National Association of Disability
Examiners
Art Spencer
Associate Commissioner
Office of Disability ProgramsSeptember 14, 2010
Disability Policy
ODP Develops• “Implementable” policy • Practical solutions to improve the disability process
- Simple - Unified
• Enhanced regulations, policies, and procedures• Real-world standards to exchange information with
public and private sectors• Policy Link with Technology• Assistance with Capacity Strategy Planning
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Use of Technology with Policy
Integrate policy in technology to provide user-friendly “policy-driven” tools that are operationally realistic
Electronic Case Processing and Policy:• eCAT• Disability Case Processing System (DCPS)• Request for Program Consultation (RPC)• Policy Feedback System (ePFS)• Electronic Consent Process (eAuthorization)• Health Information Technology (HIT)
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Technology and Policy: Electronic Claims Analysis Tool (eCAT)
eCAT is a policy compliant web-based application designed to:
• Guide users through the sequential evaluation process
• Aid users in documenting, analyzing, and adjudicating the disability claim
• Use intelligent pathing and quality checks• Produce a detailed record to support the
determination
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Technology and Policy: Disability Case Processing System (DCPS)
DCPS is a single claims processing system that is “Policy-Driven”
ODP’ s Role:• Provides policy support• Collaborates with outside components into
DCPS functionCurrent Status – Office of Acquisition and Grants is working on award preparation tasks. A contract award is expected in September 2010
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Request for Program Consultation
RPC Goal: Improve accuracy and consistency
• Processed over 3,000 cases to date• Identifies difficult policy issues for
clarification• Drives ODP policy priorities
Request for Program Consultation
RPC Modifications – Version 7.0
• Available on August 23, 2010 • Enhanced Management Information (MI),
including comparative reports • Enhanced Search Capabilities, such as:
Program diagnosis codeDeficiency typeRPC Findings (e.g. Rescission or Affirmation)
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Policy Feedback System (ePFS)
ePFS is a web-based tool to analyze trends and emerging decisional issues
• Provides an empirical basis for policy changes • Provides customizable reports and drill-down
capabilities to view data
• Full access and training for Regions and DDSs –
Coming soon!
eAuthorization
eAuthorization• Electronic authorization that eliminates the
need for a wet signature on the SSA-827
• Minimal change to the current SSA-827• Communicate with medical providers and
national organizations early
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Health Information Technology - MEGAHIT Prototype
Medical Evidence Gathering & Analysis Prototype MEGAHIT
Electronic system that automatically requests/obtains medical data from participating medical facilities in minutes (or less)• Systematically analyzes the data (codified medical
information) against SSA medical impairment listings
• Generates alert to examiner of a potential listing level impairment
• HIT Medical Evidence appears in the Electronic Folder usually before DDS receipts the case
Policy Simplification and Unification
• Integrated Disability Process (IDP)• Medical Listings, including Outreach and Feedback• Compassionate Allowances
• Military Casualty and • Collaboration with VA/DOD (e.g. Single
Collaborative Examinations)
• Online Disability Case Studies
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Integrated Disability Process
IDP is a collaborative initiative that identifies and
resolves long-standing disability issues.
Topics now being addressed are:
• Medical Source Statement
• Past Relevant Work
• Unified Disability Training
Listings Updates
Six body systems left to complete a comprehensive overhaul of the Listings:
• Mental Disorders• Neurological• Growth Impairment (Childhood Only)• Hematological Disorders• Respiratory System• Musculoskeletal System
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Medical Listings StatusThe following are at Pre-Rule Stage – Before ANPRM:
• Special Senses – Vision• Malignant Neoplastic Diseases• DAA
The following are between ANPRM & NPRM:• Cardiovascular System• Skin Disorders• Impairments That Affect Multiple Body Systems• Genitourinary Impairments• Digestive System• Immune System Disorders
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Medical Listings Status
The following are between NPRM and Final Rule:
Final Rules Published– Special Senses – Hearing Loss-Published June 2010
NPRM Published – Preparing Final Rules– Endocrine System
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Emerging Developments Disability Program Policy-Medical
Listings Effectiveness• Hosting listings effectiveness symposiums under the
sponsorship of the Institute of Medicine. Stakeholders to share ideas and suggestions to make the listings more useful and effective – NADE Represented
• Improving the way we get feedback on the listings by using a web tool for ongoing feedback
• Medical EquivalenceImproved guidance for how to considerMake POMS consistent with regulations
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Percentage of All Initial Adult Allowances that Meet a Medical Listing by Body System
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0
10
20
30
40
50
60
70
80
90
100
1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009
MUSCULOSKELETAL
SPECIAL SENSES + SPEECH
RESPIRATORY SYSTEM
CARDIOVASCULAR SYSTEM
DIGESTIVE SYSTEM
GENITO-URINARY SYSTEM
HEMIC + LYMPHATIC SYSTEM
SKIN
ENDOCRINE SYSTEM
MULTIPLE BODY
NEUROLOGICAL
MENTAL DISORDERS
NEOPLASTIC DISEASES
IMMUNE DEFICIENCY
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Listings Effectiveness - IOM
Contract with the National Academy of Sciences, Institute of Medicine (IOM) that includes:
• Standing Committee of medical experts• IOM will survey medical literature and note
advances in technology to help us keep the listings current. Examples:Cardiovascular HIV-AIDS
Compassionate Allowances
• Single Decision Maker for QDD and CALAllow State Agency Disability Examiners to make fully
favorable determinations in adult cases under QDD and CAL criteria
More efficient service
• Compassionate Allowance List expansion – Phase 3 List expansion is planned for FY 2011
• Compassionate Allowance Outreach Hearing on Cardiovascular Disease and Organ Transplants will be held 11/9/2010.
