Mr. Chairman, thank you for your invitation to participate in the first in a series of hearings on the challenges and opportunities facing the Social Security disability programs. As members of the disability community, we certainly agree that we all must work collegially to thoughtfully, carefully and realistically examine the challenges faced by these programs. 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. We agree wholeheartedly with President Bush that the first guiding principal of Social Security is to "...protect disability for American citizens".

Before commenting on five specific challenges and opportunities, we would like to restate the purpose of our organization, explain the reasons for the federal state partnership, and describe our commitment to current and future solutions to the major challenges facing the disability programs.

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 has 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 teamwork. We appreciate the recommendations of the bipartisan Social Security Advisory Board (SSAB) as stated in their report of February 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.

NCDD sees five key challenges that compromise our ability to continue to provide even basic levels of customer service for the programs that we jointly administer with SSA. These challenges relate to the tools necessary to effectively and efficiently administer the disability programs. The essential tools consist of:

1. adequate resources;
2. an organizational structure more appropriate to the scope and importance of the program;
3. clear, concise policy;
4. a quality culture promoting consistency and integrity;
5. up to date, integrated systems support.

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 is 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. Thus far, the DDSs have been the only component to perform the mission of the Social Security disability programs productively, responsibly, timely, consistently, and cost effectively. In fact, for years, various SSA components have referred to the state agencies as being the "best deal" in government service.

However, given the significance of the programs we jointly administer, we are greatly concerned that SSA is increasingly unable to provide the high quality of service that the public deserves and has come to expect. 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 at least 175,000 more cases pending that we are able to process. These applications are awaiting assignment to caseworkers because all the caseloads are full. 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.

As described in the recent reports of the Social Security Advisory Board, SSA’s current organizational structure disperses functions and authority for the disability program over too many separate components. The individual most identifiable as being responsible for the disability program is at the associate commissioner level which we find curious in view of the magnitude of the program. Policy development, program evaluation, budgeting, and systems are all administered separately. Such an environment does not provide for the level of accountability appropriate for such an important program.

NCDDD and the Advisory Board agree that the program would benefit if it were managed by having one high level individual who would report directly to the commissioner and whose authority would cut across functional lines.

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 about 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.

Quality Assurance

Along with clear and 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 application of policy among all components. The presently 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.

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 recommends that future development and enhancement of electronic systems be accomplished with greater reliance on the DDS systems personnel and through the use of private sector contracting.

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. Again, NCDDD restates its desire to continue to work in partnership with SSA during the continued evolution and improvement of the program. We appreciate this committee’s interest in addressing and resolving barriers to improved service delivery.