TEFCA Government Benefits Determination Implementation is Here!

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.