Articles from prior issues of The Advocate

January/February, 1996

NADE Reviews Progress Of Task Teams

The Early Decision Process Early Adjudication/Disability Claims Manager Task Team From Martha Marshall and Al Kamnick as directed by the NADE Board, report dated April 12, 1995

THE NATIONAL ASSOCIATION OF DISABILITY EXAMINERS (NADE) supports the concept of an early decision process (EDP). We believe that the EDP enhances both the claims representative (CR) and the Disability Examiner (DE) positions. It allows the CR to make some medical decisions, thereby expediting payment for many of the most severely disabled applicants. At the same time, the training and experience of the DE is not overlooked. The current training for a DE entails a minimum of 7 to 9 months of introductory training followed by another two years of adjudication before that individual can be considered a qualified DE. The EDP appropriately recognizes the training and expertise.

We do have concerns about the Early Decision list (EDL). Mental retardation, for example, can rarely be adequately evaluated with one or two pieces of medical evidence. Similarly, AIDS and HIV claims are among the most complex cases for us to adjudicate. If those remain on the EDL, they should be considered for PD only, not for final decision.

The report does not discuss any type of quality review. NADE feels it is important that these claims be subject to a routine Pre-effectuative review. We firmly believe that a common standard must be used at all levels--by the CR, the DE, the AO (Adjudication Officer), and the ALJ (Administrative Law Judge). Also, as there are no physicians at the place of application, the final EDP decisions should be countersigned by a DDS physician to insure the accuracy of the medical documentation. This will provide uniform requirements for both the DE and CR which is paramount in maintaining consistent and accurate decisions.

We support the Disability Claims Manager (DCM) team scenarios. These expedite receipt of the case to the person able to make the Final Decision. They also recognize the unique skills of both the DE and CR.

NADE continues to believe that the position of the DCM cannot be handled by one individual as the degree of training and experience in the technical, medical and legal areas is immense. However, it is very feasible for this position to be handled by the partnership of the CR and DE.

NADE wishes to thank you for the opportunity to participate on this Task Team and to comment on these proposals.

The CE/MER Provider Training Task Team by Nina Rabalais, Debi Gardiner and Terri Spurgeon as directed by the NADE Board, report dated April 19, 1995

These are our comments on recommendations from the CE/MER Provider Task Team:

1)We feel that Central Office providing sufficient resources to implement an outreach, education and monitoring program is extremely important. It is also felt that the production and distribution of national CE/MER provider training materials is long overdue.

2)We agree with recommendation of a national training package as proposed by the CE/MER Provider Training Task Team. 3)We agree with the Task Team in regard to ongoing, professional outreach/educational programs to the medical community and also agree that an annual DDS sponsored seminar would be beneficial; however, making this a requirement for CE providers to attend may have adverse effects.

4)We agree with the Task Team that universal guidelines should be established on preparation of the functional assessment.

5)We agree with the importance of the Professional Relations Officers and restricting their full time duties to those listed in the current POMS regulations. The PROs, along with the Field Representatives, are crucial to implementing recommendations should a national disability/public affairs training summit be held.

6)We strongly agree and encourage accessibility of information resource materials for MER providers. This should be included in SSA’s outreach/educational budget.

7)We agree that the function of the DDS Quality Assurance Units can be expanded to include a sample review of each CE providers’ reports for quality and completeness.

8)Following review of the Task Team’s Cost Considerations, we would like to point out that many of these recommendations could be implemented immediately with current resources. Nina would like to extend her appreciation for allowing her to participate on the Task Team and we would like to thank you for the opportunity to comment on these recommendations.