Retention Date: 09/30/2025
Summary of Changes:
· Resume processing of all CDRs
A. Purpose
This emergency message (EM) provides Disability Determination Services (DDS)s and Field Offices (FO)s with updated continuing disability review (CDR) guidance for resuming processing at the beginning of fiscal year (FY) 2025.
B. Background
In June 2024 our full medical CDR target was lowered from 575,000 to 375,000, which allowed the agency resources to focus on processing Initial Disability Claims and Reconsideration cases. During the pause of CDR processing, components were given specific instructions to process only excepted CDR cases (e.g. Low Birth Weight, Expedited Reinstatements (EXR), CDR Appeals, Fraud or Similar Fault, OQR returns, blindness with return to work, erroneous allowance corrections, auxiliary EXR, ALS and uneffectuated cessations) to ensure good customer service and program stewardship. All other pending CDRs (except for paper CDRs and electronic CDRs with associated paper folders) were transferred from DDSs to a federal staging queue (S0D) to await the resumption of CDR processing in FY 2025.
C. Resume Processing All CDR Workloads
Beginning October 18, 2024, FOs will resume processing and transferring CDRs to DDSs.
Beginning FY 2025, DDSs will resume receipt, assignment, and processing of all CDR workloads.
D. FO Processing Instructions
Effective October 18, 2024, in accordance with the local agreement, to ensure DDSs receive enough CDRs to meet the FY 2025 target, FOs will begin transferring medical CDRs (MCDRs) to the DDS. Prior to this date, FOs must begin developing MCDRs and building a pipeline of cases that will be transferred to the DDSs based on Regional guidance. As FOs work to build this pipeline, keep in mind the following:
· On October 12, 2024, Systems will transfer approximately 80,000 cases from the staging queue back to the FOs to be “refreshed.” These are mostly MCDRs that were unassigned at the DDSs prior to the pause.
· These cases can be identified through Workload Action Center (WAC) and Electronic Disability Collect System (EDCS).
o In WAC, the Location Date on the DCF CDR list will be October 13, 2024.
o In EDCS, the CDRs will be transferred to the FO as a pending medical CDR. Technicians will receive one of two EDCS Action Items: “Claim Transferred to FO” or “Claim Rejected to FO”. Regardless of the EDCS action received, the steps the FO should take remain the same.
o In EDCS, the CDRs will have a flag with the following language, “FY24 CDR Transfer.” This flag will be added by Systems to all CDRs previously transferred to the staging queue and is for control purposes only and cannot be edited or removed..
· Technicians will take the following actions on these CDRs prior to sending to the DDS:
o Call the beneficiary and use the attached template to update relevant medical information that is necessary for the DDS to process the case.
o Review and verify the SSA-827 was signed no more than 9 months prior to the date of refresh review.
§ If the SSA-827 was signed over 9 months ago, develop for a new SSA-827 prior to sending the case to DDS. Remember that you can complete attestation for a new SSA-827 in EDCS.
o If your call is unsuccessful, make a second attempt at another time. If you are unable to reach the beneficiary on the second attempt, take the following steps:
· Add a message in EDCS advising if updated information was obtained, and the date of the Report of Contact (SSA-5002), or if the FO was unable to reach the beneficiary/recipient to refresh information.
· FOs should follow normal business process for all other medical CDRs (DI 13005.025). However, technicians not should restart follow-up and FTC procedures on cases where the forms are still valid but development was delayed due to the pause in the workload.
· FOs can send any mixture of new CDRs and “refreshed” CDRs as they become available.
E. DDS Processing Instructions
Beginning in FY 2025 CDRs previously received at the DDS and later transferred to the federal staging queue (S0D) will be transferred back to DDS in a phased approach. These cases can be identified by an “FY24 CDR Transfer” flag and found in the DCPS Pre-Receipt queue. DDS has discretion on how to reassign these cases. The “FY24 CDR Transfer” flag will be available for use in case assignment backlog groups on September 28, 2024.
DDSs will receive a mixture of CDRs to include:
· CDRs returned directly from S0D to DDS without FO refreshment,
o The first phase of returned CDRs were nearer to a final determination when processing was paused.
· CDRs sent from S0D to the FO with FO refreshment completed, and
· New CDRs.
When determining if additional development is warranted for all cases affected by the pause in processing, (including CDRs with associated paper folders and paper CDRs the DDS held during the processing pause) the DDSs will:
· Review the electronic folder:
o For additional information submitted by the beneficiary/recipient, representative payee, third party, or appointed representative during the period of CDR pause.
o If CDR was unassigned prior to processing pause, development is necessary utilizing the information on the SSA-454 and FO supplied information.
o If development was interrupted by the processing pause, review the electronic folder to confirm processing consistent with DI 28030.020 Development of Medical Evidence.
§ For example: if the initial Function Report – Adult (SSA-3373) or medical evidence request was mailed and not received and follow up requests were not issued (due to CDR pause), the DDS must issue a follow up request.
· Review updated information from the FO. The FO will place a message in eView advising if updated information was obtained, and the date of the Report of Contact (SSA-5002), or if the FO was unable to reach the beneficiary/recipient to refresh information.
· If FO refreshment contact was unsuccessful, the CDR was returned directly to DDS without FO refreshment, or the CDRs remained in the DDS, contact the beneficiary/recipient to:
o Confirm contact information,
o Inquire if there has been a change in their impairment since last DDS contact (for example, after previously completed consultative examination), and
o Obtain updated medical source information (if applicable).
F. Failure to Cooperate
· If contact is unsuccessful, follow guidance in DI 28075.005 Failure to Cooperate (FTC) and Whereabout Unknown (WU) During a Medical Continuing Disability Review (CDR).
o While the DDS must recontact the beneficiary/recipient prior to considering FTC, if the evidence in file is sufficient to document there has been no medical improvement (MI) and no exception applies, successful contact may not be necessary to process a continuance.
DDS must make a reasonable effort to develop all evidence available without beneficiary/recipient cooperation (DI 28075.005.D1).
o DDS must follow all steps in DI 28075.005 prior to ceasing benefits on the basis of FTC. As noted in DI 28075.005.G the cessation month for the individual is the first month in which the individual fails to cooperate. The cessation month will be based on the subsequent contact attempt after the resumption of CDR processing in FY 2025.
Example: The beneficiary failed to return a completed function report and all DDS follow up actions were completed prior to the pause in CDR processing. Upon resuming CDR processing in FY 2025, the DDS should again attempt contact with the beneficiary to obtain the necessary evidence. If the beneficiary fails to respond to DDS, the cessation date for FTC will be based on the contact in FY 2025.
· Use the following policy references to determine if additional development is needed:
o DI 28005.001 Legal Standard for Determining if Disability Continues
o DI 28005.005 Overview of Development in the Continuing Disability Review (CDR) Sequential Evaluation Process, and
o DI 28030.020.D.7 Development of Medical Evidence – When current evidence is necessary
G. Development Recommendations
We recommend DDSs use judgment to mitigate unnecessary development when determining next steps for processing individual cases.
H. Additional Information
Direct all program-related and technical questions to your Regional Office (RO) support staff using vHelp or Program Service Center (PSC) Operations Analysis (OA) staff. RO support staff or PSC OA staff may refer questions, concerns, or problems to their Central Office contacts.