[Federal Register: July 10, 2007 (Volume 72, Number 131)]
[Proposed Rules]
[Page 37496-37500]
From the Federal Register Online via GPO Access [wais.access.gpo.gov]
[DOCID:fr10jy07-25]
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SOCIAL SECURITY ADMINISTRATION
20 CFR Parts 404, 405 and 416
[Docket No. SSA 2007-0032]
RIN 0960-AG47
Amendments to the Quick Disability Determination Process
AGENCY: Social Security Administration.
ACTION: Notice of proposed rulemaking.
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SUMMARY: We propose to amend our regulations to extend the quick
disability determination process (QDD), which is operating now in the
Boston region, to all of the State disability determination services.
We also propose to remove from the QDD process the existing
requirements that each State disability determination service maintain
a separate QDD unit and that each case referred under QDD be
adjudicated within 20 days. These proposed actions stem from our
continuing effort to improve our disability adjudication process.
DATES: To be sure that we consider your comments, we must receive them
no later than August 9, 2007.
ADDRESSES: You may give us your comments by: Internet through the
Federal eRulemaking Portal at http://www.regulations.gov; e-mail to
regulations@ssa.gov; telefax to (410) 966-2830; or letter to the
Commissioner
[[Page 37497]]
of Social Security, P.O. Box 17703, Baltimore, MD 21235-7703. You may
also deliver them to the Office of Regulations, Social Security
Administration, 107 Altmeyer Building, 6401 Security Boulevard,
Baltimore, MD 21235-6401, between 8 a.m. and 4:30 p.m. on regular
business days. Comments are posted on the Federal eRulemaking Portal,
or you may inspect them on regular business days by making arrangements
with the contact person shown in this preamble.
FOR FURTHER INFORMATION CONTACT: Vince Sabatino, Social Security
Administration, 6401 Security Boulevard, Baltimore, MD 21235-6401,
(410) 966-8331 for information about this notice. For information on
eligibility or filing for benefits, call our national toll-free number,
1-800-772-1213 or TTY 1-800-325-0778, or visit our Internet site,
Social Security Online, at http://www.socialsecurity.gov.
SUPPLEMENTARY INFORMATION:
Electronic Version
The electronic file of this document is available on the date of
publication in the Federal Register at http://www.gpoaccess.gov/fr/index.html
.
Quick Disability Determinations
We are dedicated to providing high-quality service to the American
public. When we announced changes in March 2006 to our administrative
review process for initial disability claims, we explained that we
expected that the changes would improve disability service. Our
commitment to continuous improvement in the way we process disability
claims did not end with the publication of those rules as we
continually explore ways to improve service to some of the most
vulnerable in our society. We nevertheless face significant challenges
now and in the foreseeable future in our ability to provide the level
of service that disability benefit claimants deserve because of the
increased complexity of and growth in claims for those benefits.
Consequently, we are proposing modifications to our administrative
review process that will further help us provide accurate and timely
service to claimants for Social Security disability benefits and
supplemental security income payments based on disability or blindness.
In early spring 2006, we published a final rule in which we laid
out changes to the administrative review process for initial disability
claims. We expected that the changes would ``improve the accuracy,
consistency, and timeliness of decision-making throughout the
disability determination process.'' 71 FR 16424 (March 31, 2006). We
planned a gradual roll-out of the changes so that we could test them
and their effect on the disability process overall. As we explained
then, ``Gradual implementation will allow us to monitor the effects
that our changes are having on the entire disability determination
process * * *. We will carefully monitor the implementation process in
the Boston region and quickly address any problems that may arise.'' 71
FR at 16440-41. Having thoroughly reviewed the initial determination
level of that process, we have concluded that we need to modify some of
the changes made last spring.
