[Federal Register Volume 59, Number 101 (Thursday, May 26, 1994)]
[Unknown Section]
[Page 0]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 94-12890]
[[Page Unknown]]
[Federal Register: May 26, 1994]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Social Security Administration
Statement of Organization, Functions and Delegations of Authority
Part S of the Statement of Organization, Functions and Delegations
of Authority for the Department of Health and Human Services covers the
Social Security Administration (SSA). Chapter S3 covers the Deputy
Commissioner for Programs. Notice is hereby given that Subchapter S3G,
Office of Hearings and Appeals, is being amended to reflect changes in
the organizational designations and functional responsibilities in the
Office of the Chief Administrative Law Judge (S3GJ), Office of
Appellate Operations (S3GC) and the Office of Management, Systems and
Policy (S3GX). Notice is further given that subchapter S3G is being
amended to reflect the abolishment of the Office of Civil Actions
(S3GL). In addition, a functional statement is being inserted for the
Vocational Expert and Medical Advisor Staff in the Office of the Chief
Administrative Law Judge. The changes are as follows:
Section S3G.10 The Office of Hearings and Appeals--(Organization)
D. The Office of the Chief Administrative Law Judge (S3GJ)
Establish
4. The Division of Medicare part B (S3GJ5).
F. The Office of Appellate Operations (S3GC)
Change Opening Sentence To Read
``The Office of Appellate Operations (S3GC), which includes the
Executive Director who also serves as Deputy Chair of the Appeals
Council, the Appeals Council and its Administrative Appeals Judges, a
Deputy Director to the Executive Director, and a Director of
Operations.
Retitle
2. The Administrative Support Staff (S3GC4) To: ``The Division of
Program Support (S3GC4).''
Delete
3. The Retirement and Survivors Insurance, Health Insurance and
Supplemental Security Income Staff (S3GC5) in its entirety.
Establish
3. The Medical Support Staff (S3GCX).
Retitle
4. The Program Review Branch 1 (S3GC6) To: ``The Disability Program
Branch 1 (S3GC6).''
5. The Program Review Branch 2 (S3GC7) To: ``The Disability Program
Branch 2 (S3GC7).''
6. The Program Review Branch 3 (S3GC8) To: ``The Disability Program
Branch 3 (S3GC8).''
7. The Program Review Branch 4 (S3GC9) To: ``The Disability Program
Branch 4 (S3GC9).''
8. The Program Review Branch 5 (S3GCA) To: ``The Disability Program
Branch 5 (S3GCA).''
9. The Program Review Branch 6 (S3GCB) To: ``The Disability Program
Branch 6 (S3GCB).''
10. The Program Review Branch 7 (S3GCC) To: ``The Disability
Program Branch 7 (S3GCC).''
11. The Program Review Branch 8 (S3GCE) To: ``The Disability
Program Branch 8 (S3GCE).''
12. The Program Review Branch 9 (S3GCG) To: ``The Disability
Program Branch 9 (S3GCG).''
13. The Program Review Branch 10 (S3GCH) To: ``The Disability
Program Branch 10 (S3GCH).''
14. The Program Review Branch 11 (S3GCJ) To: ``The Disability
Program Branch 11 (S3GCJ).''
15. The Program Review Branch 12 (S3GCK) To: ``The Disability
Program Branch 12 (S3GCK).''
16. The Program Review Branch 13 (S3GCL) To: ``The Disability
Program Branch 13 (S3GCL).''
17. The Program Review Branch 14 (S3GCM) To: ``The Disability
Program Branch 14 (S3GCM).''
18. The Program Review Branch 15 (S3GCN) To: ``The Disability
Program Branch 15 (S3GCN).''
19. The Program Review Branch 16 (S3GCP) To: ``The Disability
Program Branch 16 (S3GCP).''
Establish
20. The Disability Program Branch 17 (S3GCQ).
21. The Disability Program Branch 18 (S3GCR).
22. The Disability Program Branch 19 (S3GCS).
23. The Health Insurance Branch (S3GCT).
24. The Retirement and Survivors Insurance and Supplemental
Security Income Branch (S3GCU).
