Disability Quality Review (DQR) must use the procedures outlined below when clarification of disability program policy or quality review procedure is necessary, at any time, during the quality review process.

If policy and procedural guidelines or Program Operations Manual System (POMS) instructions do not clarify the disability program or quality review issue requiring resolution, DQRs must refer the case to Quality Studies, Analytics, and Strategy (QSAS), using the process described below.

NOTE : Under no circumstances should DQR submit policy issue referrals directly to Disability Policy (DP) or any other central office component.

When DQR policy or procedure clarification is needed, DQR will submit their question(s) using the Policy Clarification and Field Site Assistance Form located on the QSAS Field Site Home SharePoint.

The information needed to submit a question includes:

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  the subject or topic of the question,

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  the primary requestor's contact information,

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  the type and level of the case associated with the question,

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  the social security number associated with the case,

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  the specific policy issue or question,

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  the proposed resolution, and

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  any applicable policy or procedure references.

Once DQR submits a question using the designated submission form, a notification e-mail will automatically be sent to the ^^RiskQual QSAS Policy Questions mailbox.

The mailbox leads in QSAS will assign the question to a QSAS staff member(s) and change the status on the submission form to "Assigned".

NOTE : The individual designated as the "Primary Requestor", and all other individuals listed in the "Notify Other Users" field on the submission form, will receive automatic e-mail notifications upon initial submission of a question, when a question is referred to another component, and when the response to the question is completed by QSAS staff members.

For pending cases, the assigned QSAS staff member(s) will respond to the submitted question in:

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  two business days, if the question can be answered with QSAS input alone, or

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  seven business days, if the question requires multi-component collaboration and input.

For closed cases, the assigned QSAS staff member(s) will respond to the submitted question in:

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  five business days, if the question can be answered with QSAS input alone, or

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  fourteen business days, if the question requires multi-component collaboration and input.

If the assigned QSAS staff member(s) is unable to provide a response within the allotted time, that staff member will provide a status update, via e-mail, to all of the DQR staff designated on the original submission form and send a copy of the e-mail to the ^^RiskQual QSAS Policy Questions mailbox.

When DQR disagrees with a response provided by a QSAS staff member(s), and the POMS reference at issue is owned by QSAS, DQR will send an e-mail to the ^^RiskQual QSAS Policy Questions mailbox with a detailed explanation of the disagreement.

To ensure proper routing and expedite the resolution process, the subject line of the e-mail should include:

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  the word "disagreement",

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  the Request ID # associated with the initial question, and

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  any other pertinent information that may assist in the resolution process (e.g., case status, additional relevant POMS, new developments, etc.).

Upon receipt of DQR's disagreement e-mail, the question will be assigned to a different QSAS staff member(s), who did not participate in the initial response, for resolution and to help ensure that additional input is impartial. The newly assigned QSAS staff member will send a "Reply All" response to the submitting DQR's disagreement e-mail, within one business day, to acknowledge receipt.

The QSAS time frames for resolving disagreements are as follows:

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  two business days for pending cases and

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  five business days for closed cases.

If the assigned QSAS staff member(s) is unable to provide a response within the allotted time, that staff member will provide a status update, via e-mail, to all of the DQR staff designated on the original submission form and send a copy of the e-mail to the ^^RiskQual QSAS Policy Questions mailbox.

Once the disagreement is resolved, the assigned QSAS staff member(s) will forward a draft response, via e-mail, to the QSAS Branch Chief for review, approval, and final release to the involved DQR.

When DQR disagrees with a response provided by a component outside of QSAS, and the policy at issue is owned by the outside component, DQR will send an e-mail to the ^^RiskQual QSAS Policy Questions mailbox with a detailed explanation of the disagreement.

To ensure proper routing and expedite the resolution process, the subject line of the e-mail should include:

• •

  the word "disagreement",

• •

  the Request ID # associated with the initial question, and

• •

  any other pertinent information that may assist in the resolution process (e.g., case status, additional relevant POMS, new developments, etc.).

Upon receipt of DQR's disagreement e-mail, the question will be assigned to the same QSAS staff member(s), who participated in the initial response, for resolution. The QSAS staff member(s) will send a "Reply All" response to the submitting DQR's disagreement e-mail, within one business day, to acknowledge receipt.

The QSAS time frames for resolving disagreements are as follows:

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  seven business days for pending cases and

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  fourteen business days for closed cases.

If the assigned QSAS staff member(s) is unable to provide a response within the allotted time, that staff member will provide a status, via e-mail, to all of the DQR staff designated on the original submission form and send a copy of the e-mail to the ^^RiskQual QSAS Policy Questions mailbox.

Once policy clarification is received from the outside component, the assigned QSAS staff member(s) will prepare a response to the involved DQR and update the resolution in the Policy and Procedure Clarification and Field Site Assistance Request Form.