The changes in the March 2006 final rule included establishing, in
the Boston region, an initial-determination-level process to identify
and accelerate the adjudication of the claims of persons who have a
``high degree of probability'' of being disabled, where there was an
expectation that the claimant's ``allegations will be easily and
quickly verified * * * .'' 20 CFR 405.101-.110 (2006). We refer to this
as the Quick Disability Determination (QDD) process. Under QDD, a
predictive model analyzes specific elements of data within the
electronic claims file to identify claims where there is a high
potential that the claimant is disabled and where evidence of the
claimant's allegations can be quickly and easily obtained. Those claims
are then sent to a separate QDD unit in the State agency, where
experienced disability examiners review the claims on an expedited
basis. The QDD process in essence is a workload triaging tool that
helps identify, in an automated fashion, claims where the disability
should be easy to verify.
This process has been working quite well. Because our experience
with QDD has been very favorable, has proven to be of significant
benefit to those claimants who have been affected by it, has been well-
received by the State agencies in the Boston region, and has shown that
there are no significant administrative costs associated with it, we
propose to accelerate our implementation of the QDD process and extend
QDD to all States.
Nevertheless, in order to improve the efficiencies that we have
seen by using the QDD process, we propose to modify those aspects of
the QDD process that have served as a barrier to the type of
outstanding public service that we strive to provide. These proposed
modifications would give State agencies greater flexibility in managing
their QDD workloads. Specifically, we propose to eliminate the
requirement that QDD claims be adjudicated within 20 days of receipt in
the State agency and remove the performance standard and sanction
provisions related to that 20-day adjudication requirement. We also
propose to eliminate the requirement that separate QDD units be
established within the State agencies.
The QDD rules published in 2006 required the State agency to
adjudicate any claim referred to it under QDD within 20 days of the
date the claim was received in the QDD unit; any QDD claim not decided
within this time frame had to be returned by the QDD unit for regular
processing in the State agency. We propose to eliminate this 20-day
requirement for three reasons. First, the early information concerning
processing times for QDD claims is quite promising. The average QDD
processing time for the Boston region State agencies has been
approximately 12 days. For a large majority of the cases, they have
processed claims selected for QDD in 9 days or less, and only a small
minority of the claims exceeded the 20-day threshold. Given this
experience, we are confident that the State agencies will continue to
process the vast majority of QDD claims within 20 days. Eliminating the
20-day requirement will give the State agencies more flexibility in
managing this workload.
Second, even where the processing time goes beyond 20 days, we
believe disability claimants would be better served and the State
agencies' resources would be better utilized by allowing the QDD
examiner to complete the work on the claim, rather than requiring the
examiner to return the claim for regular processing in the State
agency.
Third, we are concerned that the need to obtain evidence within the
20-day period may unduly burden the medical and other providers who
submit that evidence to us, and we have reports of some resistance from
health care providers stemming from efforts to satisfy the 20-day
deadline. In turn, delays in obtaining the evidence might cause an
increasing number of otherwise suitable claims to be removed from the
QDD process because of the 20-day rule.
Though we are proposing to eliminate the 20-day adjudication
requirement to give State agencies greater flexibility, we still
believe that State agencies should strive to adjudicate any claim
referred under QDD within 20 days. We would continue to monitor the
performance of State agencies with these claims and would consider
broadly or selectively reinstituting a formal time deadline if
warranted.
Our second proposed change to the QDD rules would remove the
[[Page 37498]]
requirement that State agencies create separate QDD units to handle the
QDD claims we refer. Our intent when we created that requirement was to
ensure that QDD claims were processed by individuals with the
knowledge, training, and experience to effectively carry out the QDD
function and to ensure that they could be held accountable for
performing this important task. 71 FR at 16429. At the same time, we
recognized the State agencies' need for flexibility in handling their
workloads. 71 FR at 16429. Now that we have some experience with the
QDD process, we believe the requirement of a separate QDD unit in each
DDS is not necessary. Particularly in smaller States, we believe the
requirement of a separate QDD unit may unnecessarily restrict the
flexibility the State agency needs to best address its workloads.
Therefore, we propose to eliminate the requirement that State agencies
create a separate QDD unit. We would retain the existing requirement
that all QDD claims be handled by designated disability examiners who
have the knowledge, training, and experience to effectively carry out
the QDD process. We believe this is sufficient to afford QDD cases the
proper level of attention and accountability.
