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Notes

20 C.F.R. §§ 416.1040–416.1050

7 sections in range

§416.1040. General.

20 C.F.R. § 416.1040

The following sections provide the procedures and guidelines we use to determine whether the State agency is substantially complying with our regulations and other written guidelines, including meeting established national performance standards. We use performance standards to help assure effective and uniform administration of our disability program and to measure whether the performance of the disability determination function by each State agency is acceptable. Also, the standards are designed to improve overall State agency performance in the disability determination process and to ensure that benefits are made available to all eligible persons in an accurate and efficient manner. We measure the performance of a State agency in two areas—processing time and quality of documentation and decisions on claims. State agency compliance is also judged by State agency adherence to other program requirements.
Notes, amendments, and revision history

Amendments

[56 FR 11023, Mar. 14, 1991]

Authority

Authority: Secs. 702(a)(5), 1614, 1631, and 1633 of the Social Security Act (42 U.S.C. 902(a)(5), 1382c, 1383, and 1383b).

Source

Source: 46 FR 29211, May 29, 1981, unless otherwise noted.

Amendments

[56 FR 11023, Mar. 14, 1991]

§416.1041. Standards of performance.

20 C.F.R. § 416.1041

(a)
General. The performance standards include both a target level of performance and a threshold level of performance for the State agency. The target level represents a level of performance that we and the States will work to attain in the future. The threshold level is the minimum acceptable level of performance. Performance below the threshold level will be the basis for the Commissioner's taking from the State agency partial or complete responsibility for performing the disability determination function. Intermediate State agency goals are designed to help each State agency move from its current performance levels to the target levels.
(b)
The target level. The target level is the optimum level of performance. There are three targets—one for combined title II and title XVI initial performance accuracy, one for title II initial processing time, and one for title XVI initial processing time.
(c)
The threshold level. The threshold level is the minimum acceptable level of performance. There are three thresholds—one for combined title II and title XVI initial performance accuracy, one for title II initial processing time, and one for title XVI initial processing time.
(d)
Intermediate goals. Intermediate goals are levels of performance between the threshold levels and the target levels established by our appropriate Regional Commissioner after negotiation with each State agency. The intermediate goals are designed to help the State agencies reach the target levels. Failure to meet these goals is not a cause for considering the State agency to be substantially failing to comply with the performance standards. However, failure to meet the intermediate goals may result in consultation and an offer of optional performance support depending on the availability of our resources.
Notes, amendments, and revision history

Amendments

[46 FR 29211, May 29, 1981, as amended at 56 FR 11023, Mar. 14, 1991; 62 FR 38455, July 18, 1997]

Authority

Authority: Secs. 702(a)(5), 1614, 1631, and 1633 of the Social Security Act (42 U.S.C. 902(a)(5), 1382c, 1383, and 1383b).

Source

Source: 46 FR 29211, May 29, 1981, unless otherwise noted.

Amendments

[46 FR 29211, May 29, 1981, as amended at 56 FR 11023, Mar. 14, 1991; 62 FR 38455, July 18, 1997]

§416.1042. Processing time standards.

20 C.F.R. § 416.1042

(a)
General. Title II processing time refers to the average number of days (including Saturdays, Sundays, and holidays) it takes a State agency to process an initial disability claim from the day the case folder is received in the State agency until the day it is released to us by the State agency. Title XVI processing time refers to the average number of days, including Saturdays, Sundays, and holidays, from the day of receipt of the initial disability claim in the State agency until systems input of a presumptive disability decision or the day the case folder is released to us by the State agency, whichever is earlier.
(b)
Target levels. The processing time target levels are:
(1)
37 days for title II initial claims.
(2)
43 days for title XVI initial claims.
(c)
Threshold levels. The processing time threshold levels are:
(1)
49.5 days for title II initial claims.
(2)
57.9 days for title XVI initial claims.
Notes, amendments, and revision history

Amendments

[46 FR 29211, May 29, 1981, as amended at 56 FR 11023, Mar. 14, 1991]

Authority

Authority: Secs. 702(a)(5), 1614, 1631, and 1633 of the Social Security Act (42 U.S.C. 902(a)(5), 1382c, 1383, and 1383b).

Source

Source: 46 FR 29211, May 29, 1981, unless otherwise noted.

Amendments

[46 FR 29211, May 29, 1981, as amended at 56 FR 11023, Mar. 14, 1991]

§416.1043. Performance accuracy standard.

