Subject: Prehearing Analysis and Case Workup
HALLEX I-2-130, Professional Qualifications of Physicians and Mental Health Professionals, does not reflect fully the provisions of some of the predecessors to HALLEX regarding documenting, for the record, the professional qualifications of physicians and psychologists.
The predecessors to HALLEX provided that, absent a specific request by an Administrative Law Judge (ALJ) or from the claimant or the claimant's representative, Form HA-526, Professional Qualifications (of physician) and Form HA-4390, Professional Qualifications of Psychologist, are completed only if the professional qualifications of the physician or psychologist, whose report is entered into the record, is not part of the report itself, i.e., stationery letterhead or other document identifying medical specialty, board certification, etc.
The regulations at 20 CFR §§ 404.1503a and 416.903a establish program integrity requirements for medical evidence providers, and the regulations at 20 CFR §§ 404.1519g and 416.919g provide that the Social Security Administration will use only qualified medical sources. These sections further define the term “qualified medical sources.” Additionally, Program Operations Manual System (POMS) DI E39569.007 ff., outlines the steps the Disability Determination Services must follow to complete ongoing physicians' credentials checks.
In light of the regulatory provisions for establishing qualifications of consultative examiners and for continuing credential investigations, it is appropriate to carry forward into HALLEX the provisions of the predecessors to HALLEX regarding documenting, for the record, the professional qualifications of physicians and psychologists.
This transmittal revises HALLEX I-2-130 to reflect that when an ALJ admits a medical report, analysis, assessment or judgment by a physician or mental health professional [including a Medical Expert (ME)] into the record of a case as an exhibit, or obtains a physician's or mental health professional's testimony at a hearing, the ALJ will also admit into the record a statement of the physician's or mental health professional's qualifications [i.e., a completed Form HA-526, Professional Qualifications (of physician) or Form HA-4390, Professional Qualifications of Psychologist], unless the qualifications are adequately documented on the report, analysis, assessment or judgment, or on another document which is being admitted into the record.
The revisions also provide guidelines for determining when professional qualifications are adequately documented, and how to obtain professional qualifications and complete the appropriate professional qualifications form when they are not adequately documented.
Remove from Chapter I-2-100:
I-2-125 A. cont., through I-2-135 cont., dated June 30, 1994 (4 pages).
Insert in Chapter I-2-100:
I-2-125 A. cont., through I-2-135 A. 2. cont., dated November 21, 1994 (5 pages).
Date: November 21, 1994