Detailed Information on the
Social Security Disability Insurance Assessment

Simplifying the process for determining if an individual is disabled to improve the accuracy and speed of decisions.

Testing several demonstration projects and removing other barriers to assist Disability Insurance beneficiaries in returning to work.

Implementing a hearing backlog reduction plan to eliminate the hearing backlogs as efficiently and expeditiously as possible.

Publishing rules to update the way age is considered in making disability determinations and considering other rule changes.

Measure: Minimize average processing time in days for initial disability claims to provide timely decisions

Explanation:Processing time is measured from application date (or protective filing date) to either the denial notice date or the date the system completes award processing. Through 2007, processing time included all initial disability claims. Beginning 2008, processing time includes only initial disability claims that receive a medical decision and excludes claims that do not need a medical decision because basic eligibiy requirements are not met. The targets beginning 2008 reflect improved medical decision processing time.

Measure: Achieve the budgeted goal for average processing time in days for hearings

Explanation:Represents the elapsed time from the hearing request date until the end of disposition of all cases at the hearings level (disability and non-disability) processed during all months of the fiscal year. We measure remands from the remand order date. As of the beginning of FY 2007, we determined there were approximately 63,770 cases pending that would be in the aged category of more than 1,000 days old by the end of the fiscal year. We decided the Agency could best serve the public by focusing on these cases. Processing time is measured by the average length of time it takes to process cases from the request-for-hearing date to disposition during the fiscal year. We recognized the processing time for these aged cases would inflate the overall average processing time for the fiscal year and the goal was modified to compensate for this. We processed all but 108 of the 63,770 cases. This represents a 99.8 percent reduction of this critical workload. Consequently, although processing time for FY 2007 increased over that for FY 2006, SSA met its FY 2007 goal. Although the long-term goal reflects a substantial decrease over the FY 2009 target, we are hiring 189 ALJs in FY 2008 and they will become fully productive by the end of FY 2009. In addition, we have begun a number of initiatives that will reduce average processing time for hearings in FY 2009 and beyond.

Measure: Disability Determination Services (DDS) cases processed per workyear

Explanation:This goal measures the average number of cases processed by an individual DDS employee during the fiscal year. If we are able to process more cases per workyear, we do more work with the same input, which improves efficiency. This count represents outcomes that are directly linked to overall Agency performance. Although we did not meet this goal, the FY 2007 average cases processed per workyear of 249 shows an improvement of 3.3 percent over the FY 2006 average cases processed per workyear of 241, and continued to climb during the last six months. One factor that affected the number of cases processed per individual was the Agency's decision to focus on clearing older cases, which take more time to process. Also, on a national basis, over 47 percent of DDS medical examiners have less than five years experience and over 23 percent have less than two years. As part of the new eDib initiative, the training for all disability examiners in the new electronic document management system was completed in FY 2007. As DDS employees are now near the end of the learning curve in the move from the more-familiar paper process to the new fully electronic disability system and have gained more experience as adjudicators, performance is expected to continue to increase.

Measure: Achieve the budgeted goal for SSA hearings cases production per workyear.

Explanation:This indicator represents the average number of SSA hearings case production per workyear expended. If we are able to process more cases per workyear, we do more work with the same input, which improves efficiency. A direct workyear represents actual time spent processing cases. Note: Targets for FYs 2003 and beyond include only SSA hearings.

Measure: Disability Determination Services (DDS) net accuracy rate for combined initial disability allowances and denials.

Explanation:Net accuracy is the percentage of correct initial state disability determinations. Net accuracy is based upon the net error rate, which is defined as the number of corrected deficient cases with changed disability decisions, plus the number of deficient cases that are not corrected within 90 days from the end of the period covered by the report, divided by the number of cases reviewed. Improving net accuracy improves outcomes by increasing correct allowances and/or correct denials. Note: Prior to FY 2003, we reported allowance and denial accuracy rates separately. Starting in FY 2003, we have moved to a combined accuracy rate.

Is the program purpose clear?

Explanation: The Disability Insurance (DI) program purpose is clear: to provide benefits for eligible workers who have qualifying disabilities and for eligible members of their families.

Evidence: Social Security Amendments, effective 1956.

Does the program address a specific and existing problem, interest, or need?

Explanation: The DI program currently provides for a specific problem/need: to replace a portion of lost income for covered workers who are considered disabled, if they have a qualifying disability, as defined under the Social Security Act.

Evidence: As of December 2002, the DI program provided benefits to 5.5 million disabled worker beneficiaries and 1.7 million dependents. (Office of the Actuary Fact Sheet on OASDI, December 31, 2002.)

Is the program designed so that it is not redundant or duplicative of any Federal, state, local or private effort?

