TN 13 (12-10)

A. Definition of a grace period

A grace period is the time between the date when new, revised, or clarified policy, procedure, or a type of quality review become effective, and the date when group I deficiencies involving the new policy or procedure in initial quality assurance (QA) cases are cited to the adjudicating component and counted in the adjudicating component’s performance accuracy statistics.

A grace period covers only initial QA sample cases. There are no grace period provisions for reconsideration or continuing disability review (CDR) QA sample cases, for preeffectuation review sample cases, or for other miscellaneous sample cases, such as Targeted Denial Reviews, etc.

B. Purpose of the grace period

The purpose of the grace period is to allow the adjudicating component time to become familiar with new, revised, or clarified policies or procedures before cited deficiencies based on them are included in the computation of the adjudicating component’s performance accuracy. (For an explanation of performance accuracy, see GN 04440.003F.)

C. Types of grace periods

There are two types of grace periods:

• a high-impact grace period, and

• a low-impact grace period.

We establish a high-impact grace period when we expect the new, clarified, or changed policy or procedure to affect a large workload.

We establish a low-impact grace period when we do not expect the new, clarified, or changed policy or procedure to affect a large workload.

The Office of Quality Review (OQR) determines which type of grace period to establish.

• In a high-impact grace period, we remove all grace period cases from performance accuracy calculations.

• In a low-impact grace period, we include all grace period cases with a group I deficiency in calculating performance accuracy, but we count them as deficiency-free cases.

For a detailed description of the two types of grace periods and how they are applied, see GN 04440.123D. and GN 04440.123E in this section.

D. High-impact grace period

1. Introduction to a high-impact grace period

When we expect a new, revised, or clarified policy or procedure to affect a large workload, e.g., when there has been a major revision to one of the widely applied listings, we exclude all grace period cases from performance accuracy statistics and do not report them in the normal QA process. Instead, we track grace period cases separately, and maintain separate data. We augment the initial QA sample to replace the grace period cases to maintain statistical precision in the reported accuracy rates.

2. What is a high-impact grace period case?

A grace period case is any initial QA case in which the new, revised, or clarified policy or procedure is a factor in the adjudication of the case, regardless of whether the case contains a deficiency.

3. Excluding cases from performance accuracy

To preclude distortion of the performance accuracy data and to prevent the artificial inflation of accuracy rates, OQR central office (CO) systems staff excludes all initial QA sample cases that fall under a high-impact grace period from performance accuracy calculations. This applies to both non-deficient cases and deficient cases.

4. Sample augmentation

Since we exclude all high-impact grace period cases, regardless of whether they contain a deficiency, from performance accuracy calculations, additional "non-grace period" sample cases are selected while the grace period is in effect. This means that a larger number of randomly chosen cases for the initial QA sample are selected from each adjudicating component, and this number is approximately equal to the number of cases in each adjudicating component that involve the grace period issue. We do this to maintain the required statistical precision and validity in the sample; i.e., to ensure review of a sufficient number of cases.

5. Coding a grace period in OQR’s legacy system

The coding process is as follows:

• OQR CO issues a grace period code to use for cases that fall under the grace period as well as instructions for identifying the grace period cases and issues;

• The review component enters the grace period code in the "Grace Period" field on screen QA-4 of OQR’s legacy system for any case that falls under the grace period, deficient and non-deficient alike;

• Group I or group II deficiencies, if any, are coded as usual in the "Med/Voc Deficiency" field on screen QA-4 of OQR’s legacy system; and

• OQR CO removes all initial QA sample cases that are coded as grace period cases from adjudicating component accuracy computations; i.e., OQR CO systems staff removes all cases coded as grace period cases from the QA database.

E. Low-impact grace period

1. Introduction to a low-impact grace period

When we do not expect a new, revised, or clarified policy or procedure to affect a large workload, we do not exclude grace period cases from adjudicating component performance accuracy statistics. However, we treat initial QA cases that fall under the grace period and contain a group I deficiency as deficiency-free cases for performance accuracy calculations. We apply the grace period only to initial QA cases.

2. What is a low-impact grace period case?

A low-impact grace period case is any initial QA case in which the new, revised, or clarified policy or procedure is a factor in the adjudication of the case, regardless of whether the case contains a deficiency.

3. Coding a grace period in OQR’s legacy system

The coding process is as follows:

• OQR CO issues a grace period code and instructions to use for initial QA grace period cases that contain a group I deficiency;

• If the case contains a group I deficiency that falls under the grace period, the review component codes the group I deficiency in the "Med/Voc Deficiency" field on screen QA-4 of OQR’s legacy system; and

• The review component enters the grace period code in the "Grace Period" field on screen QA-4 of OQR’s legacy system.

F. Policy on grace periods

1. Authority

OQR establishes grace periods in consultation with the Office of Disability Programs.

2. Length of grace period

The grace period for implementing instructions provided in the Program Operations Manual System transmittals (TN), teletypes, and emergency messages (EM) is 2 full calendar months following the effective date of the issuance.

The date the adjudicating component disability examiner signs the SSA-831-C3/U3 (Disability Determination and Transmittal) determines when and whether the grace period applies.

G. Review component procedure for reviewing cases involving a grace period

1. General

Review the cases in the usual manner, including medical review, and return deficient cases to the adjudicating component for corrective action.

2. Grace period coding

High-impact grace period case

If the grace period in effect is a high-impact grace period, enter the assigned grace period code in the “Grace Period” field on screen QA-4 of OQR’s legacy system for all grace period cases reviewed, deficient and non-deficient; i.e., all initial QA cases in which the new, revised, or clarified policy or procedure is a factor in the adjudication of the case.

Low-impact grace period case

If the grace period in effect is a low-impact grace period, enter the assigned grace period code in the “Grace Period” field on screen QA-4 of OQR’s legacy system only if there is a group I deficiency in the grace period case; i.e., an initial QA case in which the group I deficiency is directly related to misapplication of the new, revised, or clarified policy or procedure.

3. Citing deficiencies and correcting cases

When a deficiency occurs in a case covered by a grace period, cite the deficiency and return the deficient case to the adjudicating component for correction. Annotate the Form SSA-1774-U5 (Request for Corrective Action) with either of the following remarks, depending on the type of grace period in effect:

• High-Impact - Case Excluded From Performance Accuracy Calculations - Informational Only or

• Low-Impact - Informational Only. Group I Deficiency Not Counted in Performance Accuracy Calculations.