20 C.F.R. Subpart I—Quick Disability Determination Unit and Other State Agency Responsibilities
Title 20 - Employees' Benefits
This subpart describes the standards of performance and administrative requirements and procedures for States making quick disability determinations for the Commissioner under titles II and XVI of the Act. It also establishes the Commissioner's responsibilities in carrying out the disability determination function and what action we will take if the State agency does not meet the quick disability determination processing standard. It supplements, and does not replace, the standards of subpart Q of part 404 or subpart J of part 416 of this chapter. (a) General. We will work with the State to provide and maintain an effective system for processing quick disability determinations. We will provide program standards, leadership, and oversight. We do not intend to become involved in the State's ongoing management of Quick Disability Determination Units, except as is necessary and in accordance with these regulations. The State will comply with our regulations and other written guidelines. (b) Our responsibilities. In addition to the responsibilities we have under §§404.1603 and 416.1003 of this chapter, we will: (1) As described in §405.10 of this part, to the extent practicable, provide medical, psychological, and vocational expertise needed for adjudication of a claim if such expertise is not otherwise available to the State, and (2) Pay the established Federal rate for the State agency's use of any medical or psychological expert affiliated with the national network and arranged by the Medical and Vocational Expert System. (c) Responsibilities of the State. (1) In addition to the responsibilities the State has under subpart Q of part 404 or subpart J of part 416 of this chapter, any State that performs the quick disability determination function will organize a separate Quick Disability Determination Unit that will comply with the requirements set out in this subpart. The unit will use experienced disability examiners in making quick disability determinations. (2) In all States to which this part applies, the medical, psychological, and vocational experts employed by or under contract with the State agency must meet the Commissioner's qualification standards prescribed under §405.10 of this part in order for the State agency to receive reimbursement for the experts' salaries or the cost of their services. Any State that currently performs the disability determination function under subpart Q of part 404 or subpart J of part 416 of this chapter will be deemed to have given us notice that it wishes to perform the quick disability determination function, in lieu of or in addition to the disability determination function. (a) When making a quick disability determination, the State agency will apply subpart B, part 405, of our regulations. (b) The State agency will make quick disability determinations based only on the medical and nonmedical evidence in its files. (c) Quick disability determinations will be made by the Quick Disability Determination Unit and a medical or psychological expert, as defined in §405.5 of this part. (d) The State agency will certify each determination of disability to us in the manner that we prescribe. (e) The State agency will furnish us with all the evidence it considered in making its determination. (f) The State agency will not be responsible for defending in court any determination made, or any procedure for making determinations, under these regulations. The State agency will prepare notices in accordance with §405.115 of this part whenever it makes a quick disability determination. The processing standard for quick disability determinations is processing 98 percent of all of the claims that we refer to the Quick Disability Determination Unit within 20 days from the day each claim is received by the State agency, including Saturdays, Sundays, and holidays. (a) How we determine processing time. For all quick disability determinations, we calculate the number of days, including Saturdays, Sundays, and holidays, from the day the claim is received by the State agency until the day the State agency releases the claim to us or until the day the State agency places the claim into its regular disability claims adjudication process. (b) Frequency of review. We will monitor the processing time for quick disability determinations on a quarterly basis separately from the other State disability determinations. We will determine whether or not the processing standard has been met at the end of each quarter. (c) Provision of performance support for the processing standard. (1) Optional support. We may offer, or a State agency may request, performance support at any time that the regular monitoring and review process reveals that support could enhance performance. The State agency does not have to be below the processing standard described §405.825. Support will be offered, or granted upon request, based on available resources. (2) Mandatory support. We will provide a State agency with mandatory performance support if regular monitoring and review reveal that the processing standard described in §405.825 is not met for one calendar quarter. (3) Support we may provide. In determining what support we may provide, we will apply §§404.1662 and 416.1062 of this chapter. If a State agency does not meet the established processing standard described in §405.825 for two or more consecutive calendar quarters and does not have good cause under §405.840 for failing to meet the processing standard, we will notify the State agency in writing that we propose to find it has substantially failed to comply with our standards regarding quick disability determinations and that it may request a hearing on that issue. After giving the State notice and an opportunity for a hearing, if it is found that a State agency has substantially failed to make quick disability determinations consistent with the Act, our regulations, or other written guidelines, we will assume responsibility for performing the quick disability determination function. We will follow the procedures in §§404.1671 and 416.1071 of this chapter to determine if the State has good cause for not following the Act, our regulations, or other written guidelines. We will follow the provisions of §§404.1675 through 404.1683 and §§416.1075 through 416.1083 of this chapter when we propose to find that the State agency has substantially failed to comply with our standards regarding quick disability determinations. (a) Notice to State. When we find that substantial failure exists, we will notify the State in writing that we will assume responsibility for performing the quick disability determination function from the State agency and the date on which the assumption will be effective. (b) Effective date of assumption. The date of assumption of the quick disability determination function from a State agency may not be earlier than 180 days after our finding of substantial failure, and not before compliance with the requirements of §§404.1692 and 416.1092 of this chapter. (c) Other regulations. The provisions of §§404.1691, 404.1693, 404.1694, 416.1091, 416.1093 and 416.1094 of this chapter apply under this subpart to the same extent that they apply under subpart Q of part 404 and subpart J of part 416 of this chapter.
Title 20: Employees' Benefits
PART 405—ADMINISTRATIVE REVIEW PROCESS FOR ADJUDICATING INITIAL DISABILITY CLAIMS
Subpart I—Quick Disability Determination Unit and Other State Agency Responsibilities
§ 405.801 Purpose and scope.
§ 405.805 Basic responsibilities for us and the State.
§ 405.810 Deemed notice that the State wishes to perform the quick disability determination function.
§ 405.815 Making quick disability determinations.
§ 405.820 Notifying claimants of the quick disability determination.
§ 405.825 Processing standard.
§ 405.830 How and when we determine whether the processing standard is met.
§ 405.835 Action we will take if a State agency does not meet the quick disability determination processing time standard.
§ 405.840 Good cause for not following the Act, our regulations, or other written guidelines.
§ 405.845 Hearings and appeals.
§ 405.850 Assumption of the quick disability determination function when we make a finding of substantial failure.
