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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Disability Policy

Questions

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