National Association of Disability Examiners National Conference Policy in Motion: What’s Hot! Office of Disability Policy August 12, 2015

JOINT MISSION: Serve Individuals with a Disability

ODP Role in the Mission Create Effective Policy: Operationally effective and efficient Empowers individuals with a disability Minimizes financial hardship Consistent with the statutory intent AIM: Keep pace with medicine, healthcare delivery, technology, and the world of work Data-driven decisions Evidence-based Inclusive Collaborative Transparent 3

Disability Policy in Motion Working with Our Internal and External Partners to Keep Pace with the Environment 4

Disability Policy in Motion We constantly scan the internal and external environment for improvement opportunities and incoming claims and data for anomalies Detect Front-line eyes on claims Case Reviewers Medical Officers/Consultants Industry Research Partner and Stakeholder input Data tools 5

Disability Policy in Motion We look to research, our internal partners, and stakeholder input for best practices and identify internal suspect areas Identify Data analytics with: o Several data sources o Policy Feedback System o RPC Data Visualization o Electronic Claims Analysis Tool (eCAT) Case Studies Research 6 Step 3: Investigate Step 4: Understand Step 5: Formulate Resolution Step 6: Implement Plan Step 7: Monitor

Disability Policy in Motion We work with our partners to dig deeper to assess the possibility of capitalizing on opportunity and to pinpoint the root cause of suspect areas Investigate ODP Medical Consultants Involve Other Partners Targeted Case Reviews Research 7 Step 4: Understand Step 5: Formulate Resolution Step 6: Implement Plan Step 7: Monitor Step 1: Detect

Disability Policy in Motion 8 Step 5: Formulate Resolution Step 6: Implement Plan Step 7: Monitor Step 1: Detect Step 2: Identify Step 3: Investigate Understand We work with internal partners and stakeholders to develop a holistic understanding and determine if next steps are needed External Stakeholders o Other Federal agencies o Industry o Advocates Internal Partners

Disability Policy in Motion We work with our partners to determine what is necessary to capitalize on the opportunity or resolve the issue Formulate Resolution Training Development of System Tools Policy change and/or clarification Correction of Behavior Referral to Office of Inspector General (OIG) 9 Step 6: Implement Plan Step 7: Monitor Step 1: Detect Step 2: Identify Step 3: Investigate Step 4: Understand

Disability Policy in Motion We work with our partners to create and implement a plan for program optimization or problem resolution Implement Plan Deliver Training Address Irregular Behavior Write New Policy Make System Enhancements Create New Tools Refer to OIG 10 Step 7: Monitor Step 1: Detect Step 2: Identify Step 3: Investigate Step 4: Understand Step 5: Formulate Resolution

Disability Policy in Motion We work with our partners and stakeholders to gain feedback and to conduct analysis to ensure desired change occurred Monitor Front-line eyes on claims Case Reviewers Medical Officers/Consultants Request for Policy Consultation Policy Net feedback Stakeholder input Case Probes eCAT 11 Step 1: Detect Step 2: Identify Step 3: Investigate Step 4: Understand Step 5: Formulate Resolution Step 6: Implement Plan

Disability Policy in Motion Step 3: Investigate We work with our partners to dig deeper to assess the possibility of capitalizing on opportunity and to pinpoint the root cause of suspect areas. Step 2: Identify We look to research, our internal partners, and stakeholder input for best practices and to identify internal suspect areas. Step 1: Detect We constantly scan the internal and external environment for improvement opportunities and incoming claims and data for anomalies. Step 7: Monitor We work with our partners and stakeholders to gain feedback and to conduct analysis to ensure desired change occurred. Step 5: Formulate Resolution We work with our partners to determine what is necessary to capitalize on the opportunity or resolve the issue. Step 6: Implement Plan We work with our partners to create and implement a plan for program optimization or problem resolution. Step 4: Understand We work with internal partners and stakeholders to develop a holistic understanding and determine if next steps are needed. Working with Our Internal and External Partners to Keep Pace with the Environment 12

Disability Policy in Motion Staying in step with advances in medicine, health care delivery, technology, and the world of work Data Driven Decisions Evidence-based Inclusive Transparent Our Aims 13