In light of these considerations, we propose to amend our
regulations to require all State agencies that perform disability
determinations for us to handle claims we refer to them under QDD and
to remove from the QDD rules the 20-day performance standard and the
separate unit requirements discussed above. In addition, because we are
proposing to accelerate our nationwide roll-out of the QDD process
independent of the other changes in the March 2006 final rules, we
would move the substantive QDD rules from part 405 of our regulations
to part 404, subpart Q, and part 416, subpart J, which contain the
provisions covering the State agency determination process.
We recognize that State agencies newly affected by this proposed
roll-out of the QDD process will need a reasonable time to establish
QDD procedures. Therefore, if these rules are adopted as final
regulations, we plan to allow the State agencies outside of the Boston
region a reasonable period of time within which to implement the QDD
process. We would welcome comments from affected State agencies as to
the amount of lead time they believe they would need to implement the
revised QDD process we now propose.
Notices of Initial Determinations
In this rule we also propose to revise the provisions in parts 404,
405 and 416 of our regulations that describe the contents of the
notices we send to inform claimants of our initial determinations on
our claims. The current regulatory provisions, while not substantively
inconsistent with one another, are phrased differently. In order to
avoid any unintended suggestion that we apply different standards when
drafting the notices to which these various sections apply, we propose
to revise the language to be consistent in all three sections. We wish
to emphasize that we are not in any way proposing to change the
substance of what must be in our notices of initial determination, but
rather are simply adopting more uniform language based on the statutory
requirements in sections 205(b)(1), 205(s) and 1631(c)(1)(A) of the
Social Security Act (Act).
Clarity of These Rules
Executive Order 12866, as amended, requires each agency to write
all rules in plain language. In addition to your substantive comments
on these proposed rules, we invite your comments on how to make them
easier to understand. For example:
Have we organized the material to suit your needs?
Are the requirements in the rules clearly stated?
Do the rules contain technical language or jargon that
isn't clear?
Would a different format (grouping and order of sections,
use of headings, paragraphing) make the rules easier to understand?
Would more (but shorter) sections be better?
Could we improve clarity by adding tables, lists, or
diagrams?
What else could we do to make the rules easier to
understand?
Regulatory Procedures
Executive Order 12866, as Amended
We have consulted with the Office of Management and Budget (OMB)
and determined that this proposed rule meets the criteria for a
significant regulatory action under Executive Order 12866, as amended.
Thus, it was reviewed by OMB.
Regulatory Flexibility Act
We certify that this proposed rule will not have a significant
economic impact on a substantial number of small entities as it affects
only States and individuals. Therefore, a regulatory flexibility
analysis as provided in the Regulatory Flexibility Act, as amended, is
not required.
Paperwork Reduction Act
This proposed rule will impose no additional reporting or
recordkeeping requirements requiring OMB clearance.
Federalism Impact and Unfunded Mandates Impact
We have reviewed this proposed rule under the threshold criteria of
Executive Order 13132 and the Unfunded Mandates Reform Act and have
determined that it does not have substantial direct effects on the
States, on the relationship between the national government and the
States, on the distribution of power and responsibilities among the
various levels of government, or on imposing any costs on State, local,
or tribal governments. This proposed rule does not affect the roles of
the State, local, or tribal governments. However, the rule takes
administrative notice of existing statutes governing the roles and
relationships of the State agencies and SSA with respect to disability
determinations under the Act.
(Catalog of Federal Domestic Assistance Program Nos. 96.001, Social
Security--Disability Insurance; 96.002, Social Security--Retirement
Insurance; 96.004, Social Security--Survivors Insurance; 96.006,
Supplemental Security Income.)
List of Subjects
20 CFR Part 404
Administrative practice and procedure; Blind, Disability benefits;
Old-Age, Survivors, and Disability Insurance; Reporting and
recordkeeping requirements; Social Security.
20 CFR Part 405
Administrative practice and procedure; Blind, Disability benefits;
Old-Age, Survivors, and Disability Insurance; Public assistance
programs, Reporting and recordkeeping requirements; Social Security;
Supplemental Security Income (SSI).
20 CFR Part 416
Administrative practice and procedure; Aged, Blind, Disability
benefits, Public assistance programs, Reporting and recordkeeping
requirements; Supplemental Security Income (SSI).
