Statement of Linda Dorn, Vice President
National Council of Disability Determinations Directors, Lansing, Michigan
Before the Subcommittee on Social Security,
House Committee on Ways and Means
Hearing on Social Security Disability Programs' Challenges and Opportunities
June 11, 2002
Mr. Chairman, thank you for your invitation to participate in this hearing on the challenges and opportunities facing the Social Security Disability process at the initial, reconsideration and continuing disability levels at the State Divisions of Disability Determination Services (DDS). Our organization agrees with your statement that improvement in the disability determination function is among the primary challenges facing the new Commissioner. The National Council of Disability Determination Directors (NCDDD) reaffirms all its previous commitments to participate in finding and implementing responsible solutions with accountability by all stakeholders.
Before commenting on specific issues on the topic of today’s hearing, we would like to restate the purpose of our organization, explain the reasons for the federal state partnership, and describe our commitment to the identification of barriers to service improvements and to the search for solutions to the challenges facing the disability programs at the DDS adjudication levels.
The NCDDD is a professional association of directors and managers of the agencies of state government performing the disability determination function on behalf of Social Security. NCDDD’s goals focus on finding ways to establish, maintain, and improve fair, accurate, timely, and economical decisions to persons applying for disability benefits.
Congress created the federal state relationship in response to the need for experts at the grass roots level working effectively and efficiently with other community-based services. The intention was that the DDS be the human face in government services to our disabled population. This still proves to be the case in most instances. State initiatives; cost effectiveness in personnel usage, and working within the individual state infrastructures to provide referrals to related state agencies have served the disability program and the American public well. This relationship should continue to be nurtured and supported to allow for alignment with other community-based one-stop services. In reality, the federal state partnership, while not perfect, is at its best when integrated with the Administration’s mandate of empowering the states to act on behalf of and empowering our most vulnerable citizens.
The SSA/DDS partnership is held to a high standard by close contact with individual state governors, U.S. Congressional delegations and the American public. Serving the public requires close, collaborative teamwork. We appreciate the recommendations of the bipartisan Social Security Advisory Board (SSAB) as stated in their report of January 2001 and generally concur with their findings, particularly in regard to strengthening the federal state relationship in the short run.
The definition of disability has remained essentially unchanged in the past 30 years. It was always meant to be a more stringent standard compared to many other programs. Recent attention has been focused on allowance rates and other issues when, in fact, the program was never designed to allow every individual with any disability. Contrary to some statements contending the disability programs have not changed over the past years, the program has indeed experienced multiple changes in leadership, focus and direction. For example, mental, childhood, pain, treating source opinion, and credibility issues have engendered many changes which in turn impacted our ability to provide thoughtful, consistent, timely adjudication of Social Security disability cases.
Our recommendations today focus on key issues on which the Commissioner must take prompt and decisive action in order to improve public service for the programs that we jointly administer with SSA.
1. Resources
The complex task of applying the statutory definition of disability requires extensive development of medical evidence, expert analysis of the evidence, and careful explanation of the conclusions. The process is therefore costly. Because determining eligibility for disability benefits are far more than a medical clerical function, the process requires staff trained in making complicated medical, psychological and vocational judgments. This is not done in a “lab” situation or vacuum but rather in the real world of mounting pressures. The DDSs continue to be the component performing the mission of the Social Security disability programs productively, responsibly, timely, consistently, and cost effectively. In fact, various SSA components have referred to the state agencies as being the “best deal” in government service.
A clear relationship exists between the level of service we are able to provide and the resources available to provide that service. The recent history of downsizing, the attempts to implement multiple costly projects, pilots and prototypes, the creation of new policies that are expensive to administer, and other unfunded mandates have contributed to the current situation in which the program and the resources available to carry it out are seriously out of alignment.
The task-to-resource deficit has resulted in an alarming situation about which we want to be very clear. Presently our program has well over 125,000 cases pending than we are unable to process. These disability applications are awaiting assignment to caseworkers because all the caseloads are at maximum capacity for the resources available. Worse, SSA has predicted that, with the current resource allocation, this number will continue to grow.
NCDDD feels that this quality of service delivery is unacceptable and amounts to a failure to provide the level of service that the public deserves.
