Identification Number:
DI 22510 TN 47
Intended Audience:See Transmittal Sheet
Originating Office:ORDP ODP
Title:Development of Consultative Examinations (CE)
Type:POMS Full Transmittals
Program:All Programs
Link To Reference:
 

PROGRAM OPERATIONS MANUAL SYSTEM

Part DI – Disability Insurance

Chapter 225 – Case Development Procedures

Subchapter 10 – Development of Consultative Examinations (CE)

Transmittal No. 47, 10/11/2024

Audience

PSC: DE, DEC;
OCO-OEIO: CR, ERE, FCR, FDE, RECONE;
OCO-ODO: DE, DEC, DS, RECONE;
ODD-DDS: ADJ, DHU;

Originating Component

ODP

Effective Date

Upon Receipt

Background

The Office of Disability Policy created this new POMS section to differentiate from the instructions provided in revised POMS DI 22510.065. In addition, we created instructions for consistency with the Disability Case Processing System (DCPS).

Summary of Changes

DI 22510.070 CE Report to Medical Source - Potential Emergency, Life or Death Situation

In this new POMS section we:

  • Named subsection A "Policy for sending the Consultative Examination (CE) report to a medical source" and provided corresponding information and cross-references;

  • Named subsection B "Procedure for releasing the CE report to the medical source" and provided instructions;

  • Named subsection C "Claimant has a medical source - potentially life-threatening situation" and provided instructions; and

  • Named subsection D "Claimant does not have a medical source - potentially life-threatening situation" and provided instructions and model language for the letter.

DI 22510.070 Consultative Examination Report Reveals a Potentially Life-Threatening Situation

CITATIONS:

20 CFR 401.160

A. Policy for sending the Consultative Examination (CE) report to a medical source

When the CE discloses new diagnostic information or test results that reveal a potentially life-threatening situation(s) (i.e., an emergency, life or death situation where harm is believed to be imminent), send a copy of the CE report to the claimant's current medical source.

For more information on determining whether a circumstance meets the agency's criteria for disclosure without consent involving matters of health and safety, see GN 03316.135.

B. Procedure for releasing the CE report to the medical source

The Disability Determination Services (DDS) can only disclose a CE report to the claimant's medical source without permission if the report contains new diagnostic information or test results that reveal a situation meeting the criteria described in GN 03316.135, i.e., an emergency, life or death situation where harm is believed to be imminent.

If the situation does not constitute an emergency, life or death situation where harm is believed to be imminent, but otherwise raises agency concern or if there are any questions concerning the appropriateness of the disclosure, contact the regional Privacy Act Coordinator, who may in turn contact the Office of the General Counsel.

Follow the instructions in DI 22510.070C, in this section, when releasing a CE report, with a cover letter, to a claimant's medical source. For cover letter model language, see NL 00705.0753.

C. Claimant has a medical source - potentially life-threatening situation

If the CE report contains new information that reveals an emergency, life or death situation:

  • Send the CE report to the claimant's medical source,

  • Include a copy of the cover letter to the medical source in the electronic folder,

  • Annotate the Case Development Worksheet (CDW) indicating you sent a copy of the CE report to the claimant's medical source (see NL 00705.753 for model language for the cover letter to the medical source),

  • Notify the claimant if you send the CE report to the medical source without the claimant's permission (refer to GN 03316.135C for template language to be included in the notice to the claimant), and

  • Include a copy of the letter to the claimant in Section E (Disability Related Development (Blue)) of the disability folder.

IMPORTANT: Send the CE report using an expedient method (e.g., Electronic Records Express (ERE) or direct fax if available) and contact the medical source by telephone to notify them that the CE report was sent.

D. Claimant does not have a medical source - potentially life-threatening situation

If the claimant does not have a medical source and the CE report indicates an emergency, life or death situation where harm is believed to be imminent, advise the claimant in a letter to see a health care provider for evaluation or treatment. Include a copy of the letter to the claimant in Section E (Disability Related Development (Blue)) of the disability folder. Use the following model language in the letter:

The Social Security consultative examination/test indicated a situation which requires immediate medical evaluation and/or treatment. We recommend that you be evaluated and/or treated immediately. If you do not have a medical source, or cannot pay for such services, please contact your local agency or medical facility where you can receive services at limited or no cost.

NOTE: In addition to sending a letter to the claimant, the DDS should also attempt to contact the claimant by telephone to provide this information.



DI 22510 TN 47 - Development of Consultative Examinations (CE) - 10/11/2024