Dated: June 25, 2007.
Michael J. Astrue,
Commissioner of Social Security.
For the reasons set out in the preamble, we propose to amend
subparts J, P and Q of part 404, subparts
[[Page 37499]]
A, B and I of part 405, and subparts I, J and N of part 416 as set
forth below:
PART 404--FEDERAL OLD-AGE, SURVIVORS AND DISABILITY INSURANCE
(1950- )
Subpart J--[Amended]
1. The authority citation for subpart J of part 404 continues to
read as follows:
Authority: Secs. 201(j), 204(f), 205(a), (b), (d)-(h), and (j),
221, 223(i), 225, and 702(a)(5) of the Social Security Act (42
U.S.C. 401(j), 404(f), 405(a), (b), (d)-(h), and (j), 421, 423(i),
425, and 902(a)(5)); sec. 5, Pub. L. 97-455, 96 Stat. 2500 (42
U.S.C. 405 note); secs. 5, 6(c)-(e), and 15, Pub. L. 98-460, 98
Stat. 1802 (42 U.S.C. 421 note); sec. 202, Pub. L. 108-203, 118
Stat. 509 (42 U.S.C. 902 note).
2. Amend Sec. 404.903 by revising paragraphs (x) and (y) to read
as follows:
Sec. 404.903 Administrative actions that are not initial
determinations.
* * * * *
(x) Determining whether to select your claim for the quick
disability determination process under Sec. 404.1619;
(y) The removal of your claim from the quick disability
determination process under Sec. 404.1619;
* * * * *
3. Revise Sec. 404.904 to read as follows:
Sec. 404.904 Notice of the initial determination.
We will mail a written notice of our initial determination to you
at your last known address. The written notice will explain in simple
and clear language what we have determined and the reasons for and the
effect of our determination. If our determination involves a
determination of disability that is in whole or in part unfavorable to
you, our written notice also will contain in understandable language a
statement of the case setting forth the evidence on which our
determination is based. The notice also will inform you of your right
to reconsideration. We will not mail a notice if the beneficiary's
entitlement to benefits has ended because of his or her death.
Subpart P--[Amended]
4. The authority citation for subpart P continues to read as
follows:
Authority: Secs. 202, 205(a), (b), and (d)-(h), 216(i), 221(a)
and (i), 222(c), 223, 225, and 702(a)(5) of the Social Security Act
(42 U.S.C. 402, 405(a), (b), and (d)-(h), 416(i), 421(a) and (i),
422(c), 423, 425, and 902(a)(5)); sec. 211(b), Pub. L. 104-193, 110
Stat. 2105, 2189; sec. 202, Pub. L. 108-203, 118 Stat. 509 (42
U.S.C. 902 note).
5. Amend Sec. 404.1503 by removing the last sentence in paragraph
(a).
Subpart Q--[Amended]
6. The authority citation for subpart Q continues to read as
follows:
Authority: Secs. 205(a), 221, and 702(a)(5) of the Social
Security Act (42 U.S.C. 405(a), 421, and 902(a)(5)).
7. Amend Sec. 404.1602 by adding a definition for ``Quick
disability determination,'' to read as follows:
Sec. 404.1602 Definitions.
* * * * *
Quick disability determination means an initial determination on a
claim that we have identified as one that reflects a high degree of
probability that you will be found disabled and where we expect that
your allegations will be easily and quickly verified.
* * * * *
8. Amend Sec. 404.1603 by revising paragraph (c)(2) to read as
follows:
Sec. 404.1603 Basic responsibilities for us and the State.
* * * * *
(c) * * *
(2) Provide an organizational structure, adequate facilities,
qualified personnel, medical consultant services, designated quick
disability determination examiners (Sec. Sec. 404.1619 and
404.1620(c)), and a quality assurance function (Sec. Sec. 404.1620
through 404.1624);
* * * * *
9. Add a new Sec. 404.1619 under the new undesignated center
heading QUICK DISABILITY DETERMINATIONS to read as follows:
Sec. 404.1619 Quick disability determination process.
