National Association of Disability Examiners Art Spencer Associate Commissioner Office of Disability Programs September 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 2

3 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)

4 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

5 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 function Current Status – Office of Acquisition and Grants is working on award preparation tasks. A contract award is expected in September 2010

6 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 code  Deficiency type  RPC Findings (e.g. Rescission or Affirmation) 7

8 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 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 9

10 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 11

12 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 13

Medical Listings Status The 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 14

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 15

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 Equivalence  Improved guidance for how to consider  Make POMS consistent with regulations 16

Percentage of All Initial Adult Allowances that Meet a Medical Listing by Body System 17

18 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 CAL  Allow 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/

20 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

21 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 22

Capacity Strategy ODP Supports DDS Capacity Strategy by: CE Expedients AM  When and when not to purchase  MDI in existing evidence Mental and Physical Expedients DI  How to determine if further development is necessary  How to complete forms accordingly Reconsideration AM  Reminders and Best Practices  Sound determination at earliest level 23

Capacity Strategy, Continued SDM for CAL and QDD Failure to Cooperate POMS Revision Medical Consultant/Psychological Consultant (MC/PC) Handbook 24

CE Expedients AM CE Expedients P rovides guidance for adjudicators in determining when a CE is, or is not, necessary. When to purchase a CE, DI When Not to Purchase a CE, DI Also has Reminders, Best Practices, and Examples PMhttp://policynet.ba.ssa.gov/reference.nsf/links/ PM. 25

Mental/Physical Expedients Mental and Physical Expedients DI 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 26

Reconsideration AM 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 PMhttp://policynet.ba.ssa.gov/reference.nsf/links/ PM. 27

Expediting Steps 4 and 5 Expediting Vocational Assessment at Steps 4 and 5 of Sequential Evaluation Allows for: Administrative efficiency Greater flexibility in developing vocational evidence POMS DI will be issued soon after IRD and then a regulation will be drafted 28

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 29

Disability Policy Questions 30