Identification Number:
DI 12015 TN 15
Intended Audience:See Transmittal Sheet
Originating Office:ORDP ODP
Title:Disability Redesign Tests
Type:POMS Transmittals
Program:Disability
Link To Reference:
 

PROGRAM OPERATIONS MANUAL SYSTEM
Part DI – Disability Insurance
Chapter 120 – Appeals Processing
Subchapter 15 – Disability Redesign Tests
Transmittal No. 15, 11/19/2018

Audience

FO/TSC: CS, CS TII, CS TXVI, CSR, CTE, DRT, FR, OA, OS, RR, TA, TSC-CSR;
PSC: CS, DE, DEC, DTE, ICDS, IES, ISRA, RECONR, SCPS, TSA, TST;
ODD-DDS: REF;
OCO-OEIO: BET, CR, ERE, FCR, FDE, RECONE, RECONR, RECOVR;
OCO-ODO: BET, CR, CST, CTE, CTE TE, DE, DEC, DS, PETE, PETL, RCOVTA, RECONE, RECOVR;
OHO/OAO: OHAAC, OHACO (SAWDY), OHAHOs, OHAROs;

Originating Component

ODP

Effective Date

Upon Receipt

Background

Section 832 of the Bipartisan Budget Act (BBA) of 2015, requires the Commissioner of Social Security to make every reasonable effort to ensure that in all initial disability determinations a qualified physician (where a physical impairment is alleged) or a qualified psychiatrist or psychologist (where a mental impairment is alleged) complete the medical review of the file and any applicable residual functional capacity (RFC) assessment.

Essentially, section 832 of the BBA ends the single decisionmaker (SDM) model of the testing modifications to the disability determination procedures. Since passage of the BBA of 2015, SSA has been working to end the SDM model. In a notice published in the Federal Register on August 25, 2016, we stated that we would phase out the SDM model by December 28, 2018. We are planning to end the SDM model in all Prototype and SDM II States effective on October 1, 2018. With the elimination of the SDM model, SDM II States will no longer exist.

 

Summary of Changes

DI 12015.003 The FPM Disability Claims Process

This section is obsolete.

 

DI 12015.006 FO Procedures - Case is No Longer Part of the Test

This section is obsolete.

 

DI 12015.100 Disability Redesign Prototype Model

Subsection A- We added the acronym “SDM” following the text “single decisionmaker.”

Subsection B- We explain that section 832 of the BBA terminates the SDM test. We added language explaining the publication of a regulation and the subsequent termination of SDM by December 28, 2018. We also corrected language to recognize the Office of Hearing Operations, formerly the Office of Disability Adjudication and Review (ODAR).

Subsection C – We removed all references to SDM II States.

DI 12015.100 Disability Redesign Prototype Model

A. Background

The Social Security Administration (SSA) has tested several disability process initiatives to improve the disability determination process. Some of those tests have been stand-alone tests, while others tested various combinations of modifications to the disability determination procedures. In 1997, we tested the Disability Redesign Full Process Model (FPM). The FPM initially tested four initiatives, the:

  1. 1. 

    Single decisionmaker model,

  2. 2. 

    Predecision interview model,

  3. 3. 

    Reconsideration elimination model, and

  4. 4. 

    Adjudication Officer model.

SSA later:

  • combined a test of the elimination of the Appeals Council request for review with the FPM and tested the elimination of the Appeals Council request for review as an adjunct to the FPM test;

  • identified the most successful elements of the FPM pilot and used them to create the Disability Redesign Prototype model; and

  • began testing the Disability Redesign Prototype model in the Disability Determination Services in 10 States in October 1999.

See details:

DI 12015.001 Introduction for Disability Redesign Tests

B. Disability redesign prototype model

The Disability Redesign Prototype model test features included the:

  1. 1. 

    Single decisionmaker (SDM) model

    Disability Examiners with SDM authority completed all disability determination forms and made initial disability determinations in many cases without medical or psychological consultant (MC or PC) signoff. MC review and signoff was required for all Title XVI childhood disability claims and for all Title II and Title XVI less than fully favorable determinations involving a mental impairment.

    Section 832 of the Bipartisan Budget Act of 2015 (BBA) requires the Commissioner to make every reasonable effort to ensure that in all initial disability determinations a qualified physician (where a physical impairment is alleged) or a qualified psychiatrist or psychologist (where a mental impairment is alleged) complete the medical review of the file and complete any applicable residual functional capacity (RFC) assessment. Therefore, section 832 of the BBA requires us to end the SDM test. In a notice published in the Federal Register on August 25, 2016, we stated that we would phase out the test by December 28, 2018. We are ending SDM authority in all Prototype and SDM II States by October 1, 2018.

    Effective October 1, 2018, Prototype continues without the use of SDM.

  2. 2. 

    Reconsideration elimination model

    There is no reconsideration step of the administrative review process for disability issues. The field office (FO) sends initial determination appeals on disability issues to the Office of Hearings Operations (OHO) for a hearing, as the first step in the administrative appeals process.

C. Test States

There are 10 States participating in the Prototype test:

  1. 1. 

    Alabama,

  2. 2. 

    Alaska,

  3. 3. 

    California (Los Angeles North and Los Angeles West Branches),

  4. 4. 

    Colorado,

  5. 5. 

    Louisiana,

  6. 6. 

    Michigan,

  7. 7. 

    Missouri,

  8. 8. 

    New Hampshire,

  9. 9. 

    New York, and

  10. 10. 

    Pennsylvania.

D. Prototype operating instructions manual

The procedures for processing claims under the prototype test are in the Prototype Operating Instructions Manual. A copy of the manual is available on the Internet at http://www.ssa.gov/disability/Documents/Prototype_Operating_Instructions.doc and on the Office of Disability Determinations intranet website at: http://oddweb.ssahost.ba.ssa.gov/disability-processes/sdm-prototype/default.htm.

NOTE: Some processing instructions in the manual may no longer be current due to electronic disability processing enhancements.

 


DI 12015 TN 15 - Disability Redesign Tests - 11/19/2018