Quality Assurance Independence
Highlights
GAO reviewed the Social Security Administration's (SSA) regional structure for ensuring the quality of disability decisions made by state disability determination services (DDS). GAO found that: (1) each SSA region's Disability Quality Branch (DQB) works cooperatively with regional medical consultants (RMC) to review the accuracy of disability decisions; (2) based on DQB review, SSA assesses whether DDS comply with regulatory performance accuracy standards; (3) DQB and RMC organizational placement and Regional Disability Program Branches' technical assistance compromise DQB organizational independence; (4) in 1987, SSA transferred DQB responsibility from regional commissioners' offices to a nonrelated branch of SSA; and (5) although RMC are an integral part of the DDS quality assurance review function, they have remained under the management and supervision of the regional commissioners' offices.
Recommendations
Recommendations for Executive Action
| Agency Affected | Recommendation | Status |
|---|---|---|
| Social Security Administration | In order to ensure the independence of the quality assurance review function for SSA disability programs, the organizational responsibility for RMC should be transferred from the regional commissioners' offices to a SSA unit with no disability programs management responsibility. |
Closed – Implemented
SSA is redesigning the disability determination process, including the overall quality assurance (QA) system. SSA's Commissioner has approved a set of "guiding principles" for the new QA system. One of these principles addressed the recommendation in that the reviews will be performed by an organizational unit with no disability program management responsibility.
|