Effective Dates: 05/15/2024 - Present Previous | Next

TN 43 (05-24)

DI 22510.014 Telehealth Consultative Examination (THCE) Agreement and Notice

A. Agreement requirement to participate in a THCE

The claimant (parent of a minor child or legal guardian) must agree in advance to the claimant’s participation in a THCE. Disability Determinations Services (DDS) will not schedule the THCE unless:

  • •

    The appropriate individual(s) per DI 22510.014B in this section agrees to participate, and

  • •

    The agreement is documented per DI 22510.014C in this section.

DDS will schedule an in-person consultative examination (CE) in the absence of such agreement.

B. Who must agree to participate in a THCE

IMPORTANT: An appointed representative (AR) may not agree to the claimant's participation on the claimant's behalf.

1. Adult claims

For adults, the claimant (or, if applicable, legal guardian) must agree to the claimant's participation.

2. Child claims

IMPORTANT: The parent or legal guardian of a minor child must agree to be present at the THCE.

a. Children under age 12

For children aged 5 until attainment of age 12, the parent (or, if applicable, legal guardian) must agree to the child's participation.

b. Children over age 12

For children aged 12 until attainment of age 18, both the claimant and parent (or, if applicable, legal guardian) must agree to the child's participation.

C. Obtaining agreement to participate in a THCE

DDS must contact the claimant (parent of a minor child or legal guardian) by telephone or by letter to:

  • •

    Explain the need for a CE,

  • •

    Explain the option to attend a THCE,

  • •

    Explain the claimant requirements for a THCE in DI 22510.013D,

  • •

    If applicable, explain the need for an email address to participate in a THCE, and

  • •

    Ask whether the claimant (parent of a minor child or legal guardian) understands and agrees to participate in a THCE.

IMPORTANT: DDS should not contact the claimant (parent of a minor child or legal guardian) about a THCE until the DDS has made every reasonable effort to obtain evidence from the claimant's medical source(s) and has determined that a CE is needed. For more information on when to purchase a CE, see DI 22510.005.

For Office of Hearing Operations (OHO) procedures for obtaining and documenting agreement to participate in a THCE, see HALLEX I-2-5-20.

1. Contact by telephone

  1. a. 

    When contacting the claimant (parent of a minor child or legal guardian) by telephone, DDS will:

    • •

      Confirm the individual is in a private location in which no one can overhear the conversation,

    • •

      Verify the individual's identity consistent with existing policy for disclosure and identity (DI 39567.210 and GN 00203.020),

    • •

      Advise the individual that personal information will be collected during this telephone call, and

    • •

      Respond to questions, if applicable.

  2. b. 

    After verifying the individual's identity, DDS will read aloud the call script, which provides required information for the claimant (parent of a minor child or legal guardian) to determine their willingness and ability to participate in a THCE and solicits their agreement to proceed with scheduling a THCE. For Children aged 12 until attainment of age 18, read the call script aloud to both the parent or legal guardian and the claimant.

    The call script for adults is here -

    View In PDF

    The call script for adults with a legal guardian is here -

    View In PDF

    The call script for children is here -

    View In PDF

  3. c. 

    DDS will document the telephone conversation (i.e., agreement or lack of agreement to participate in the THCE), along with a copy of the script, in an SSA-5002 (Report of Contact) or a Case Note in the Disability Case Processing System (DCPS) and "write to" the Case Development Worksheet (CDW).

IMPORTANT: If the claimant (parent of a minor child or legal guardian) does not have internet access or requests a copy of the Privacy Act statement for their records, send the full Privacy Act statement by letter.

REMINDER: If the claimant has an AR, the DDS must obtain the AR’s consent to contact the claimant before making direct contact with the claimant (parent of a minor child or legal guardian) by telephone, unless the AR has already given permission to contact the claimant directly. For more information on contacting a represented claimant by telephone, see DI 31001.010B. If the AR refuses to permit direct contact with the claimant by telephone, DDS will send a letter to the claimant with a copy to the AR. Document the telephone conversation with the AR (i.e., consent or lack of consent to contact the claimant) in a Case Note in DCPS and "write to" the CDW.

2. Contact by letter

When contacting the claimant (parent of a minor child or legal guardian) by letter, DDS will send the THCE Agreement Form below.

The THCE Agreement Form for adults is here -

View In PDF

The THCE Agreement Form adults with legal guardians is here -

View In PDF

The THCE Agreement Form for children is here -

View In PDF

If the claimant (parent of a minor child or legal guardian) does not respond to the letter, DDS will schedule an in-person CE.

If the claimant (parent of a minor child or legal guardian) returns the completed THCE Agreement Form, DDS will ensure the form is included in the certified electronic folder (CEF).

NOTE: If the claimant (parent of a minor child or legal guardian) contacts DDS by telephone after receiving the letter, answer questions, if applicable, and document the conversation per DI 22510.014C in this section. If DDS obtains all the required information by telephone, there is no need to return the form.

D. THCE appointment notice from DDS by letter

Follow existing policy for:

  • •

    CE appointment notice and confirmation procedures in DI 22510.016.

  • •

    CE appointment notice follow up and reminder in DI 22510.019.

In addition, the written CE appointment notice must include the following:

1. Technology Information

The written CE appointment notice must include the name of the specific video technology to be used, and:

  • •

    The instructions for how to use the chosen technology and the web address for the appointment, or

  • •

    A statement that the CE source or DDS will send the instructions for how to use the chosen technology and the hyperlink for the appointment.

2. Option to attend a CE in person

The THCE appointment notice must include the statement, “If you decide that you want to attend/you want [name of claimant] to attend an in-person examination instead of a telehealth examination, please call us before the examination so that we can reschedule.”

3. SSA Publication No. 64-126

To help claimants prepare for a THCE, include SSA Publication No. 64-126 Tip Sheet: Preparing for a Telehealth Consultative Examination with the CE appointment notice as an enclosure or include the statement, "See https://www.ssa.gov/pubs/ and type "Tip Sheet" in "Filter by Number or Title" for details on how to prepare for a telehealth consultative examination."

E. THCE information from DDS or CE source by email

The email for the THCE may include:

  • •

    The name of the claimant (parent of a minor child or legal guardian),

  • •

    The appointment date and time,

  • •

    The hyperlink to the appointment, and

  • •

    The instructions for using the video technology.

IMPORTANT: The email cannot mention the appointment is for a disability claim, the type of appointment, or any personally identifiable information (PII) (e.g., SSN or date of birth) about the claimant other than the information authorized in the bullets above. For more information on using email to send PII, see AIMS GAM 15.04.07.

F. CE report content for THCEs

Follow existing policy for:

In addition, the CE report must include:

  • •

    A statement that the CE was conducted using video technology, and

  • •

    The name of the video application used.

 

To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0422510014
DI 22510.014 - Telehealth Consultative Examination (THCE) Agreement and Notice - 05/15/2024
Batch run: 11/01/2024
Rev:05/15/2024