We all know what it’s like to get forms completed with all the right information (and to get it done quickly!), and patients seeking determinations on their eligibility for Social Security Disability Insurance know this all too well. Patients and providers often spend significant time and resources retrieving, reviewing, copying, and transmitting relevant medical records. The Department of Health and Human Services and the Social Security Administration (SSA) are taking on the challenge to improve this process through the Trusted Exchange Framework and Common Agreement™ (TEFCA™).

The Assistant Secretary for Technology Policy and Office of the National Coordinator for Health Information Technology (ASTP/ONC), SSA, and the TEFCA Recognized Coordinating Entity® (RCE®) have collaborated to release the Exchange Purpose Implementation Standard Operating Procedure (SOP): Government Benefits Determination to help make this process more efficient for the patients and the providers who provide the information patients need to submit.

The SOP details how government entities at the federal, state, local, or tribal level can leverage TEFCA to obtain information needed to determine an individual’s eligibility for non-health care government benefits. The Government Benefits Determination Exchange Purpose includes a sub-exchange purpose that supports two SSA programs that provide benefits based on disability: the Social Security Disability Insurance program (title II of the Social Security Act) and the Supplemental Security Income (SSI) program (title XVI of the Act). By obtaining medical records through interoperability networks supported by TEFCA, SSA can accelerate disability determinations through faster medical record collection – which could take minutes or seconds instead of weeks or months for traditional methods. This in turn can reduce SSA’s operating costs by eliminating the need to print and mail documentation.

Technological requirements have also been updated to make this a reality. The Qualified Health Information Network® (QHIN^TM) Technical Framework Agreement (QTF) Version 2.1 was updated to help make this process more efficient and facilitate implementation of the SOP. The update ensures that requests from government entities for benefits determinations are efficiently routed to specific organizations that the government knows are stewarding the information needed, rather than openly querying the entire network.

The 11 QHINs will implement updates to align with these documents and the updated Exchange Purposes SOP. ASTP/ONC is thrilled to work with our federal and non-federal partners to make sure TEFCA continues to support the needs of the care community. To keep abreast of all the recent TEFCA updates, we recommend following along through the new transparent process for amendments to framework agreements, technical requirements, and SOPs by visiting the RCE’s Topics in Change Management page.

View The SOP