TN 4 (10-16)

A. Introduction

DDS submits an RPC request when they disagree with a deficiency citation.

Before submitting a case for RPC, the DDS may attempt to resolve the deficiency via the informal resolution request (IRR) process with the DQB; see GN 04440.401B.1. If the DDS determines IRR is not appropriate, or the DDS and the DQB cannot reach an agreement through the IRR process, DDS may submit the case for RPC.

EXCEPTION: If the only basis for the DDS RPC submission is that the DQB has cited a wrong deficiency, the DDS must attempt IRR prior to submitting an RPC.

B. RPC case submission time frame

The DDS should submit a case for RPC as soon as possible, but no later than 30 calendar days from the date of receipt of a deficiency. The DDS is not required to perform any documentation actions directed by the DQB prior to submitting the case for RPC.

If more than 30 calendar days have elapsed since the DQB return, the DDS must obtain permission from the regional Center for Disability (CD) prior to submitting the case for RPC to the “^ODP OPCA Controls” mailbox. If the CD grants permission, the CD will send DDS a notice of permission, and cc the “^ODP OPCA Controls” mailbox.

The DDS will upload a copy of the permission notification to the Disability Related Development (blue section, “E”) of the electronic folder (EF). The DDS may then submit an RPC. If the case had an IRR, the 30-day calendar count begins when DQB responds.

NOTE: At no time will RPC accept a case the DDS has already closed.

A case the DQB closes without returning it to the DDS is NOT a case the DDS has already closed.

C. The DDS submits an RPC

The DDS may submit an RPC if they:

• Disagree with the DQB about a Group I or Group II deficiency;

• Do not wish to resolve the disagreement informally with the DQB; or

• IRR has failed.

D. Cases accepted for RPC

The RPC process includes review of initial, reconsideration, and continuing disability review determinations in which the DQB cited a Group I or Group II deficiency but the DDS does not believe the cited deficiency is supported by policy (for a discussion of Group I and Group II deficiencies, see DI 30005.001C.).

NOTE: The RPC process only applies to certified electronic folders (CEF).

E. Cases not accepted for RPC

RPC will not accept the following types of cases:

• CEFs that have prior paper folders (see DI 30005.510);

• Closed cases (see DI 30007.125B NOTE in this section);

• Technical corrective actions (TCAs) (see GN 04440.230);

• DQB deficiencies that the DDS does not dispute;

• The only basis for the DDS RPC submission is that the DQB has cited a wrong deficiency. The DDS must attempt IRR prior to submitting an RPC.

• More than 30 calendar days have elapsed since the DQB return and the CD has not granted prior permission to submit the case for RPC (see DI 30007.125B. in this section.)

• DQB subsequent returns when the DDS did not request an RPC for the initial deficiency. In these cases, the DDS may choose to contact the DQB to discuss their concerns informally (see GN 04440.401B.1.).

• Cases with untranslated evidence or medical records written in a language other than English.

EXCEPTION: RPC will accept cases processed by the Puerto Rico DDS and Puerto Rico DPU that have untranslated evidence and/or medical records.

F. How to submit a case for RPC

To submit a case for RPC, a DDS-authorized requester must access the RPC tool to initiate and complete an on-line RPC template. The DDS inputs information obtained from the CEF about issues related to the deficiency citation, including:

• A brief summary of the case facts;

• A discussion of the disagreement with the DQB’s deficiency citation; and

• Case-specific policy references.

The DDS is not required to undertake any additional development prior to submitting the case for RPC. The DDS must include all post-adjudicative evidence in the case record.

NOTE: The RPC panel discussion members do not consider post-adjudicative evidence prior to reaching a resolution on the RPC submission. The panel members only consider post-adjudicative evidence after they reach a resolution (see DI 30007.145J.2.).

G. RPC status requests

RPC makes every attempt to schedule RPC panel discussions to evaluate and resolve RPC submissions in a timely manner. If RPC has not resolved a submission within 21 calendar days, DDS may request status using the “^ODP OPCA Controls” mailbox. In the email subject line, enter “RPC Status Request” and the RPC case number.