Background

In September 2003, the Commissioner of Social Security and the Associate Commissioner for the Office of Hearings and Appeals (OHA) requested that OHA form a workgroup to review OHA's critical case procedures. The Critical Case Workgroup found that many of the existing procedures in HALLEX I-2-1-40 were not being strictly adhered to by Hearing Offices (HOs) and Regional Offices because the procedures are outdated, cumbersome or ineffective, and do not reflect current best practices and procedures. The critical case instructions had last been updated in November 1994.

Explanation of Content and Changes

This transmittal revises and updates section I-2-1-40 that provides guidelines and procedures for handling critical cases.

We added a second paragraph to I-2-1-40A to specify the intent of the instructions: “[T]o guide the Hearing Offices (HOs) and Regional Offices (ROs) in establishing a priority plan and procedures for processing the most serious claims first.”

The critical case criteria in I-2-1-40 have not been modified, but additional guidance and definitions and terms have been added in I-2-1-40.B for consistency with definitions and language found in POMS. In particular, we added language from POMS SI 02004.005(a)(2)(definition of “financial emergency”) to define dire need situations in I-2-1-40B.2.a and as additional guidance in I-2-1-40B.2.c. We also adopted language from POMS DI 23020.030 (Hardship) as additional guidance in I-2-1-40B.2.d.

Section I-2-1-40B. — We added a paragraph referring to and establishing a link to the Critical Request Evaluation Sheet (HALLEX I-2-1-95 Exhibit).

Section I-2-1-40B.1 — We repeated the NOTE instructions that appear at the end of former Section C (Terminal Illness) and added “TERI” in brackets.

Section I-2-1-40B.2 — We added “DIRE NEED” in brackets to clarify that this critical criterion is meant to be consistent with SSA's “dire need” and “financial emergency” situation definitions.

Section I-2-1-40B.3 — We added “SUICIDAL/HOMICIDAL” in brackets.

Section I-2-1-40B.4 — We added “AGED/PUBLIC RELATIONS” in brackets. We had originally removed the definition of “inordinate delay” and the emphasis on “and” for the initial draft. After receiving comments, we reinstated the original version. We also added a NOTE to cross-reference HALLEX I-1-6-1, the procedures for handling cases with congressional interest.

Section I-2-1-40C. — Emphasis was added to “but are not limited to,” the fourth bullet point under this section, to clarify that the list of terminal illness situations is not exclusive of other medical conditions which can also be considered terminal illnesses.

Section I-2-1-40D. — The title of this section has been changed from “Critical Case Identification” to “Critical Case Designator”. The section has been revised to remove the requirement that the critical case designator in the Hearing Office must be the HOCALJ or his/her designee “who must be an ALJ”, due to the fact that ALJs are now bargaining unit employees. The revision allows the HOCALJ flexibility to permit a Hearing Office Management team member (a Hearing Office Director or Group Supervisor) to designate critical cases for expedited processing. It preserves the ALJ's ability to designate cases as critical when the case is assigned to the ALJ. To assist the designator, we have developed a Critical Request Evaluation Sheet for efficient identification, assessment and designation of a critical case (I-2-1-95 Exhibit).

We added a new section I-2-1-40E. (“Critical Case Identification and Expediting Procedures”) to provide process-specific instructions for employees to illustrate appropriate expediting and documentation procedures for critical cases that are designated at various stages of the hearing process. The tracking and monitoring procedures have been moved to Section G. We added a reference to CPMS, the new HO data system being implemented nationwide. We eliminated the OHA Early Development Instructions which were temporary instructions (T.I. I-5-3-11) and are currently outdated and obsolete. We also eliminated the NOTE in this section, because the procedures described in it are also outdated and obsolete.

Section I-2-1-40 F. was added to include instructions addressing data entry for tracking critical cases in the two HO data systems — the Hearing Office Tracking System (HOTS) and the Case Processing Management System (CPMS).

Former subsections I-2-1-40 E through H have been renumbered as I-2-1-40 G through J. We have eliminated the RO reporting requirements to OHA headquarters because they are outdated and obsolete, and have renamed the “Reporting and Expediting Procedures” sections (formerly Sections E and F) to “Monitoring and Expediting Procedures” (Sections G and H). We added a sentence in Section G to explain that HOs may be required to produce reports to other components from time to time (e.g., for HO reviews). We have maintained the internal HO and RO documentation, monitoring and expediting requirements. Sections I and J (formerly Sections G and H) have not been modified.

Section I-2-1-95 Exhibit is new and consists of the Critical Request Evaluation Sheet referenced throughout I-2-1-40. Former I-2-1-95 is renumbered as I-2-1-96.

Date: July 16, 2004