SSA ORGANIZATIONAL MANUAL

Chapter TK

OFFICE OF QUALITY PERFORMANCE


  1. Mission

    The Office of the Deputy Commissioner, Quality Performance directs the development of innovative changes to the current Agency quality management program, including the program’s initiatives and mechanisms not clearly delineated by statutory authority. Such changes may affect Agency-wide quality in terms of its programs, policies, and procedures. The Office of Quality Performance (OQP) is responsible for rendering formal advice and recommendations to Agency executives on a range of issues relating specifically to in-line and end-of-line quality performance management in each of the Agency's core business areas. It works with Deputy Commissioner-level components to direct the Agency-wide quality performance management program, its policies, and initiatives.
  2. Organization
    1. The Deputy Commissioner, Office of Quality Performance (TK).
    2. The Assistant Deputy Commissioner, Office of Quality Performance (TK).
    3. The Immediate Office of the Deputy Commissioner, Quality Performance (TKA).
      1. The Systems Support Staff (TKA-2).
    4. The Office of Quality Review (TKB).
      1. Division of Title II Quality and Special Studies (TKBA).
      2. Division of Title XVI Quality (TKBC).
      3. Division of Disability Initial (TKBE).
      4. Division of Disability Appeals (TKBG).
      5. Division of Public Service Evaluation (TKBH).
      6. Division of Review Automation Support (TKBJ).
      7. The Office of Field Site Operations (TKG-F1 to TKG-FX and TKGA)
        1. Boston (TKG-F1)
        2. New York (TKG-F2)
        3. Philadelphia (TKG-F3)
        4. Atlanta (TKG-F4)
        5. Chicago (TKG-F5)
        6. Dallas (TKG-F6)
        7. Kansas City (TKG-F7)
        8. Denver (TKG-F8)
        9. San Francisco (TKG-F9)
        10. Seattle (TKG-FX)
        11. Baltimore (TKGA)
    5. The Office of Quality Improvement (TKC).
      1. Division of Continuous Improvement Programs (TKCB).
      2. Division of Automated Solutions (TKCC).
      3. Division of Management Analysis (TKCE).
      4. Division of Modeling (TKCG).
      5. Division of Software Application Support (TKCH).
      6. Division of Continuing Disability Reviews Support (TKCJ).
  3. Functions
    1. The Deputy Commissioner, Quality Performance (TK) is directly responsible to the Commissioner for carrying out the OQP’s mission and providing general supervision to the major components of the OQP.
    2. The Assistant Deputy Commissioner, Quality Performance (TK) assists the Deputy Commissioner in carrying out his/her responsibilities and performs other duties as the Deputy Commissioner may prescribe.
    3. The Immediate Office of the Deputy Commissioner, Quality Performance (TKA) provides the Deputy Commissioner with management support on the full range of his/her responsibilities.
      1. The Systems Support Staff (TKA-2) is responsible for directing and managing the configuration, monitoring, and support of OQP’s nationwide network, data processing, and intranet infrastructures. Serves as the liaison with the Office of Systems on national network infrastructure and other systems projects; prioritizes and procures all necessary OQP hardware and software; supports all OQP LAN servers for installation, configuration, maintenance, and support; assists and supports local user desktop support services; and maintains OQP information technology assets inventory. Maintains the component web development and production platforms. Serves as the OQP component security office, ensuring the security and integrity of OQP data nationwide.
    4. The Office of Quality Review (TKB) reviews, evaluates, and reports on the integrity and quality of the administration of Social Security programs in headquarters and in the field. Conducts broad-based reviews, studies, and analyses of Agency operations with emphasis on compliance with laws, regulations, and policies. Establishes quality review policy for the OQP field review policy for the OQP field reviewers, analyzes and reports on review results, and recommends changes in programs, policies, or legislation aimed at quality and productivity improvement and program simplification. Assesses the medical determinations made by the State and Federal disability determination components and decisions by the Office of Disability Adjudication and Review, including decisions by Senior Attorney Advisors and Administrative Law Judges. Evaluates the quality of the Agency’s operations with emphasis on the prevention of program and systems abuse, the elimination of waste, and the increase of efficiency. Performs customer surveys that measure the public’s perceptions of the Agency’s service delivery and provides insights for Agency planning. Leads the development and maintenance of the quality assurance systems that support OQP’s nationwide studies and reviews. Oversees all field site activities.