25. The Court Case Preparation and Review Branch 1 (S3GCV).
26. The Court Case Preparation and Review Branch 2 (S3GCW).
Delete
G. The Office of Civil Actions (S3GL) In Its Entirety
Establish
G. The Office of Policy, Planning and Evaluation (S3GK)
1. The Division of Litigation Analysis and Implementation (S3GK1).
2. The Division of Planning and Evaluation (S3GK2).
3. The Division of Policy (S3GK3).
Retitle
H. The Office of Management, Systems and Policy (S3GX) to ``The Office
of Management (S3GX)''
Delete
2. The Division of Policy, Planning and Evaluation (S3GX2).
Renumber
``3'' to ``2'', ``4'' to ``3'', ``5'' to ``4'', ``6'' to ``5'' and
``7'' to ``6''.
Section S3G.20. The Office of Hearings and Appeals--(Functions)
D. The Office of the Chief Administrative Law Judge (S3GJ)
Replace ``seven'' with ``ten'' in the fifth sentence. Add the
following after ``coordinates hearing office activities;'' in the last
sentence: ``Preparing, reviewing and drafting decisions and dismissals
in Medicare part B cases;''
Establish
3. The Vocational Expert and Medical Advisor Staff (S3GJ2)
formulates, develops and oversees the national program for recruitment
and use of Vocational Experts and Medical Experts at hearings before
Administrative Law Judges. On an ongoing basis, monitors Regional and
Hearing Office operations regarding the program and when appropriate
provides guidance and makes necessary changes. Responsible for
monitoring court trends and determines their impact on the progam and
the need for additional expert witnesses. Is responsible for reviewing
fees and revising national fee schedules when appropriate. Identifies
the need for special studies or management reviews of the Program.
4. The Division of Medicare part B (S3GJ5) processes Medicare part
B cases on receipt from Health Care Financing Administration (HCFA)
contractors. Assigns docket numbers and establishes case control,
identifies proposed exhibits, prepares exhibit files, drafts exhibit
lists. Identifies technical dismissals and drafts all orders of
dismissal for the signature of the Administrative Law Judge. Prepares a
detailed analysis of the facts and issues in each case that reaches the
hearing level, including appropriate citations of law, regulations and
policy, and recommendations for development of additional evidence or
testimony from the claimant or expert witnesses at the hearing.
Researches the law, regulations and relevant policy to resolve case-
related issues as necessary. Drafts all decisions where an on-the-
record decision is requested and drafts decisions where hearings are
held by an Administrative Law Judge. Receives post-hearing files from
Hearing Offices, identifies and forwards favorable decisions to the
Health Care Financing Administration Regional Office for effectuation.
Maintains all relevant case processing and workflow statistics relating
to the part B workload and prepares all management reports. Serves as
custodian of all files until full appeals rights are exhausted, that
is, through Appeals Council or court action. Receives requests for
Appeals Council review. Processes Appeals Council remands and obtains
any requested development. Provides technical and staff assistance to
the Chief Administrative Law Judge and all Administrative Law Judges
concerning the adjudication of Medicare part B cases.
F. The Office of Appellate Operations (S3GC)
Add As the Second Paragraph:
The Office of Appellate Operations (S3GC) is also responsible for
OHA action on cases in which a civil suit has been filed, including
actions on new court case requests for voluntary remand and court
remands. Provides professional and technical advice to the Associate
Commissioner, the Appeals Council, the Chief Administrative Law Judge
and other OHA officials in all litigated cases involving claims for
benefits filed under Titles II, XVI and XVIII of the Social Security
Act, as amended, and Title IV of the Federal Coal Mine Health and
Safety Act of 1969, as amended; claims to establish dependency status
under Title II of the Act; claims for individual enrollment to
participate under parts A and/or part B of Title XVIII of the Act; and
claims by hospitals, skilled nursing facilities and independent
laboratories seeking certification or continued certification under the
Social Security Act. Tracks and analyzes court case trends and
disseminates information to guide adjudicators with respect to case
law, to implement an effective appeals strategy, and to identify areas
and make recommendations as to policies which need to be developed and/
or clarified, new regulations which need to be developed, or clarifying
legislation which should be sought.
Retitle
2. The Administrative Support Staff (S3GC4) To: `` The Division of
Program Support (S3GC4).'' Delete statement beginning with ``under''
and replace with the following:
2. ``Under the direction of the Director of Operations of the
Office of Appellate Operations, provides support services to Appeals
Council Members, including reconstruction of lost claim files and
receiving and analyzing fee petitions. Provides reprographic services
in preparation of the official answer to civil actions filed against
the Secretary of DHHS under Titles II, XVI, and XVIII of the Social
Security Act, as amended, and Title IV of the Federal Coal Mine Health
and Safety Act of 1969, as amended. This includes reproduction of
documents for all individual litigant cases as well as class action
cases and discovery requests. Manages equipment, personnel and
facilities necessary to ensure timely provision of reprographic
services. Controls and maintains all requests for transcription of
hearing cassettes and performs audit functions for hearing transcripts
returned from the private contractor.''
