From Emergency Message EM-25009 issued last Friday:
This emergency message (EM) provides the Disability Determination Services (DDS) and federal disability adjudicating components with disability case processing guidance for Disability Examiner Decisional Authority (DEDA). DEDA will temporarily allow qualifying disability examiners to make fully favorable disability determinations in adult cases based on physical impairments alone without medical review by medical consultants (MC), but with the flexibility to consult with an MC at the disability examiner’s discretion.
These temporary instructions apply to initial level claims, including initial-level claims pending at the DDS and federal disability case processing sites (DPB, DPU, etc.).
The Social Security Administration (SSA) faces unprecedented initial disability claims backlogs surpassing the 1.12 million case mark, resulting in high average processing times and claimant wait times. A contributing factor to the increase in average processing time is the general requirement that qualified physicians, psychiatrists, and psychologists (referred to in our policy as medical consultants (MC) and psychological consultants (PC)) complete the medical review of all initial level disability determinations combined with an insufficient number of MCs and PCs. See Section 221(h).….
If this issue comes up in your confirmation hearing, Frank Bisignano, what say you?
17 comments:
Would this unprecedented initial disability claims backlog have an affect on SSA 455 disability update form processing?
I am a former SDM (single decision maker) adjudicator. This system worked well when we had it before. Medical consultants take forever to review cases and in my experience, typically didn't do a very comprehensive job because they are paid a flat fee per case reviewed and there is no incentive for them to actually review everything as thoroughly as they should. I expect this will be a positive change for deserving claimants. They are using seasoned adjudicators for this work and they are at least as qualified as ALJs to make these decisions.
We used to be able to do this but only with certain impairments. A newborn weighing 700 grams for example. They took that away when there was a marginally increased approval rate. There was no increased error rate
Frank Bisignano will NOT implement this EM but ending telework is on top of his agenda.
I suppose it's harmless given it's only as to favorable determinations...but isn't this directly in violation of 42 USC § 421(h)?
I used to be able to do this with all physical impairments when I was a SDM 20 years ago.
Interesting that EM directs agency/DDS to use telework as an incentive to lure MCs to work for SSA/DDS. lol
Guess MCs won't have to RTO.
Regarding the comment about telework, even if the new commissioner wants to end telework, the SSA disability program is administered by the states. Wouldn't telework/no telework be at the discretion of each state's governor?
Yes
I have more confidence in some of the examiners' judgment than I do in some of their alleged doctors.
This is illegal. It's really a backdoor way to get examiners to complete 416, RFC, & PRT/MRFC for the MCs to "review & sign" or rubber stamp. I work in a DPB in a PC. I was never a SDM. I thought per codified federal law, SDM were now illegal (SDM downfall started with Hallex I-5-4-61. Goodnight v. Apfel, I think). Then 42 USC § 421(h) was codified eventually.
For the past few years management has told us there's been a shortage of MCs. They've started pushing DPSs in DPB to complete ALL the forms (416, RFC, PRT/MRFC) for the MCs. Last year we had some half-ass, bs "training" where we were told "it's just your opinion" and "there are no right or wrong answers" when we complete these forms. You don't have a phys MC complete a PRT/MRFC or vice versa, but management expects examiners to do it. We were also told to "try" and complete vision & special senses ratings (when some phys MCs can't even complete these ratings. lol). Why not? "It's just your opinion" & "There are no right or wrong answers". We had one training session from a regional office (think it was Denver) and we were told by one "trainer" we didn't have to read every page of MER. Just to "show our face to it".
SSA is in dire straits from top to bottom. People are already packing their bags in my office. 25-30% of staff can retire. When telework ends, the ship will be practically deserted.
By the way, a few years back when this bootleg SDM crap was first resurrected I talked to a DDS examiner in a New England DDS. She told me that the old SDMs in her office were still completing the RFC, but not PRT/MRFC, etc. She said these "old" SDMs were not considered to be examiners but alternate managers/supervisors, and that they were paid on the management scale (not examiner). She also said examiners in her region were no longer being trained to complete the forms. I guess since it is, you know, ILLEGAL.
I'm curious about how DDSs in other regions are doing this.
I was a SDM and with the knowledge given after they did away with SDM’s is not the same and will take months of training to get employees subpar to do the work properly. This is a disadvantage to the recipients but it’s about the numbers and not doing things correctly.
I guess I'm a little confused procedurally how this would work. Reviewer, without MC, decides that there's not enough to approve, does it then go to an MC? If so, does the Reviewer's notes/opinions make it into the file which can then be used by an ALJ for the basis of denial, or does that just go away?
Yes. Like I said, I think it's a way to get examiners to complete the RFC for the MCs. If examiner cannot make a fully favorable decision, it would be referred to MC for review. Per this EM, it is for physical cases only.
DPB employees in my region had training prior to the EM where management was pressing DPS/examiners to "try" (and I hear in some regions they are being forced to) and complete 416s, RFCs, PRT/MRFCs. Essentially, complete forms/reviews for physical, special senses and mental ratings.
Per 404.1616 Code of Federal Regulations: "The medical consultant completes the medical portion of the case review and any applicable residual functional capacity assessment about all physical impairment(s) in a claim." And "The psychological consultant completes the medical portion of the case review and any applicable residual functional capacity assessment about all mental impairment(s) in a claim. When we are unable to obtain the services of a qualified psychiatrist or psychologist despite making every reasonable effort (see § 404.1617) in a claim involving a mental impairment(s), a medical consultant will evaluate the mental impairment(s)."
DPS/examiners notes & case summary on FOFAE are how they "assist" the MCs with completing the applicable forms. Our position descriptions states that we "assist", not complete the forms for the MCs.
Since there is a shortage of MCs, management is now wanting examiners to complete the forms for the MCs to "review and sign". This appears to violate federal law.
In other words, it's a way to get examiners (without medical degrees or licenses) to do MC work, but not get MC $$$.
I don’t see the disadvantage to claimants as the decisions were quicker and more favorable. I have been doing this job for 44 years in three DDSs and examiners have always prepared the forms for the doctors to review and sign. I am aware of one state that they do not. It is in New England. Some of their cases have been sent to other offices for their doctors to prepare and sign. So maybe that is the state that will take months of preparation to do as SDMs. Coincidentally there is an OQR in that city so maybe that is why we occasionally receive ridiculous OQR returns since feds often hire DDS
Yes. But applicants will know that they are ultimately working for SSA, and will be aware of its reputation for treating its employees like robot slaves.
As a DDS employee, I know doctors sign 200+ cases a day. Time stamps indicate doctors take less then 2 minutes to review and sign RFCs. Medical consultants in my state are paid by the case. If I have objective evidence of this occurring, any suggestions on how to report this? I don’t expect this new single decision maker initiative is going to help since examiners are essentially single decision makers already
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