      1. The Division of Title II Quality and Special Studies (TKBA) reviews, evaluates, and reports on the integrity and quality of the administration of Social Security’s Title II program and is responsible for studies of special workloads. Recommends corrective changes in programs, policies, procedures, or legislation aimed at quality and productivity based upon the results of the reviews. Conducts ongoing quality reviews and analyses of the non-medical aspects of the Title II program; provides support and guidance to quality assurance staff in the field; conducts quality reviews and special studies of the full range of legal requirements, policies, procedures, systems, and operations for the Title II program. Reports on the prescription drug (Medicare D) subsidy program, including the review of initial entitlements and redeterminations of eligibility to subsidies. Conducts ongoing quality reviews of the enumeration process in accordance with the Agency’s performance measurement plan to assign Social Security numbers and issue Social Security cards accurately. Assesses the accuracy of the Numident as it relates to data matches from State and other Federal agencies and the Agency’s internal processes. Provides quality review feedback to Operating components; transmits quality review data to appropriate parties; performs ad-hoc reviews as required.
      2. The Division of Title XVI Quality (TKBC) reviews, evaluates, and reports on the integrity and quality of the administration of the Title XVI program. Recommends corrective changes in programs, policies, procedures, or legislation aimed at quality and productivity improvement based upon the results of the reviews. Conducts quality reviews, special studies, and analyses of the full range of legal requirements, policies, procedures, systems, and operations for the non-medical aspects of the Title XVI program; provides support and guidance to program and integrity field staff; ensures proper case documentation; provides quality review feedback to Operating components; and transmits quality review data to appropriate parties.
      3. The Division of Disability Initial (TKBE) has overall responsibility for the design, development, coordination, analysis, and reporting on quality review and feedback at the initial and reconsideration levels of disability adjudication, including the State and Federal disability determination components. Develops disability quality review policy and procedures; analyzes data to identify significant trends to determine their cases and costs, and to target areas needing study to determine corrective action. Uses improved quality selection models to ensure the validity of the data and to respond to disability program and quality review program changes. Issues periodic reports related to all reviews.
      4. The Division of Disability Appeals (TKBG) has overall responsibility for the design, development, coordination, analysis and reporting of quality review and feedback data at the hearing level of review, which includes the decisions issued by Senior Attorney Advisors and Administrative Law Judges. Develops disability quality review policy and procedures; analyzes data to identify significant trends to determine their cases and costs and to target areas needing study to determine corrective action. Conducts ad hoc analyses addressing specific issues and requests for information. Issues periodic reports related to all reviews.
      5. The Division of Public Service Evaluation (TKBH) conducts an ongoing quality review of the Agency’s telephone service, monitoring both the national 800 number and local field offices, to measure the accuracy and courtesy of incoming business calls. Performs customer surveys that measure the public’s perceptions of the Agency’s service delivery. Provides insights for Agency planning—evaluating both ongoing services and new Agency initiatives.
      6. The Division of Review Automation Support (TKBJ) provides headquarters and field components with systems design, requirements, maintenance, support, and training for the Electronic Quality Assurance (EQA), Business Intelligence Gateway (BIG—Hyperion), Disability Case Adjudication and Review System (DCARS), and Disability Quality Review (DQR) applications and databases. Maintains a Help Desk for handling user questions, requests, and issues; conducts periodic security/privilege reviews to verify user access; provides workload reports and other analytical data. Supports reviews conducted by OQR divisions.
      7. The Office of Field Site Operations (TKG-F1 to TKG-FX and TKGA) manages quality assurance and evaluation activities in the field. Conducts reviews to determine payment and eligibility error rates in Social Security programs, including errors in Federally-administered State supplementary payments. Conducts reviews to determine the quality of adjudication processes of Social Security programs. Provides reports, data, and analyses; identifies error trends and sources, and recommends corrective actions; and performs special assessment surveys and analyses. Acts as a liaison to regional counterparts.