(a) If we identify a claim as one involving a high degree of
probability that the individual is disabled, and we expect that the
individual's allegations will be easily and quickly verified, we will
refer the claim to the State agency for consideration under the quick
disability determination process pursuant to this section and Sec.
404.1620(c).
(b) If we refer a claim to the State agency for a quick disability
determination, a designated quick disability determination examiner
must:
(1) Have a medical or psychological consultant verify that the
medical evidence in the file is sufficient to determine that, as of the
alleged onset date, the individual's physical or mental impairment(s)
meets the standards we establish for making quick disability
determinations;
(2) Make quick disability determinations based only on the medical
and nonmedical evidence in the files; and
(3) Subject to the provisions in paragraph (c) of this section,
make the quick disability determination by applying the rules in
subpart P of this part.
(c) If the quick disability determination examiner cannot make a
determination that is fully favorable to the individual or if there is
an unresolved disagreement between the disability examiner and the
medical or psychological consultant, the State agency will adjudicate
the claim using the regularly applicable procedures in this subpart.
10. Amend Sec. 404.1620 by adding a new paragraph (c) to read as
follows:
Sec. 404.1620 General administrative requirements.
* * * * *
(c) Each State agency will designate experienced disability
examiners to handle claims we refer to it under Sec. 404.1619(a).
PART 405--ADMINISTRATIVE REVIEW PROCESS FOR ADJUDICATING INITIAL
DISABILITY CLAIMS
11. The authority citation for part 405 continues to read as
follows:
Authority: Secs. 201(j), 205(a)-(b), (d)-(h), and (s), 221,
223(a)-(b), 702(a)(5), 1601, 1602, 1631, and 1633 of the Social
Security Act (42 U.S.C. 401(j), 405(a)-(b), (d)-(h), and (s), 421,
423(a)-(b), 902(a)(5), 1381, 1381a, 1383, and 1383b).
Subpart A--[Amended]
Sec. 405.5 [Amended]
12. Amend Sec. 405.5 by removing the definitions of the terms
``Quick disability determination'' and ``Quick Disability Determination
Unit.''
13. Amend the appendix to subpart A by removing paragraph (d).
Subpart B--[Amended]
14. Amend Sec. 405.101 by removing from the first sentence the
phrase ``unless it makes a quick disability determination under
Sec. Sec. 405.105-.110'' and the commas that immediately precede and
follow that phrase.
Sec. Sec. 405.105 and 405.110 [Removed]
15. Remove and reserve Sec. Sec. 405.105 and 405.110.
16. Revise Sec. 405.115 to read as follows:
Sec. 405.115 Notice of the initial determination.
We will mail a written notice of our initial determination to you
at your last known address. The written notice will
[[Page 37500]]
explain in simple and clear language what we have determined and the
reasons for and the effect of our determination. If our determination
involves a determination of disability that is in whole or in part
unfavorable to you, our written notice also will contain in
understandable language a statement of the case setting forth the
evidence on which our determination is based. The notice also will
inform you of your right to review by a Federal reviewing official and
explain your right to representation. We will not mail a notice if the
beneficiary's entitlement to benefits has ended because of his or her
death.
Subpart I--[Removed]
17. Remove and reserve subpart I, consisting of Sec. Sec. 405.801
through 405.850.
PART 416--SUPPLEMENTAL SECURITY INCOME FOR THE AGED, BLIND, AND
DISABLED
Subpart I--[Amended]
18. The authority citation for subpart I is revised to read as
follows:
Authority: Secs. 702(a)(5), 1611, 1614, 1619, 1631(a), (c),
(d)(1), and (p), and 1633 of the Social Security Act (42 U.S.C.
902(a)(5), 1382, 1382c, 1382h, 1383(a), (c), (d)(1), and (p), and
1383b); secs. 4(c) and 5, 6(c)-(e), 14(a), and 15, Pub. L. 98-460,
98 Stat. 1794, 1801, 1802, and 1808 (42 U.S.C. 421 note, 423 note,
1382h note).
19. Amend Sec. 416.903 by removing the last sentence in paragraph
(a).
