

We define those situations where we must not assume jurisdiction.

In subsection C1, we explain we cannot assume jurisdiction for any group one deficiencies.

In subsection C2, we explain we cannot assume jurisdiction for possible disability hearing cases to include continuing disability review (CDR) medical cessations, adverse reopenings of favorable initial determinations based on medical factors, adverse reopenings of reconsideration reversals based on medical factors and adverse reopenings of cessations that change only the basis for the cessation.

Subsection D:

We provide the steps that must be taken by the review component when assuming jurisdiction.

 

GN 04440.245 Assuming Jurisdiction Overview

We are archiving this section. We incorporated current and relevant information into GN 04440.244.

GN 04440.244 Assuming Jurisdiction

A. Introduction to assuming jurisdiction

The Social Security Administration (SSA) uses regulations and sub-regulatory guidelines to implement disability programs established by Congress in the Social Security Act (Act). The Act also provides State agencies the authority to make disability determinations following SSA’s regulations and the Commissioner the authority to review these determinations. It is with this reviewing authority that the Office of Quality Review (OQR) evaluates the correctness of claims processed by an adjudicating component on SSA’s behalf.

When OQR conducts a quality review of a claim and finds a deficiency or a need for a technical corrective action (TCA) (for more information, see GN 04440.003C), the review component either makes the correction, returns the case to the adjudicating component for correction or assumes jurisdiction of the claim and makes the needed correction.

When the review component assumes jurisdiction of a claim, they assume responsibility for the determination, completes all necessary corrective action(s), and prepares a new disability determination.

Assuming jurisdiction provides claimants and beneficiaries with timely action on their claim and expedites payment of any benefits due.

B. When to assume jurisdiction

Generally, the OQR assumes jurisdiction for:

  • medical assessment form technical corrective actions (TCAs) (see GN 04440.232 for more information)

  • regulation basis code TCAs (see GN 04440.231 for more information)

  • mental impairment TCAs (see GN 04440.232 for more information)

  • second returns (see GN 04440.203 for more information)

Note: Assuming jurisdiction is not required if the incorrect regulation basis code is due to an obvious typographical error.

C. When a review component cannot assume jurisdiction

When a review component assumes jurisdiction of a case, the determination becomes a federal determination. In specific situations, review component will not assume jurisdiction of a case and will return it to the adjudicating component for correction. Review components cannot assume jurisdiction in the following situations.

1. Group I deficiencies

When returning a group I deficiency to the adjudicating component for the first time, the review component cannot correct the deficiency. This is the responsibility of the adjudicating component.

2. Disability hearing and possible disability hearing unit cases

Review components cannot assume jurisdiction for disability hearing cases or when the next level of appeal is a disability hearing. This includes the following types of determinations:

  • Continuing disability review (CDR) medical cessations;

  • Adverse reopenings of favorable initial determinations based on medical factors;

  • Adverse reopenings of reconsideration reversals based on medical factors; and

  • Adverse reopenings of cessations that change only the basis for the cessation.

For an explanation of disability hearing unit cases, see DI 29001.001.

D. General requirements when jurisdiction is assumed

When assuming jurisdiction, the review component must:

  1. 1. 

    assume jurisdiction in the case processing system and prepare an amended determination

  2. 2. 

    obtain form completion from a medical or psychological contractor as appropriate

  3. 3. 

    prepare a new notice and rationale, if necessary

  4. 4. 

    enter the statement “SSA jurisdiction exercised. This amends the unapproved adjudicating component determination of MM/DD/YY” in item 34 of the SSA-831 for initial and reconsideration cases

  5. 5. 

    enter the statement “SSA jurisdiction exercised. This amends the unapproved adjudicating component determination of MM/DD/YY” on the SSA-832 or SSA-833 for a CDR case

  6. 6. 

    notify the adjudicating component of the correction via the SSA-847

  7. 7. 

    keep the original determination form(s) and rationale(s) in file as part of the audit trail and annotate as “Do Not Process” in the electronic folder

  8. 8. 

    annotate the original notice as “Do Not Send” in the electronic folder, if applicable

  9. 9. 

    route the case to the field office.


GN 04440 TN 74 - Federal Quality Review of Disability Determinations - 8/08/2019