OF THE NATIONAL ASSOCIATION OF DISABILITY EXAMINERS
TO THE HOUSE COMMITTEE ON WAYS AND MEANS
SUBCOMMITTEE ON SOCIAL SECURITY
AND SUBCOMMITTEE ON HUMAN RESOURCES
HEARING ON MANAGEMENT OF THE DISABILITY CASELOAD
by Terri Spurgeon, President
NADE is a professional association with the majority of our members being disability examiners, quality assurance and public relations personnel, hearing officers, physicians, administrators and support staff employed in the state Disability Determination Service (DDS) agencies. However, our membership also includes physicians, psychologists, attorneys, advocates, representatives form private insurance companies, Social Security claims representatives and other professionals not in the DDSs who work with, and are interested in, the evaluation of disability claims. We believe it is the diversity of our membership, as well as our experience working directly with the Social Security and SSI disability programs, which provides us with a unique perspective and understanding of those programs and the public they serve. Many of our members have been, or are currently, involved in testing the process changes envisioned in the Redesign initiative. For a number of reasons we are concerned about the management of the disability caseload.
Since 1994, SSA has piloted various initiatives in an effort to redesign the disability claims process. In March 1999 Commissioner Apfel announced his decision to prototype a new disability process which encompassed several of those initiatives. This new process creates new roles for both the disability examiner and the State Agency medical consultant and includes a claimant conference (an opportunity for the applicant to talk directly with the decision maker if a fully favorable decision cannot be made based on the evidence already in file), elimination of the reconsideration level of appeal and improvements in the hearings process. At the DDS level claims will no longer require medical sign-off except where required by statute. This is expected to allow State Agency medical consultants additional time to assist with the more difficult and complex claims. The prototype involves 10 states and approximately 20% of the initial disability caseload (continuing disability reviews are not included in the new process).
NADE applauded the Commissioner’s decision to proceed with a prototype rather than national rollout. Although the time frame to prepare for implementation of the new process was short, we felt that the October 1, 1999 start up date was feasible. Unfortunately, however, many of the operating instructions and notification letters necessary to implement the new process were not available to the DDSs by that date and as late as mid-October claims which were ready for a claimant conference were being held pending operating instructions and training. This is unfortunate for DDS staff and for individuals applying for disability benefits but it continues a long established pattern by SSA of proceeding with its announced plans regardless of whether the necessary tools for implementing those plans are in place, or even exist.
Moreover, we continue to be concerned that elimination of the reconsideration step will impact negatively on the Office of Hearings and Appeals by increasing the number of appeals to that level. Statistics and claimant satisfaction surveys available from the pilots have shown that the claimant conference (formerly known as the pre-decision interview or PDI) actually had a negative impact on the claimant’s satisfaction with the process if the claim was denied and increased the likelihood that the individual would file an appeal. In addition, for the new process to succeed, changes at the front end must necessarily be accompanied by changes at the hearings level. These have been proposed. Unfortunately, we are already seeing strong resistance opinion offered by the GAO and the Social Security Advisory Board that the planned changes at the hearings level will be very difficult to implement and will require the active involvement and strong support to SSA leadership.
Despite our reservation NADE is committed to providing full support for the new process. While we do not believe in change for the sake of change, we strongly support any initiative to assure that claims, that should be allowed, are allowed at the earliest level possible. In numerous previous testimonies we have expressed our commitment to the concept of a nationally uniform disability program with consistent application of policy at all levels in the adjudicative process. It is our hope currently being prototyped, which does include process unification initiatives and improvements at the hearing and appeals level, will lead to this uniformity. It is important to recognize that the initiatives contained in the new prototype process will increase processing time for initial claims. They will also almost certainly increase the administrative costs of the program. However we believe that, while all government agencies must be fiscally responsible, it is imperative that SSA’s administrative budget is sufficient to ensure efficient operation – and that it provides appropriate resources for the DDSs and the Field Offices. Ensuring that the Field Offices and the DDSs have adequate and well-trained staff is essential to reaching SSA’s stated goal of strengthening the public’s understanding of the Social Security programs. We are concerned that the cost savings projections forecasted by the elimination of the reconsideration step will not be sufficient to pay for the increased front end costs associated with the new disability process. If the projections are incorrect, then where will SSA obtain the necessary funds to pay these new costs? There does not seem to be a contingency plan in place and we have been warned that SSA cannot expect to receive additional new appropriations. However, at all levels, and for all components, adequate resources, including appropriate staffing levels, ongoing training initiatives, and clear and timely operating instructions, must be provided.
The Telecenters and Field Offices are the first point of contact for most disability applicants. While disability is a relatively small part of their workload, the quality of the completed application at this level can have a significant impact on the efficiency with which the claim is processed at the DDS level. It is important, then, that these components work together to provide quality service to all applicants. To do this requires ongoing communication and an emphasis on teamwork. Unfortunately, communication between the field Offices and the DDSs was severely curtailed with the workforce reductions in the 1980s. Efforts to increase communication between all components have recently been initiated and these efforts must be maintained. This, again, will require adequate staffing levels and coordinated training initiatives. SSA must invest in the training of its personnel to insure that those who take the applications for disability benefits, as well as those who adjudicate the claims, have the necessary skills and knowledge to do so.