20 C.F.R. § 416.1043

(a)
General. Performance accuracy refers to the percentage of cases that do not have to be returned to State agencies for further development or correction of decisions based on evidence in the files and as such represents the reliability of State agency adjudication. The definition of performance accuracy includes the measurement of factors that have a potential for affecting a decision, as well as the correctness of the decision. For example, if a particular item of medical evidence should have been in the file but was not included, even though its inclusion does not change the result in the case, that is a performance error. Performance accuracy, therefore, is a higher standard than decisional accuracy. As a result, the percentage of correct decisions is significantly higher than what is reflected in the error rate established by SSA's quality assurance system.
(b)
Target level. The State agency initial performance accuracy target level for combined title II and title XVI cases is 97 percent with a corresponding decision accuracy rate of 99 percent.
(c)
Intermediate goals. These goals will be established annually by SSA's regional commissioner after negotiation with the State and should be used as stepping stones to progress towards our targeted level of performance.
(d)
Threshold levels. The State agency initial performance accuracy threshold level for combined title II and title XVI cases is 90.6 percent.
Notes, amendments, and revision history

Authority

Authority: Secs. 702(a)(5), 1614, 1631, and 1633 of the Social Security Act (42 U.S.C. 902(a)(5), 1382c, 1383, and 1383b).

Source

Source: 46 FR 29211, May 29, 1981, unless otherwise noted.

§416.1044. How and when we determine whether the processing time standards are met.

20 C.F.R. § 416.1044

(a)
How we determine processing times. For all initial title II cases, we calculate the mean number of days, including Saturdays, Sundays, and holidays, from the day the case folder is received in the State agency until the day it is released to us by the State agency. For initial title XVI cases, we calculate the mean number of days, including Saturdays, Sundays, and holidays, from the day the case folder is received in the State agency until the day there is systems input of a presumptive disability decision or the day the case folder is released to us by the State agency, whichever is earlier.
(b)
Frequency of review. Title II processing times and title XVI processing times are monitored separately on a quarterly basis. The determination as to whether or not the processing time thresholds have been met is made at the end of each quarter each year. Quarterly State-by-State mean processing times are compared with the threshold levels for both title II and title XVI.
Notes, amendments, and revision history

Amendments

[46 FR 29211, May 29, 1981, as amended at 56 FR 11023, Mar. 14, 1991]

Authority

Authority: Secs. 702(a)(5), 1614, 1631, and 1633 of the Social Security Act (42 U.S.C. 902(a)(5), 1382c, 1383, and 1383b).

Source

Source: 46 FR 29211, May 29, 1981, unless otherwise noted.

Amendments

[46 FR 29211, May 29, 1981, as amended at 56 FR 11023, Mar. 14, 1991]

§416.1045. How and when we determine whether the performance accuracy standard is met.

20 C.F.R. § 416.1045

(a)
How we determine performance accuracy. We determine a State agency's performance accuracy rate on the basis of decision and documentation errors identified in our review of the sample cases.
(b)
Frequency of review. Title II and title XVI initial performance accuracy are monitored together on a quarterly basis. The determinations as to whether the performance accuracy threshold has been met is made at the end of each quarter each year. Quarterly State-by-State combined initial performance accuracy rates are compared to the established threshold level.
Notes, amendments, and revision history

Authority

Authority: Secs. 702(a)(5), 1614, 1631, and 1633 of the Social Security Act (42 U.S.C. 902(a)(5), 1382c, 1383, and 1383b).

Source

Source: 46 FR 29211, May 29, 1981, unless otherwise noted.

§416.1050. Action we will take if a State agency does not meet the standards.

20 C.F.R. § 416.1050

If a State agency does not meet two of the three established threshold levels (one of which must be performance accuracy) for two or more consecutive calendar quarters, we will notify the State agency in writing that it is not meeting the standards. Following our notification, we will provide the State agency appropriate performance support described in §§ 416.1060, 416.1061 and 416.1062 for a period of up to 12 months.
Notes, amendments, and revision history

Amendments

[56 FR 11023, Mar. 14, 1991]

Authority

Authority: Secs. 702(a)(5), 1614, 1631, and 1633 of the Social Security Act (42 U.S.C. 902(a)(5), 1382c, 1383, and 1383b).

Source

Source: 46 FR 29211, May 29, 1981, unless otherwise noted.

Amendments

[56 FR 11023, Mar. 14, 1991]