Identification Number:
GN 04461 TN 16
Intended Audience:See Transmittal Sheet
Originating Office:OARO Office of Quality Review
Title:SSI Quality Reviews
Type:POMS Transmittals
Program:
Link To Reference:
 

PROGRAM OPERATIONS MANUAL SYSTEM
Part GN – General
Chapter 044 – Quality Appraisal
Subchapter 61 – SSI Quality Reviews
Transmittal No. 16, 10/19/2020

Audience

FO/RO/OQR: CR, CR TXVI, DM, MSS, OS, RO CPS, TE, TXVI AIPQB;

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

GN 04461.010 Supplemental Security Income (SSI) Quality Reviews

B.2 Changed Office of Anti-Fraud Programs (OAFP) to Office of Program Integrity (OPI).

GN 04461.010 Supplemental Security Income (SSI) Quality Reviews

A. Introduction to SSI quality reviews

The Office of Quality Review (OQR) monitors the quality of the Supplemental Security Income Program (SSI) program. OQR reviews measure payment accuracy and compliance with national and regional instructions.

OQR uses the results from ongoing SSI reviews and special studies to:

  • establish accuracy information;

  • report to Congress on the financial health of the SSI program;

  • identify program policy and system areas for corrective action; and

  • assist other components in formulating operating policy.

There are two ongoing SSI reviews:

  1. 1. 

    The Stewardship Review is a payment review. Cases are selected by Housed Under Number based on a payment made in the sample period.

  2. 2. 

    The Transaction Accuracy Review (TAR) is a Program Operation Manual System (POMS) compliance review of selected initial claim, redetermination (RZ) and limited issue (LI) transactions. The review measures POMS compliance by evaluating the accuracy of Field Office (FO) adjudicative decisions.

NOTE: Special studies provide management with specific data in areas of particular concern.

B. Process for SSI quality reviews

1. SSI quality review

  • OQR selects a random sample of cases each month.

  • Quality reviewers in OQR field sites throughout the country conduct reviews on the selected cases.

  • The quality review consists of one or more of the following actions by OQR:

    1. a. 

      A review of the SSI claim or RZ or LI folder and other documents and records related to the SSI case;

    2. b. 

      A contact (mail or telephone) with the SSI recipient or representative payee; and

    3. c. 

      Contacts with third-party collateral sources of information.

  • OQR prepares reports for publication and develops corrective action recommendations based on the review data. Recommendations may take the form of changes to the law, regulations, or policy and procedures.

2. Quality Review (QR) and contact with the public

OQR field sites contact members of the public to complete their reviews.

  1. a. 

    For Stewardship Reviews, the OQR reviewer sends the SSI recipient or representative payee an appointment letter to schedule a telephone interview and explain the purpose of the review. The appointment letter or request notice provides the quality reviewer's name and a telephone number in the OQR field site that the SSI recipient or representative payee can call with questions regarding the SSI QR.

  2. b. 

    For TAR, the reviewer may send a request notice to the recipient or representative payee if he or she needs further development for an issue.

The SSI recipient or representative payee may contact the field office (FO) or teleservice center (TSC) to verify the authenticity of the SSI QR or identity of the OQR employee. When the TSC receives an inquiry, follow the instructions in TC 00101.035. When the FO receives an inquiry, the FO should follow the steps below to verify the identity of the interviewer and provide the individual with further assistance or information regarding the QR:

  • Open Outlook Exchange System and access the address book, known as the “Global Address List” (GAL). Use the GAL in Outlook to confirm that the reviewer is an employee of OQR.

  • Did you verify the employee’s name?

    • If yes, advise the caller that the individual is an OQR employee who is responsible for contacting beneficiaries. Assure the caller that OQR does request documents and or forms by mail for reviews.

    • If no, treat this as a suspicious contact and prepare a report via the Allegation Referral Intake System (ARIS). Users may access ARIS from SSA's IMAIN page, select the ARIS - Allegation Referral Intake System link. The link to ARIS is also on the Fraud Security and PII and the Office of Program Integrity homepages.

3. OQR field site contact information

You can find contact information for OQR field sites at this link: OQR Field Sites.

 


GN 04461 TN 16 - SSI Quality Reviews - 10/19/2020