Delete in Its Entirety
3. The Retirement and Survivors Insurance, Health Insurance and
Supplemental Security Income Staff (S3GC5).
Establish
3. The Medical Support Staff (S3GCX) provides expert professional
judgment to the Appeals Council on individual disability and health
insurance claims. The Medical Support Staff also provides
informational, advisory and consultant services to Administrative
Appeals Judges and their support staff on matters of interpretation and
application of national policy on SSA and OHA disability criteria and
regulations. It consists of staff physicians, consulting physicians,
and support staff. The qualifications of these physicians are
representative of the major medical specialities. Each physician is
familiar with the pertinent provisions of the Social Security Rules and
Regulations. The physicians conduct training seminars for the Appeals
Council and its support staff and newly appointed Administrative Law
Judges. They review disability evaluation training manuals for
consistency and national uniformity. The Medical Support Staff
represents OHA in contacts with appropriate professional affiliations
to promote understanding of OHA practices and problems in the
evaluation of disability. It advises and participates with the Appeals
Program Officer and Executive Director of OAO in the recruitment,
selection and training of the medical consultant staff. The Medical
Support Staff coordinates with the Office of Disability and
International Operations all matters of joint interest in the area of
medical disability evaluation.
Establish
20. The Disability Program Branch 17 (S3GCQ).
21. The Disability Program Branch 18 (S3GCR).
22. The Disability Program Branch 19 (S3GCS).
Add as the Last Five Sentences
4.-22. The Disability Program Branches (S3GC6-9 and S3GCA-S).
Analyze and recommend action on cases referred by the Office of General
Counsel (OGC) for consideration of whether remand should be requested
at the Secretary's motion. Recommend to OGC defense on the record of
certain litigated cases if further administrative action is not
warranted. Analyze and recommend action of cases remanded by the
courts. Prepare affidavits and related correspondence; and, as
necessary, prepare comprehensive decisions and remand orders for the
signature of the Executive Director and other Administrative Appeals
Judges in civil action cases.
Establish
23. The Health Insurance Branch (S3GCT) serves as a support staff
for the Appeals Council in reviewing Administrative Law Judge (ALJ)
decisions and dismissals involving claims to establish entitlement to
Health Insurance benefits under Title XVIII of the Social Security Act,
including claims for individual enrollment to participate under Parts A
and/or B of Title XVIII and claims by hospitals, skilled nursing
facilities and independent laboratories seeking certification under the
Social Security Act. Advises the Appeals Council on all matters
relating to entitlement to benefits under the Social Security Act, as
amended, for health insurance claims, and supports the Appeals Council
in all phases of its review function as the final step in the
administrative appeals process. Acting on behalf of the Appeals
Council, undertakes necessary development and responds to such
administrative matters as requests for extensions of time to submit
additional evidence, requests for copies of exhibits from the claim
file and requests for copies of the hearing cassette or transcript of
the hearing. Following an analysis of the record and any additional
evidence and/or argument submitted, and applying a thorough knowledge
of applicable case law, examines hearing decisions and other final
actions of the Administrative Law Judge and requests for Appeals
Council review and makes recommendations to the Administrative Appeals
Judges as to what action should be taken on cases pending before the
Council. Recommendations include whether own motion review should be
taken or review granted and the appropriate course of action if
jurisdiction is assumed, including issuing a decision, dismissal, or
remand of the case to an Administrative Law Judge. The staff initiates
implementing action on behalf of the Administrative Appeals Judges
including drafting comprehensive decisions and orders. Analyzes and
recommends action on cases referred by OGC for consideration of whether
remand should be requested at the Secretary's motion. Recommends to OGC
defense on the record of certain litigated cases if further
administrative action is not warranted. Analyzes and recommends action
of cases remanded by the courts. Prepares affidavits and related
correspondence; and, as necessary, prepares comprehensive decisions and
remand orders for the signature of the Executive Director and other
Administrative Appeals Judges in civil action cases.
24. The Retirement and Survivors Insurance and Supplemental
Security Income Branch (S3GCU) serves as a support staff for the
Appeals Council in reviewing Administrative Law Judge decisions and
dismissals involving claims to establish entitlement and the amount of
benefits in old-age, survivors and disability under Title II of the
Social Security Act; and claims to establish eligibility for and
benefits payable in Title XVI cases. Advises the Appeals Council on all
matters relating to entitlement to benefits under the Social Security
Act and supports the Appeals Council in all phases of its review
function as the final step in the administrative appeals process.
