Statement of The Honorable Jo Anne B. Barnhart, Commissioner, Social Security Administration Testimony Before the Subcommittee on Income Security and Family Support of the House Committee on Ways and Means September 27, 2005 Chairman
McCrery, Chairman Herger and Members of the Subcommittees:
Thank
you for inviting me today to discuss my approach to improve the Social Security
disability claims process. Throughout my tenure as Commissioner, I have made
improving the disability determination process one of my highest priorities.
As
I have discussed in previous appearances before you, we have taken a number of
steps toward that end--especially the successful implementation of the
electronic disability process. And I want to thank the members of the
Subcommittees for your support of our efforts. It has been clear to me from
the beginning that we need
to make some significant changes to streamline the system if we are to provide
the kind of service the American people expect and deserve.
But before
I go any further, I want to take a moment and address Social Security’s role in
the national response to the devastation left by Hurricane Katrina. Foremost,
I want you to know that we are doing all that we can to make sure that beneficiaries
are receiving their benefits.
Approximately
one million Social Security and Supplemental Security beneficiaries live in the
affected counties or parishes of Louisiana, Mississippi and Alabama. And every
month, they receive almost a billion in benefits.
To meet the
needs of these beneficiaries, I invoked immediate payment procedures which
permit payments to be made to any Social Security beneficiary or Supplemental
Security Income recipient who has lost access to their benefit check. This means
that beneficiaries from the Gulf Coast can go to any Social Security office
throughout the United States and request an immediate payment, and a check will
be issued on the spot.
Within a
few days of the hurricane, we knew that there was no way for many of our
beneficiaries to reach one of our offices. So, for those who relocated to
evacuation centers or shelters, Social Security established an on-site presence
to issue immediate replacement checks.
We have
already issued about 53,000 immediate payments. To put this in perspective, in
a typical month a district office provides an average of 8 immediate payments,
but in a single day we issued almost 200 at the Astrodome alone. We hope to
have new addresses for as many people as possible for the October checks, but
will still issue immediate payments for those who need them.
We’re also
working with federal, State and local officials in affected areas to assist
families who – after the hurricane – may now be eligible for Social
Security benefits. In this regard, we have put into place emergency procedures
that will enable us to quickly process applications for survivors – widows,
widowers and their children – or other Social Security benefits.
Clearly
with the complete devastation of Hurricane Katrina, many citizens do not have
identification. To make sure evacuees have the Social Security information
necessary for employment or other federal assistance, SSA staff are assisting
individuals through a simplified protocol to get them the documentation they
need.
Our
dedicated employees are at the core of our efforts. When I had the opportunity
to visit the Gulf Coast, I saw in person the professionalism and compassion of
the men and women of SSA and the State Disability Determination Services. There
has been a tremendous outpouring of support from these employees. These
dedicated men and women, many of whom have lost their own homes and face other
losses related to Hurricane Katrina, are working long hours, and in some
instances sleeping in offices and commuting over long distances to make sure
that those on the Gulf Coast are receiving the help they need. I am incredibly
proud to lead an agency with the spirit and the compassion that is the
character of our nation’s Social Security employees.
For
example, in Mobile, an employee delivered an immediate payment check to a local
shelter and stayed to help serve dinner. Later that night, she returned to
donate items for a baby staying at the shelter. I am sure there are countless
other stories like this that remain to be told.
Our work
continues in shelters and in field offices everywhere in the country where
there are evacuees. It continues with file recovery, establishment of
temporary offices, and work toward repairing damaged buildings. And it
continues through our commitment to making sure that the pending disability
claims of people who were affected by Hurricane Katrina are completed as timely
as possible.
We have
retrieved all of the 6,321 paper files from the New Orleans Disability Determination
Services (DDS) office. With a special pass arranged by the Office of the
Inspector General, we gained entry into the DDS building in New Orleans, packed
400 boxes of files, which contractors carried down many flights of stairs lit
only by flashlights. We will make sure these cases are processed as soon as
possible.
In previous appearances before you, I’ve stressed the
importance of our electronic disability process—eDib—which is replacing
voluminous paper files with electronic files. Electronic files had been
established for about 1900of the cases pending in the New Orleans DDS
office. I’m pleased to report that we electronically reassigned these cases to
the Shreveport office of the DDS beginning in the first week of September.
This brings
me back to our topic today--how to make major improvements in the disability
process so that we can provide better service to all Americans who apply for
benefits.
Status
of eDib
When I
first discussed with you my new approach to the disability process, I said that
the foundation for the new approach was successful implementation of eDib.