Subpart J--[Amended]
20. The authority citation for subpart J continues to read as
follows:
Authority: Secs. 702(a)(5), 1614, 1631, and 1633 of the Social
Security Act (42 U.S.C. 902(a)(5), 1382c, 1383, and 1383b).
21. Amend Sec. 416.1002 by adding a definition for ``Quick
disability determination,'' to read as follows:
Sec. 416.1002 Definitions.
* * * * *
Quick disability determination means an initial determination on a
claim that we have identified as one that reflects a high degree of
probability that you will be found disabled and where we expect that
your allegations will be easily and quickly verified.
* * * * *
22. Amend Sec. 416.1003 by revising paragraph (c)(2) to read as
follows:
Sec. 416.1003 Basic responsibilities for us and the State.
* * * * *
(c) * * *
(2) Provide an organizational structure, adequate facilities,
qualified personnel, medical consultant services, designated quick
disability determination examiners (Sec. Sec. 416.1019 and
416.1020(c)), and a quality assurance function (Sec. Sec. 416.1020
through 416.1024);
* * * * *
23. Add a new Sec. 416.1019 under the new undesignated center
heading QUICK DISABILITY DETERMINATIONS to read as follows:
Sec. 416.1019 Quick disability determination process.
(a) If we identify a claim as one involving a high degree of
probability that the individual is disabled, and we expect that the
individual's allegations will be easily and quickly verified, we will
refer the claim to the State agency for consideration under the quick
disability determination process pursuant to this section and Sec.
416.1020(c).
(b) If we refer a claim to the State agency for a quick disability
determination, a designated quick disability determination examiner
must:
(1) Have a medical or psychological consultant verify that the
medical evidence in the file is sufficient to determine that, as of the
alleged onset date, the individual's physical or mental impairment(s)
meets the standards we establish for making quick disability
determinations;
(2) Make quick disability determinations based only on the medical
and nonmedical evidence in the files; and
(3) Subject to the provisions in paragraph (c) of this section,
make the quick disability determination by applying the rules in
subpart I of this part.
(c) If the quick disability determination examiner cannot make a
determination that is fully favorable to the individual or if there is
an unresolved disagreement between the disability examiner and the
medical or psychological consultant, the State agency will adjudicate
the claim using the regularly applicable procedures in this subpart.
24. Amend Sec. 416.1020 by adding a new paragraph (c) to read as
follows:
Sec. 416.1020 General administrative requirements.
* * * * *
(c) Each State agency will designate experienced disability
examiners to handle claims we refer to it under Sec. 416.1019(a).
Subpart N--[Amended]
25. The authority citation for subpart N continues to read as
follows:
Authority: Secs. 702(a)(5), 1631, and 1633 of the Social
Security Act (42 U.S.C. 902(a)(5), 1383, and 1383b); sec. 202, Pub.
L. 108-203, 118 Stat. 509 (42 U.S.C. 902 note).
26. Amend Sec. 416.1403 by revising paragraphs (a)(22) and (a)(23)
to read as follows:
Sec. 416.1403 Administrative actions that are not initial
determinations.
(a) * * *
(22) Determining whether to select your claim for the quick
disability determination process under Sec. 416.1019;
(23) The removal of your claim from the quick disability
determination process under Sec. 416.1019;
* * * * *
27. Amend Sec. 416.1404 by revising paragraph (a), removing
existing paragraph (b) and redesignating existing paragraph (c) as
paragraph (b), to read as follows:
Sec. 416.1404 Notice of the initial determination.
(a) We will mail a written notice of our initial determination to
you at your last known address. The written notice will explain in
simple and clear language what we have determined and the reasons for
and the effect of our determination. If our determination involves a
determination of disability that is in whole or in part unfavorable to
you, our written notice also will contain in understandable language a
statement of the case setting forth the evidence on which our
determination is based. The notice also will inform you of your right
reconsideration. We will not mail a notice if the beneficiary's
entitlement to benefits has ended because of his or her death.
* * * * *
[FR Doc. E7-13288 Filed 7-9-07; 8:45 am]
BILLING CODE 4191-02-P