    5. The Office of Quality Improvement (TKC) promotes the sharing of information across organizational boundaries that allows managers to make informed decisions and improves processes and procedures to reduce errors and improper payments. Provides a variety of services to Agency management, including business process models, data analytics, geospatial visualizations, risk analyses, automated solutions, continuous improvement solutions, statistical predictive models, and support for the continuing disability reviews (CDR) process. Identifies and addresses emerging quality issues based on data trends and root cause analysis. Works with Operating components to implement and facilitate quality improvements. Develops software and techniques that identify and correct errors, and provides automated assistance to technicians and managers. Develops models that allow managers to assess the effect of business process or policy changes as well as changes in staffing plans, provides sophisticated analysis on the probability of meeting Agency goals and targets, and provides horizontal Agency-wide data analytics based on authoritative data sources and geospatial visualizations. Supports the Agency’s data quality activities. Manages updates, and designs quality selection models across Operating components. Directs the Agency’s CDR process, associated strategies, and predictive modeling methodology.
      1. The Division of Continuous Improvement Programs (TKCB) fosters excellence in quality performance across the Agency by continually evaluating processes, policies, and procedures to identify opportunities for improvement. Collaborates with other components to develop solutions to improve quality; provides project management services; conducts post-implementation assessments of major Agency initiatives; analyzes business processes for streamlining and enhancement; and conducts internal surveys to capture employee feedback. Promotes continuous improvement and knowledge management.
      2. The Division of Automated Solutions (TKCC) develops software and techniques to evaluate quality, identify errors, and process actions to change Agency records. Collects data from multiple sources and organizes it for use by other components throughout the Agency for studies and for recommendations of policy changes. Collaborates with other Agency components to identify problems and develop solutions designed to increase accuracy, productivity, and timeliness while reducing costs and improving service. Conducts studies and provides data analysis in the earnings enforcement and earnings suspense areas to support program integrity. Develops assistive tools and utilities to address issues that affect the quality of the Agency’s work and to increase accuracy and efficiency.
      3. The Division of Management Analysis (TKCE) directs, develops, and conducts Agency-wide reviews and studies, using industrial engineering, model building, and other scientific approaches and methodologies. Provides predictive analytics for Agency workloads and processes. Documents business processes, determines tasks times, and the related staffing and hours worked. Uses business process simulation to predict the attainment of goals, processing times, or pending workloads. Creates risk analyses to gauge the likelihood of meeting the predictions. Optimizes the results of a business process simulation or risk analysis to highlight potential changes to produce better results. Supports the Agency through predictive analytics to test pilot processes and the impact of automation changes.
      4. The Division of Modeling (TKCG) creates, refreshes, and maintains statistical predictive models based on past outcome data to predict future outcomes. These models allow cost-effective targeting of Agency resources for workloads such as SSI redeterminations, disability pre-effectuation reviews, and Medicare Part D reviews. Conducts research studies of Agency programs and management issues designed to improve the efficiency of operational workloads. Manages, updates, and designs quality selection models across Operating components. Provides statistical consultation for OQP and the Agency on issues such as sample size and study methodology.
      5. The Division of Software Application Support (TKCH) provides direction and technical support in the establishment, management, and execution of OQP’s internal application development initiatives to streamline OQP processes. Leads the Agency’s data quality initiative and the development of a comprehensive data quality plan.
      6. The Division of Continuing Disability Reviews Support (TKCJ) develops guidelines and technical procedures for the CDR process and oversees this process. Estimates the number of CDRs that the Agency must process annually for the Agency to be current in its reviews responsibilities. Develops strategies to establish the schedules and processes for CDRs directly released as full medical reviews and those released as mailers. Applies sophisticated predictive modeling methodology to “score” every Social Security disability and SSI beneficiary for potential CDRs. Designs and maintains databases and extracts in support of the CDR process. Conducts yearly integrity checks of the CDR mailer process for Title II and Title XVI.