The
new approach to disability claims processing can work efficiently only when all
components involved in disability claims adjudication and review move to an electronic
business process through the use of an electronic disability folder.
I
am pleased to say that eDib is becoming a reality across the nation.
As
planned, roll out is being staggered to ensure that SSA is able to provide each
DDS with the support necessary for successful implementation. Once roll out
begins in a DDS, the number of DDS decision makers working with electronic
folders gradually expands as the DDS develops expertise with the process. So
far, 53 of the 54 DDSs in 49 out of the 50 States have rolled out the
electronic disability folder, which means that some or all of the decision
makers in these DDSs are adjudicating cases in an electronic environment.
In
January 2004, the Mississippi DDS started implementing eDib. This past
January, the Mississippi DDS became the first in the nation to start processing
virtually all cases in a totally electronic environment. Since eDIB was fully implemented
in the Mississippi DDS, the DDS has reduced its processing times for Title II
disability claims by 7.1 days and for Title XVI disability claims by 9.8 days.
Hawaii, Illinois, and Nevada have joined Mississippi and are processing all
new disability claims in a totally electronic environment. We are reviewing
the progress being made in several other States and by the end of the year
another 13 DDSs may be totally electronic.
At
the Office of Hearings and Appeals (OHA), our Case Processing and Management
System has been implemented in all of the hearing offices and is being used to
control case flow and provide management information. In addition, 79 hearing
offices in 26 States have conducted over 700 hearings using electronic
folders. The initial response from OHA’s Administrative Law Judges, and
claimants and their representatives has been positive.
In
addition, we have been replacing all of our hearing offices’ aging tape
recorders with digital recording equipment. This equipment is less bulky than
the old analog equipment and offers enhanced quality, more stable storage
capacity, and greater business process functionality. Furthermore, it provides
an electronic recording that eventually will be stored in the electronic
folder. Currently, digital recording has been installed in 8 regional offices
and 106 hearing offices. We expect all hearing offices to be converted to
digital recording by April 2006.
By
the end of next year, I expect each of the DDSs and OHAs to be processing their
workloads with electronic disability folders on a regular basis. As I noted
earlier, eDib allows SSA and DDS adjudicators to view an individual’s claims
file anywhere in the country. This flexibility affords SSA a new opportunity
to make changes to improve the administrative efficiency of the program.
The
New Approach
Last year,
I testified before you on my vision for the new approach to disability
determination. I described to you a conceptual framework for the new approach,
and I promised that, before we published proposed rules to turn the conceptual
framework into a comprehensive plan, we would conduct an open consultation
process to hear from those involved at every step of the disability process.
As you know, on July 27, we published a Notice of Proposed Rulemaking
(NPRM) which sets out my plan to improve the disability determination process.
This NPRM was developed after an extensive outreach program I launched to let
interested parties know what I was considering and to listen to their reaction.
I personally conducted over 100 meetings with almost 60 groups, both internal
and external. My staff participated in many more meetings. We also received
hundreds of emails from individuals currently receiving disability benefits,
individuals currently applying for benefits, and other interested citizens
providing recommendations on how to improve the process.
As a result of these discussions, the NPRM includes
significant changes to the framework I originally put forth. For instance:
- We initially
believed that Quick Disability Determination claims should be adjudicated in
regional units across the country, and not in the State agencies. However,
many of the groups we met with and numerous individuals believed that the State
agencies could effectively adjudicate these claims. In the NPRM, we have
proposed that the State agencies be allowed to adjudicate Quick Disability
Determination claims.
- Several
organizations and numerous individuals also urged us to allow the State
agencies to continue to use State agency medical consultants when making
initial disability determinations under the proposed plan. The NPRM provides
that State agencies may continue use State medical and psychological
consultants in the disability determination process, as long as they meet SSA’s
qualification standards in those areas where standards have been established.
A number of the groups we spoke with asked that we consider
providing for good cause exceptions to closing the record after the issuance of
the ALJ decision. Although the NPRM proposes to close the administrative
record after the ALJ issues his or her decision, it also provides for limited
good cause exceptions to closing the record.
Another area of concern involved our plans to eliminate the
Appeals Council step of the administrative review process. For example, some
thought that if claimants could not request administrative review with the
Appeals Council, the Federal courts would see a large influx of Social Security
disability cases following the ALJ hearing level. Accordingly, a number of
organizations and groups asked us to retain the Appeals Council until we could
be sure that the proposed new process was working as intended.