14 STRATEGIC GOALS TOP ODP WORK OBJECTIVES IN SUPPORT OF THE STRATEGIC GOALS: 1.Update and revise medical listings (Goal I) 2.Enhance the vocational factors used to assess work capacity (Goal I) 3.Implement a revised regulation for submission of evidence (Goal II) 4.Clarify, simplify, and update the regulations for considering opinion evidence, including Acceptable Medical Source, Treating Source (Goal II) 5.Develop an approach forward for the Single Decision Maker (SDM), Prototype Tests, and Disability Examiner Authority (Goal II) 6.Increase transparency and stakeholder input, through such venues as the Disability Forum (Goal II) 7.Evaluate the Continuing Disability Review (CDR) policies and procedures for policy enhancements and training opportunities (Goal III) 8.Expand data sources, functionality, and MI such as the Policy Feedback System (Goal IV) 9.Develop and promote policy compliance tools such as eCAT (Goal V) 10.Increase use of health information technology (HIT) to acquire medical records (Goal V) 11.Continue to identify ways to improve employee morale and retention (Goal VI) As a primary emphasis, to empower and support individuals with a disability in-line with the statutory intent we: I. Create and Maintain Responsive Medical and Vocational Policies II. Establish Efficient, Effective Policies III. Strengthen Program Responsiveness and Integrity IV. Improve Policy Continuously V. Innovate Using Technology and Management Information VI. Empower Employees Goals

Disability Policy in Motion Staying in step with advances in medicine and health care delivery Multiple Listings updated in FY 15 o Growth o Hematological o Cancer More in process o Mental listings workgroup Responsive Medical Policy 15

Disability Policy in Motion Opinion Evidence o Eliminate Treating Source Controlling Weight o Acceptable Medical Source (AMS) Symptom Evaluation SSR Inability to Sustain/Significantly Less than Sedentary Issues – SSR Revisions Effective and Efficient Processes 16

Disability Policy in Motion Strengthen Program Responsiveness and Integrity Continuing Disability Reviews Anti-Fraud Efforts o Fraud and Similar Fault (FSF) o Redeterminations due to FSF Ruling 17 Goals

Disability Policy in Motion Improving Quality Continuously Documentation and Data via Technology CME Training for MC/PCs Cross Component Training Cadre Enhanced Data Analytics and Management Information

19 Disability Information Website Website: /ODP/content/DCCD

20 PFS Increased Functionality Visuals Capacity (Near Future) Data Analytics

Hovering over any item in a visual provides the category and figure Chart 1: counts by Region Chart 2: counts by State within each Region Chart 3: counts by DDS Site within each Region Year filter automatically set to current FY, but can be changed to single or multiple years RPC View 1 – Submitted, Closed & Expedited Review Counts Two ways to specify Region in State & Site charts 1. click anywhere in Region bar in first chart, or 2. click to scroll through tile bar Allows application of multiple additional criteria

Disability Policy in Motion Innovate with Technology eCAT Natural Language Processing (NLP) Increase Use of Health Information Technology (HIT) o Through June 2105, 5.71% of all disability claims had HIT o 44 HIT partners covering 6,255 health care organizations, across almost 33 states Goals

Disability Policy in Motion Inability to Communicate in English as a Factor Medical-Vocational Guidelines Concerns Vocational Factors Vocational Factors Modernization 23

24 Making it Happen Vocational Factors Why? Keeping in step with changes in the environment - policy nearly 30 years old Multi-faceted Evidence-Based Approach: Literature Reviews (LOC/AIR) & Evidence Syntheses (ORDES) Institute of Medicine (IOM) Consultation Disability Forum Federal Expert Panels (Labor/Education/Aging/NIMH) Private Sector Interviews (Cigna/UNUM) Academic Panels Advocate Meetings Partners: Multi-component Vocational Regulations Modernization (VRM) workgroup will develop an evidence-based approach forward Tentative Next Steps: Publish ANPRM on modernizing the vocational factors Publish NPRM removing inability to speak English as an educational Tentative Timeframe: Final Regulation - 12/2016

FLASH Workgroup on Inability to Sustain & Significantly Less than Sedentary RFC Issues 25 Why? ODAR Issue/SSR Difficult Policy to Apply at ALL Levels Workgroup-Defined Approach: Training/Monitoring Revising SSRs 96-8p &96-9P Partners: ODAR/ODD/DDS/OQR/OGC/OLCA 25 Work on a “Regular & Continuing” Basis Function-by-Function RFC Assessment RFC and Occupational Base Erosion of the Occupational Base Manipulative Limitations Clarification Mental Limitations Clarification  Off-task Behavior  Inability to Concentrate  Unscheduled Breaks, and  Frequent Absences Need for Vocational Resource/Expert Narrative Rationale Requirements Additional Guidance & Clarification

Disability Policy in Motion Innovate with Technology MI – Disability Data Landing Page Increase Use of HIT o Through June 2015,, 5.71% of all disability claims had HIT o 44 HIT partners covering 3,500 health care organizations, across almost 30 states o RPC Data Visualization 26