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Military Casualty Initiative
• Building good relationships with Military Commanders, Liaisons, and Advocacy Groups
• Educate service members and their families about disability benefits
• Further collaboration with VA/DOD information exchange initiatives
• Maintain outreach at some Military Treatment Facilities nationwide
• Early identification of Wounded Warriors• FOs and DDSs partner to provide expedited service
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Disability Training
• Provides Policy review of disability training for Disability Examiners, Decision Writers and ALJs
• Coordinates IVTs with Office of Learning, including bi-monthly Disability Topics
• Conducts Vocational Specialist Train-the-Trainer Classes• Developing Sequential Evaluation Policy Training
(SEPT) case studies
• Developing Web-based Disability Case Studies
• Developing MC/PC Handbook
Emerging Developments Disability Policy-Vocational
• Onset Rulings• Recontacting Regulation • Failure to Cooperate• Symptoms and Credibility Desk Guide• Medical Source Opinion Desk Aide • Vocational Training Webpage• Sustainability and RFC Assessment• Expediting Vocational Assessment at Steps 4 and 5 of
Sequential Evaluation• Considering adding to Acceptable Medical Sources
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Capacity Strategy
ODP Supports DDS Capacity Strategy by:• CE Expedients AM-10109
When and when not to purchaseMDI in existing evidence
• Mental and Physical Expedients DI 24505.030How to determine if further development is necessaryHow to complete forms accordingly
• Reconsideration AM-09106Reminders and Best PracticesSound determination at earliest level
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Capacity Strategy, Continued
• SDM for CAL and QDD• Failure to Cooperate POMS Revision• Medical Consultant/Psychological
Consultant (MC/PC) Handbook
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CE Expedients AM-10109
CE Expedients
Provides guidance for adjudicators in determining when a CE is, or is not, necessary.
• When to purchase a CE, DI 22510.005 • When Not to Purchase a CE, DI 22505.006• Also has Reminders, Best Practices, and
Exampleshttp://policynet.ba.ssa.gov/reference.nsf/links/08062010023215PM
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Mental/Physical Expedients
Mental and Physical Expedients DI 24505.030
Provides guidance for adjudicators in:• How to determine if further development of a
potential mental or physical impairment is necessary
• How to expedite processing of such cases
http://policynet.ba.ssa.gov/poms.nsf/lnx/0424505030.
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Reconsideration AM-09106
Reconsideration reminders include:• Preparation of the Reconsideration Determination• Affirmation of the Previous Determination• Revision of the Prior Determination• Implementation of Simplified Decision Rationale• Case Processing Requirement Reminders
http://policynet.ba.ssa.gov/reference.nsf/links/08212009013330PM
.
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Expediting Steps 4 and 5
Expediting Vocational Assessment at Steps 4 and 5 of Sequential EvaluationAllows for:• Administrative efficiency• Greater flexibility in developing vocational
evidence
POMS DI 25005.005 will be issued soon after IRD and then a regulation will be drafted
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Acceptable Medical Sources
Acceptable Medical Sources
ODP is:• Considering adding nurse practitioners, physician
assistants, and possibly licensed clinical social workers, and audiologists
• OQP studying how these sources may have established an MDI
• Must assure nationwide consistency regarding education, training, licensure, and certification
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