The NPRM
makes it clear that we intend to roll out the new process gradually on a
region-by-region basis, and that we also intend to retain the Appeals Council
and continue its operations in those regions where the new process has not yet
been implemented. This gradual implementation also will provide us with the
opportunity to assess the effects of the elimination of the Appeals Council and
to make any necessary adjustments.
The
Objective of the Changes we have Proposed
My
objective in proposing changes in SSA’s disability determination process is to
fundamentally improve the quality of service that the agency provides both to
claimants and to the public at large.
When
I first spoke with President Bush about the current disability program, he
asked me three questions. Those questions were:
- Why does it take so long to make a disability decision?
- Why can’t people who are obviously disabled get a
decision immediately?
- Why would anyone want to go back to work after going
through such a long process to receive benefits?
I realized
that designing an approach to fully address the central and important issues
raised by the President required a focus on two over-arching operational goals:
- to make the right decision as early in the process as
possible; and
- to foster return to work at all stages of the process.
To
accomplish this, the NPRM proposes changes aimed at expediting the disability
decision making process; improving the accuracy, consistency, and fairness of
decisions; and making the process more understandable and more credible. We
are also working on a series of demonstration projects that we believe will
help us determine how best to assist disabled individuals in their efforts to
participate in the Nation’s work force.
Before I
describe some of the features of the NPRM, I want to take a moment to talk
about what I believe is a unique opportunity to make the kind of changes that
will substantially improve the disability process. This is a difficult
challenge because people who view the process from different vantage points,
have different perspectives, and different views on what we should do to
improve it.
I think
this is one reason that past efforts have not been successful. But, this time,
I believe that we can be successful. I say this because of the spirit of
cooperation, openness, and constructive dialogue that I have seen in the
conversations we’ve had with people involved at every stage of the process.
As I said a
moment ago, this NPRM is the blueprint for what began as a conceptual framework
for our new approach. I do not expect that everyone will embrace every element
of the process proposed in the NPRM. I am looking forward to reviewing those
comments and fully expect that there will be changes from the NPRM to the final
rules. I do hope that when we review the comments, we will continue to see the
same cooperative and constructive spirit and that we can focus on the ultimate
goal of improving the process from start to finish.
Before
I go any further, I would like to acknowledge the hard work and dedication of
our SSA and State Disability Determination Services (DDS) employees. The
current backlogs and associated delays exist despite their best efforts. I
want to emphasize that no Social Security or State employee will be adversely
affected by my new approach. I believe the new approach will allow them to
provide even better service to the public.
The proposed regulations
do preserve some of the significant features of the current system. Initial
disability claims will continue to be handled by SSA’s field offices; State DDS
agencies will continue to adjudicate claims for benefits; and Administrative
Law Judges (ALJs) will continue to conduct de novo hearings and issue
decisions. However, the proposed regulations also make some important
changes. Today I would like to talk about the major changes we have proposed
and why we have proposed them.
Quick Disability Determination Unit
The
proposed rules would establish a Quick Disability Determination (QDD) process
through which State agencies would expedite cases for people who are clearly
disabled. Appropriate claims would be identified and referred directly to
special units in the State agencies. We expect that these QDD units would then
process these claims in 20 days or less, thereby potentially reducing waiting
times for those claimants by several months.
Federal Expert Unit
We realized
that under our current disability adjudication process, medical and vocational
experts are not consistently available to adjudicators at every level or in all
parts of the country. Therefore, we proposed to create a Federal Expert Unit
to oversee a national network of medical, psychological, and vocational experts
that will be available to assist adjudicators at all levels throughout the
country. The purpose of this Federal Expert Unit, would be to augment and
strengthen the medical and vocational expertise that currently exists in our
DDS’s. State medical consultants can choose to become part of the Federal
Expert Unit if they meet the qualifications. And, as we have said before, we
want to ensure that each case is seen by the right medical eyes. For example,
an adjudicator evaluating a musculoskeletal impairment would be able to receive
an orthopedist’s opinion before deciding the claim, thus ensuring a more
accurate decision. Presently, 20 percent of the disability workload is
comprised of musculoskeletal cases, yet only 2.5 percent of DDS medical
consultants are orthopedists.
Eliminate State Agency Reconsideration and Create Federal
Reviewing Officials
Several of
the groups and individuals with whom we met described the reconsideration
review level in the disability process as having little value. Based on the
belief that claimants perceive this level as little more than a rubber stamp,
the proposed regulations would eliminate the reconsideration level of review.