Acting on behalf of the Appeals Council, the staff undertakes necessary
development and responds to such administrative matters as requests for
extensions of time to submit additional evidence, requests for copies
of exhibits from the claim file and requests for copies of the hearing
cassette or transcript of the hearing. Following an analysis of the
record and any additional evidence and/or argument submitted and
applying a thorough knowledge of applicable case law, examines hearing
decisions and other final actions of the Administrative Law Judge and
requests for Appeals Council review and makes recommendations to the
Administrative Appeals Judges Member as to what action should be taken
on cases pending before the Council whether before or after a civil
action is filed. Recommendations include whether own motion review
should be taken or review granted and the appropriate course of action
if jurisdiction is assumed, including issuing a decision, dismissal, or
remand of the case to an Administrative Law Judge. The staff initiates
implementing action on behalf of the Administrative Appeals Judges
including drafting comprehensive decisions and orders. Analyzes and
recommends action on cases referred by OGC for consideration of whether
remand should be requested at the Secretary's motion. Recommends to OGC
defense on the record of certain litigated cases if further
administrative action is not warranted. Analyzes and recommends action
of cases remanded by the courts. Prepares affidavits and related
correspondence; and, as necessary, prepares comprehensive decisions and
remand orders for the signature of the Executive Director and other
Administrative Appeals Judges in civil actions cases.
25.-26. The Court Case Preparation and Review Branches 1-2 (S3GCV-
S3GCW) serve as a support staff to the Office of Appellate Operations.
Prepare remand orders and affidavits and related correspondence. Within
published guidelines, recommend to OGC defense on the record for
certain litigated cases if further administrative action is not
warranted. Analyze and recommend action on cases remanded by the
courts. Prepares all court transcripts and controls and maintains all
certified records of claims at the civil actions level.
Delete
G. The Office of Civil Actions (S3GL) In Its Entirety
Establish
G. The Office of Policy, Planning and Evaluation (S3GK) plans,
analyzes and develops OHA-wide policy for the hearings, appeals and
civil actions processes. Manages the overall OHA policy communications
system. Is responsible for OHA activity with respect to Social Security
regulations, including developing an OHA position with respect to
program regulations proposed by SSA components. Monitors OHA's
implementation of program regulations governing the hearings and
appeals process. Plans and conducts a comprehensive OHA-wide evaluation
program designed to support OHA policy and regulatory initiatives and
measure the overall effectiveness of the nationwide hearings and
appeals process. Provides advice and guidance throughout OHA on matters
involving program policies, planning and evaluation. Coordinates
policy, planning and evaluation matters within OHA, with other SSA
components and with HCFA, OGC and other HHS components, other Federal
agencies and private organizations. Responsible for SSA policy with
respect to claimant representation and the fees charged for these
services. Develops and coordinates program training in conjunction with
appropriate OHA, SSA, HCFA, HHS and OGC components. Develops and
implements an appeals strategy, in conjunction with other OHA
components, that identifies the issues and types of cases which OHA
believes should be appealed. Captures court trend information for
dissemination to other components to assist in formulating the Agency's
litigation strategy and improving the adjudication process.
1. The Division of Litigation Analysis and Implementation (S3GK1)
develops and implements, in conjunction with other OHA components, an
appeals strategy that identifies the issues and types of cases which
OHA believes should be appealed. Captures court trend information for
dissemination to other components to assist in formulating the agency's
litigation strategy and improving the adjudication process. Develops
and maintains a compendium of circuit court case law with systems-based
access. Tracks pending class actions, forecasts potential workload
impact, and makes recommendations to workload components regarding
workload impact. Uses court trend information to identify and make
appropriate recommendations with respect to areas in which policies
need to be developed and/or clarified, new regulations need to be
developed, or clarifying legislation should be sought. Prepares and
updates significant court case requirements used in reviewing court
cases. Uses court trend information to identify areas where additional
training is needed or other measures are needed to improve
defensibility. Advises the Associate Commissioner, the Chief
Administrative Law Judge and other OHA officials, as appropriate, of
significant cases and trends and of litigation issues which may require
revision of operating instructions, and assists with the preparation of
the instructions. Coordinates OHA's views on proposed Social Security
Acquiescence Rulings. In response to OHA-identified cases and to
requests for appeals recommendations from the Litigation Staff, Office
of the Deputy Commissioner for Programs, obtains the views of affected
OHA components and formulates an OHA position on appeal. Maintains
liaison with OGC and the Litigation Staffs of the Office of the Deputy
Commissioner for Programs and the Office of Disability to coordinate
the settlement of class actions and class action implementation. In
coordination with the Office of the Chief Administrative Law Judge and
other OHA components, develops instructions for OHA implementation of
class action orders and monitors implementation. Serves as a focal
point for questions from OHA adjudicators concerning class action
orders. Responds to requests from OGC and the SSA Litigation Staff
regarding OHA's procedures, statistics and other information with
respect to OHA operations requested in the course of litigation.