2. Improving Policy and Training to Produce More Consistent and Accurate Decision Making.
As recommended by the Advisory Board in its report of August of 1998, “the most important step SSA can take to improve the process is to develop on-going joint training for all adjudicators in all the components that make and review disability determinations”. The Board also noted that such a training program presumes the existence of a policy base, which is clear, concise, and applicable in a real world setting.
Presently, SSA policy for evaluating disability claims is fragmented, complex, conflicting, confusing, and sometimes obsolete. This compromises the ability of the DDSs to adjudicate cases consistently and accurately and is part of the reason that more than 60% of the applicants who appeal denial of benefits at the initial level receive those benefits after appeal.
While SSA should be commended for its recent efforts to introduce a greater degree of consistency into the process, much more remains to be done.
3. Quality Assurance
Along with clear, concise policy and guidelines, NCDDD recommends that SSA assign a high priority to revising its quality assurance system so as to achieve the goal of unifying the applicationof policy among all components. The present QA system is out of date, applies differently to the various components, and induces inconsistency of decision-making.
SSA presently is in possession of an independent consultant’s report concerning changes in the QA system. NCDDD endorses many aspects of the Lewin report and recommends that it receive expedited attention by top management at SSA. We commend SSA for their recent steps to appoint an executive lead to this important focus on quality.
NCDDD is committed to work with SSA to help create a new quality culture and a new quality process.
4. Systems Support
The development and enhancement of effectively performing electronic systems is critical to delivering high quality service at a reasonable cost. Historically, DDSs have an excellent track record of having worked together to develop systems capabilities to support their business processes. In the last several years, SSA has embarked on various initiatives to develop, at the centralized level, alternative systems that would replace the equipment and software used in the DDSs. These initiatives have been extremely costly and have not produced advantages commensurate with their costs. While the available resources were diverted to the unsuccessful development of SSA systems, enhancement of the DDS systems has been curtailed due to lack of funding.
NCDDD wants to express our support for accelerated electronic disability technology initiatives.
NCDDD recommends that future development and enhancement of electronic systems be accomplished with greater reliance on the DDS systems experts and personnel.
We believe it is reasonable to consider system software development be a task for which the knowledge, skills and ability of the private sector should be better utilized. Only by working together with the DDS systems experts and private sector will SSA achieve the bold timeline announced by the Commissioner.
5. Support for the interim suggestions “Post-Prototype” and strengthened Reconsideration.
We applaud the Commissioner’s expeditious actions on prototype issues ending years of testing and pilots. We want to acknowledge the decisions are the beginning steps of process improvements. Further the Social Security Advisory Board (SSAB) reported in January 2001 any plans to eliminate the reconsideration should be reviewed carefully. The rationale was that recon had become a meaningless step that only delayed the correct decision. But a second level of review at the DDS level need not be meaningless. Claimants could be provided the opportunity for a face-to-face de novo hearing conducted by highly trained and experienced DDS reviewers. This should enhance the reliability and accuracy of DDS decisions and reduce the need for claimants to go through the complex and lengthy ALJ hearing process.
NCDDD’s position is an alignment of the SSAB’s recommendation.
6. Consistency
We are concerned that by attempting to move on so many fronts simultaneously, SSA will sacrifice progress toward solving what we see as its most important task --- bringing reasonable consistency to the decision making processes and outcomes between the state DDSs and the SSA Office of Hearings and Appeals (OHA).
We believe that variance in decision making between the two levels is a serious problem in the disability program. Without asserting which component is “right”, the facts are as follows: DDSs process initial and reconsideration level decisions on average in about 70 days at a cost of about $300 per case. According to SSA quality reviews, DDS claims have a decisional accuracy of about 97%. Additionally, we believe that it is critically important to remember that eighty percent (80%) of all the individuals who receive disability benefits are allowed through a decision made by the DDS.
NCDDD agree that cases meeting the definition of disability should be allowed at the earliest step in the process.
There has historically been an absence of uniformity and stated clear policy instructions for adjudicators at the two levels. There has been no established ongoing common training for personnel.
Separate and opposite quality assurance and case review systems tend to drive the two components apart rather than to bring them together.
Mr. Chairman and members of the committee, thank you again for the opportunity to provide these comments on the challenges and opportunities facing the disability program. NCDDD restates its desire to continue to work together with SSA during the continued evolution and improvement of the program. We appreciate this committee’s initiative in addressing and resolving barriers to improved service delivery.