The new disability process requires experienced staff. It also requires new skills for both the disability adjudicator and the State Agency medical consultant. Unfortunately, the reality of staff turnover in the DDSs is that the experience level in these offices is at its lowest point ever. Nearly 50% of all disability examiners have less than two years of program experience. This is a critical statistic since it has long been acknowledged that it takes a new disability examiner a minimum of two years to become proficient at the job and to be a productive employee. In addition, in FY’96 Congress appropriate funding specifically earmarked foe continuing disability reviews. This has resulted in significant program savings. However, these congressionally mandated reviews have diverted DDS staff from initial claims processing. This could be problematic for states involved in the prototype.
SSA’s Strategic Plan recognizes the employees of SSA and the DDSs as the Agency’s most important asset. A highly skilled, high performing and highly motivated workforce is critical to SSA’s ability to achieve its mission. Ongoing training is essential if the new process is to succeed. Adjudicators must have sufficient program and medical knowledge to conduct a claimant conference and to do so in a manner which can be understood by the applicant. Because process unification requires the disability adjudicator to evaluate not only the objective medical evidence but to also consider the individual’s subjective complaints and to assess credibility, the adjudicator must also have appropriate training and experience in this area. State agency medical consultants must be able to explain complex medical issues to the adjudicator and frequently must do so in a way that will allow the adjudicator to then explain these issues to the applicant. Further, the Social Security Advisory Board, in its August 1998 report, concluded that, “The most important step SSA can take to improve consistency and fairness in the disability determination process is to develop and implement an ongoing joint training program for all of the 15,000 disability adjudicators, including employees of the state disability determination agencies (DDSs), Administrative Law Judges (ALJs) and others in the Office of Hearing and Appeals (OHA) and the quality assessment staff who judge the accuracy of decisions made by others in the decision making process”. NADE would echo that sentiment. Ongoing training is important; joint training is essential.
Nationally uniform decisions with consistent application of policy at all adjudicative levels requires a consistent and inclusive quality assurance review process. Without ongoing, joint training and an inclusive and consistent quality review process, the decision making process will remain fragmented and public confidence in the program will not be restored. NADE has, on several occasions, urged SSA to address the problems and the perceived problems in the federal quality assurance review process. We have frequently expressed concerns that the quality is not nationally consistent. It must be recognized that SSA’s quality assurance review process does have significant ability to shape disability policy and impact program costs and caseloads selected for review, or even by increasing or decreasing the size of a review sample. The quality assurance review process can and should be a major tool for identifying and correcting errors in policy and procedure to assure that program policy is implemented in a manner that is consistent and fair to individuals. Likewise, the quality assurance review process should apply in a similar manner to decisions made by the DDSs and by OHA.
Commissioner Apfel, in his testimony, compared our disability programs with those in other developed countries. As he stated, “Comparisons aren’t always simple.” By the same token we would like to point out that it is not reasonable to compare private disability insurance programs and the Social Security and SSI disability programs. As the Commissioner noted, “SSA’s programs have always awarded benefits on the basis of a single strict standard of disability defined by statute.” Not only is SSA’s standard stricter than private insurance programs, the documentation requirements are stricter. Decisions made by private insurance disability programs are not subject to the extensive quality assurance review process to which Social Security and SSI disability claims are and these companies are able to make decisions using a more liberal documentation standard. In addition, private disability programs offer partial or short term disability programs. They rely on the decision made on the individual’s Social Security claim to determine eligibility for long term benefits.
Agreeing with Chairman Shaw that, “Ensuring that American workers who experience a disability have all the protection they paid for is a core function of the SSA”. NADE recently prepared a Position Paper calling for the elimination of the five month waiting period for Title II applicants. Title II disability beneficiaries must currently wait five full calendar months from the onset of their disability before they can begin receiving cash benefits. The Title XVI (SSI) beneficiary, on the other hand, can begin receiving benefits immediately. This fosters a perception that the Title II program is unfair to the disabled worker who has actually paid into the system. This is particularly evident in cases involving claimants with terminal illnesses. Many of these claims are closed by the DDS as “no decision” cases due to the fact that the claimant dies during the waiting period. We have been strongly encouraged by recent actions by the Congress and by SSA to address many issues that deal with the public’s confidence in the disability program and the public’s perception of “fairness” between the two disability programs. NADE strongly urges Congress and SSA to work together to produce legislation that will eliminate, or significantly reduce, the waiting period. We offer the expertise of our membership to assist in this effort.
Mr. Chairman, Madam Chairman and members of the subcommittees, NADE members take pride in the quality of the service we deliver. We understand and appreciate that the Social Security and Supplemental Security Income programs make an enormous difference in the quality of life of millions of people. We are proud of our part in the administration of these programs. We welcome this opportunity to comment on the Social Security Administration’s management of its disability caseload and to offer our support of, and suggestions for, improvements in the process. Thank you.