Coordinates OHA's response to discovery requests, including maintaining
a central file of information disclosed. Administers and coordinates
the Freedom of Information Act and Privacy Act provisions for OHA.
2. The Division of Planning and Evaluation (S3GK2) develops,
coordinates and conducts a comprehensive OHA-wide program of studies
and analyses of the application of and compliance with SSA and OHA
policies and procedures in all phases of OHA's hearings and appeals
processes and the quality of results achieved. Provides advice and
assistance to other OHA components in designing and implementing
appropriate systems and procedures for collecting, recording, analyzing
and evaluating data pertinent to assessing the quality of work
emanating from the hearings and appeals processes. Conducts studies of
policy implementation within OHA. Conducts special studies and analyses
of the timeliness of the hearings and appeals process, OHA workloads
and/or results to develop OHA recommendations for SSA policy and
procedural changes or other corrective managerial initiatives.
Identifies problem areas and deficiencies in policies, policy
application, methods and procedures and recommends corrective action.
Develops techniques and systems for conducting evaluations of the
substantive and technical aspects of claims throughout OHA. Designs and
conducts a variety of program evaluation studies and analyses in
support of OHA program policy and administrative initiatives and
coordinates OHA action on initiatives for simplifying the appeals
process. Designs and conducts various program integrity studies and
analyses of OHA processes and operations to ensure that OHA programs,
policies and practices are consistent with the highest standards of
integrity and equity. Analyzes the results of OHA's evaluation systems
to determine deviations from statutory, regulatory, policy, or
procedural requirements and/or from established administrative quality
standards. Assesses the compatibility of operating results with program
philosophy and objectives, and recommends corrective action to program
managers and other OHA officials.
3. The Division of Policy (S3GK3) plans, develops and coordinates
the preparation of regulations, policies and guidelines for the
hearings, appeals, civil actions and claimant representation processes
under Titles II, XVI and XVIII of the Social Security Act, as amended,
and under Title IV of the Federal Coal Mine Health and Safety Act of
1969, as amended. Ensures that operating procedures and instructions
developed to implement the hearings and appeals process conform with
national SSA and OHA policy. Provides advisory services, consultation,
and staff assistance to other components of OHA. Maintains an effective
system for communicating policy positions through program guides and
directives and informational notices necessary for an effective
hearings and appeals process. Develops and maintains publications,
informational materials, references and forms on the hearings, appeals,
claimant representation and civil actions processes. Maintains ongoing
liaison with SSA, HCFA, HHS, OGC and others with respect to program,
legislative and policy matters. Develops and coordinates benefit
program policy and regulatory activity for OHA. Reviews, coordinates,
develops and comments on program regulations, rulings, and other
program instructions emanating from SSA, HHS and other administrative
law bodies that may influence or impact on OHA policy areas. Reviews
current and developing trends in administrative law and litigation;
analyzes and prepares policy recommendations; and develops long-range
and short-range plans for hearing and appeals policy matters and OHA's
implementation of benefit program policy matters. Develops and
coordinates program training in conjunction with other OHA components
and SSA, HCFA, HHS and OGC program components.
Retitle
H. The Office of Management, Systems and Policy (S3GX) to ``The Office
of Management (S3GX)''
Delete First Three Ssentences and Replace With the Following
The Office of Management provides administrative support to the
Associate Commissioner for all management and systems related
activities for OHA. Coordinates with the Chief Administrative Law Judge
with respect to management and systems support functions which affect
the field operations.
Renumber
``3'' to ``2'', ``4'' to ``3'', ``5'' to ``4'', ``6'' to ``5'' and
``7'' to ``6''.
Dated: May 9, 1994.
Ruth A. Pierce,
Deputy Commissioner, for Human Resources.
[FR Doc. 94-12890 Filed 5-25-94; 8:45 am]
BILLING CODE 4190-29-P
