[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