State agency examiners would be required to more fully document and explain the
basis for their determinations at the initial level. We would create a Federal
reviewing official (RO) who would review initial State agency denials if a
claimant appealed. The RO would provide a written decision on the claim, give
reasons for accepting or rejecting findings, and consult with an expert
affiliated with the national network if he or she disagrees with the initial
determination.
During
the course of our outreach, as we discussed this appeals step, people told us
that the RO does not need to be an attorney about as often as others told us
that the RO absolutely should be an attorney. As we indicated in the NPRM, we
believe that attorneys are ideally suited to perform certain critical RO
functions, such as drafting well-supported, legally-sound decisions. Moreover,
we believe that using attorneys will improve the level of confidence in the
integrity of this level of review. Therefore, we have proposed filling this
position with attorneys. As these subcommittees are well aware, we already
employ many excellent attorneys who have significant experience in SSA’s
disability programs.
Retains
the de novo Hearing Before The Administrative Law Judge (ALJ)
ALJs would
continue to hold de novo hearings and issue decisions based on all the
evidence presented during the hearing. ALJs would not be required to give any
legal deference or weight to the decisions previously made by the RO; however,
ALJs would be required to provide in their decisions an explanation as to why
they agree or disagree with the rationale in the RO’s decision. This
explanation would be used to provide constructive feedback to reviewing
officials to improve future case reviews.
Submitting Evidence Timely and Closing the Record
Throughout
our discussions, there was a general concern that we need to receive claimants’
evidence in a more timely manner. The NPRM proposes that claimants must submit
evidence no later than 20 days before the hearing. Furthermore, the record
would close after the ALJ issues a decision. We believe that these changes will
increase our ability to process hearing requests in a more timely manner.
Similarly,
we heard from a number of people who were concerned that these new changes
would harm those claimants who, through no fault of their own, were unable to
submit their evidence in a timely manner. The NPRM proposes closing the record
but includes good cause exceptions to the submission requirements I have just
described.
These
proposed changes would protect a claimant’s right to fairly present his or her
case while reducing unnecessary delays in the hearing process.
Decision Review Board (DRB)
Under
the proposed rules, Appeals Council functions gradually shift to a newly
established Decision Review Board (DRB). The DRB would review both allowances
and denials. A claimant’s right to request review of an ALJ decision in a
disability claim would be eliminated; however, a claimant could still seek
review when an ALJ dismisses his or her request for a hearing.
The
DRB would consist of both ALJs and Administrative Appeals Judges serving
staggered terms who would review both favorable and unfavorable decisions that
are likely to be error-prone. As I mentioned, the disability review functions
currently performed by the Appeals Council would gradually shift to the DRB as
the new approach is implemented region by region.
One
of the concerns related to elimination of the Appeals Council was the
possibility of an increase in court workloads. The NPRM proposes to gradually
eliminate the Appeals Council only in those regions where we have implemented
the changes in the NPRM. We will monitor the cases appealed to the Federal District Court, and the gradual rollout allows us to make adjustments as necessary.
Quality
The
NPRM addresses the need for in-line and end-of-line quality review at all
levels of the disability determination process. Pre-effectuation review at the
initial level would continue.
The
lynchpin of quality assurance under the new approach is accountability and
feedback at each level. The new quality process would focus on both denials
and allowances, and concentrate on ensuring that cases are fully documented at
each stage. This last point is crucial because we believe that better
documentation would allow cases to move through the system more quickly and will
produce better decisions.
Demonstration Projects
Currently,
we have numerous incentive programs that encourage disability beneficiaries to
work, such as the Ticket to Work and Self-Sufficiency program and expedited
reinstatement. Despite these incentives, few disability beneficiaries choose
to work.
We
have designed several demonstration projects to test the impact of different
work incentives on disability beneficiary and claimant behavior. These
projects include the following:
Accelerated Benefits Demonstration Project. This demonstration project will
provide immediate private health benefits and employment supports for a
specified period (2 to 3 years) to newly entitled SSDI beneficiaries who are
highly likely to improve medically with aggressive medical care. For instance,
a new beneficiary with a fractured hip would benefit from immediate health care
to facilitate a return to the workforce. We expect to award a contract for
this project within a month and to begin enrolling participants next year.
National Benefit Offset Demonstration Project ($1 for $2). This demonstration
will test the effects of allowing Disability Insurance beneficiaries to work
without total loss of benefits by reducing their monthly benefit one dollar for
every two dollars of earnings above a specified level. While the contractor
for the national demonstration project is designing the project, we are
operating a smaller four-state benefit offset demonstration in Connecticut, Utah, Wisconsin, and Vermont. This four-state project will help inform the
national demonstration project. These projects are well underway and the States
began enrolling participants in August 2005.
Early Intervention Demonstration Project. This project would
provide immediate medical and cash benefits as well as employment supports to
SSDI applicants with certain impairments presumed disabling who elect to pursue
work rather than proceed through the disability determination process. We will
be conducting this demonstration as a part of our National Benefit Offset
project.
Mental
Health Treatment Study. The purpose of the Mental Health Treatment Study (MHTS) is to
study the impact that better access to medical treatment and employment
services would have on outcomes such as medical recovery, and ultimately
employment for SSDI beneficiaries who have a mental impairment as a primary
diagnosis. The project will provide outpatient treatments (pharmaceutical and
psychotherapeutic) and/or employment support services. The interventions will
be implemented through demonstration projects in multiple sites. SSA awarded a
contract to the Urban Institute to develop and administer a 10-member Technical
Advisory Panel (TAP), consisting of experts in the fields of psychology,
psychiatry, research, private insurance, and employment supports. The final
report was issued in April 2005 and provided recommendations for appropriate
interventions for this population. We expect to award a contract for this
project this year with enrollments starting next year.
Youth
Transition Demonstration. In
September 2003, to further the President’s New Freedom Initiative goal of
increasing employment of individuals with disabilities, SSA awarded cooperative agreements to six States (California, Colorado, Iowa, New York, Maryland, and Mississippi) for the purpose of developing programs to assist youth with
disabilities to successfully transition from school to work. These
projects are beginning their third year of operation, have enrolled 622
participants to date, and have successfully helped many youth to obtain jobs.
Disability
Program Navigator.In
September 2002, SSA and the Department of Labor’s (DOL) Employment and Training
Administration collaboratively funded a 2-year pilot of the Disability Program
Navigator (DPN). As of August 2005, 267 DPNs operate in 17 States (Arizona, California, Colorado, Delaware, Florida, Illinois, Iowa, Maryland, Massachusetts, Mississippi, New Mexico, New York, Oklahoma, Oregon, South Carolina, Vermont, and Wisconsin). The Department of Labor recently announced its intention to add
DPNs to 15 more States and the District of Columbia.
DPNs work
in one-stop career centers where beneficiaries with disabilities can receive
employment services. The purpose of the Navigators is to provide a connection
between beneficiaries and jobs through the local workforce investment boards.
California HIV/Immune Disorder Demonstration
Project.
The purpose of the California
HIV/Immune Disorder Demonstration Project is to determine whether immediate and
ongoing comprehensive medical benefits along with employment service
coordination helps to improve the health of participants to enable them to
increase their economic self sufficiency through work. SSA plans to work with
the California Department of Rehabilitation (DOR) to provide employment
services coordination so that participants will have ongoing supports
throughout the process to facilitate an employment goal. Also, SSA will
provide DOR with a network of California medical expertise that will provide
assistance in developing employment plans that are consistent with limitations
or needs associated with the individual’s impairment. SSA will provide the
funding for services provided by DOR and the medical network.
This is the first time that such a
unique approach will be tested, i.e. federal and State entities working
collaboratively with the medical community for purposes of helping individuals
with disabilities return to work. SSA will evaluate the impact these
changes have on beneficiaries’ health, work behavior, and dependency on
long-term benefits.
We expect to begin enrolling participants in calendar year
2006.
Next
Steps
As
I said earlier, we published the proposed regulations on July 27. The 90-day
comment period closes on October 25. Again, Mr. Chairman, I want to emphasize
my personal commitment as well as that of the agency to review comments in the
spirit that has characterized this entire process with the expectation that
there will be changes in the final rule.
I am
committed to making sure that implementation proceeds carefully so that all
claims are handled fairly and responsibly. We expect
to begin roll-out next spring in one of our smaller regions.
Just
as we did with e-Dib--as we gain experience--we will gradually roll-out the
process nationwide, making
modifications as needed.
Conclusion
When
I accepted the job of Commissioner, I made it clear that I did not accept this
position to manage the status quo. Nowhere was the need for change more
apparent than in the disability process. Therefore, from the outset I made
improving service to our disability claimants a priority.
I
want to thank everyone who has shared their views and those who plan to submit
comments. Finally, I would be remiss if I did not thank you Chairman McCrery
and Chairman Herger and the members of your subcommittees for your support and
guidance. Your leadership and interest have played a significant role in our
ability to get people from all perspectives to work together. I look forward
to continuing to work with you and your staffs as we improve service to
individuals with disabilities.
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