Explanation: While there are other private or governmental programs that may provide some disability benefits (e.g., workers' compensation, long term disability), the DI program is a universal program that provides a safety net for covered workers who have qualifying disabilities.

Evidence: Section 223 of the Social Security Act. Code of Federal Regulations 404.130.

Is the program design free of major flaws that would limit the program's effectiveness or efficiency?

Explanation: When it was first created, the DI program was probably effective in its legislative objective to replace a portion of income lost due to a qualifying disability. However, because of the many changes that have occurred since 1956, the program design does not optimally meet the needs of people with disabilities. For example, advances in technology and legislation like the Americans With Disabilities Act have opened the workplace and made it more accessible to all people. The President's New Freedom Initiative is actively working to expand employment opportunities for Americans with disabilities. In addition, many impairments that in the past may have been permanent and/or completely disabling, may now be treatable because of advances in medicine. These changes have made some aspects of the current disability program outdated. GAO expressed a similar conclusion when they recently placed all Federal disability programs on their high-risk list. SSA is exploring how to reshape the DI program in the future to reflect these changes and ways to improve the processing of disability claims, which can be lengthy.

Evidence: Social Security Amendments, effective 1956; GAO's Informational Final Report (GAO-03-119), "2003 High Risk Series - An Update, Audit # 12003009.".

Is the program effectively targeted, so program resources reach intended beneficiaries and/or otherwise address the program's purpose directly?

Explanation: The low hearings accuracy rate of 88% and inconsistency in initial and hearings decisions across states suggest that the DI program is not designed to have the smallest practicable share of funds going to unintended beneficiaries. This inconsistency partially reflects the differences between the Disability Determination Services (DDSs) and the Office of Hearings and Appeals (OHA) determination processes. GAO, Social Security Advisory Board (SSAB), and a private consulting firm recommend that SSA overhaul its current Quality Assurance process to help address these issues. As first steps, SSA has created an internal team to look at these recommendations and established a revised definition of quality.

Evidence: FY 2004 APP, pg. 20. GAO, "Major Management Challenges and Program Risks: SSA," January 2003. The Lewin Group, "Evaluation of SSA's Disability Quality Assurance processes and Development of QA Options That Will Support the Long-Term Management of the Disability Program," March 2001. SSAB, "Charting the Future of Social Security's Disability Programs: The Need for Fundamental Change," January 2001.

Does the program have a limited number of specific long-term performance measures that focus on outcomes and meaningfully reflect the purpose of the program?

Explanation: SSA has a limited number of long-term performance measures that focus on outcomes and meaningfully reflect the purpose of the program and address the management of the program. These include processing time, productivity, accuracy, and other measures. (The performance goals encompass a broader scope than just the DI program.)

Evidence: SSA's Strategic Plan 2003 - 2008; Performance Plan for FY 2004 and Revised Final Performance Plan for FY 2003, pgs. 59-61.

Does the program have ambitious targets and timeframes for its long-term measures?

Explanation: SSA has set realistic and challenging targets for initial claims processing time, hearings processing time, and hearings productivity. However, targets for DDS productivity are not ambitious given SSA's commitment to annual productivity increases of 2% in FY 2004-2008. Also, SSA's DDS net accuracy target, held constant at the FY2004 level, does not promote continued improvement.

Evidence: SSA's Strategic Plan 2003 - 2008; FY 2005 Budget Submission.

Does the program have a limited number of specific annual performance measures that demonstrate progress toward achieving the program's long-term measures?

Explanation: SSA has a limited number of annual measures that address the management of the program. These include processing time, productivity, decisional accuracy, and other measures. (The performance goals encompass a broader scope than just the DI program.)

Evidence: Performance Plan for FY 2004 and Revised Final Performance Plan for FY 2003, pages 18 - 20. Performance and Accountability Report FY 2002 pages 32-33, 113-114, 118.

Does the program have baselines and ambitious targets and timeframes for its annual measures?

Explanation: SSA has baselines and ambitious annual targets that address the management of the program. These include processing time, productivity, decisional accuracy, and other targets. (The performance goals encompass a broader scope than just the DI program.)

Evidence: Performance Plan for FY 2004 and Revised Final Performance Plan for FY 2003, pages 18 - 20. Performance and Accountability Report FY 2002 pages 32-33, 113-114, 118.

Do all partners (including grantees, sub-grantees, contractors, cost-sharing partners, etc.) commit to and work toward the annual and/or long-term goals of the program?

Explanation: Both long-term and annual performance goals are established for and committed to by SSA's partners (DDSs). DDS Administrators commit to specific performance goals.

Evidence: SSA's Strategic Plan 2003 - 2008; Performance Plan for FY 2004; and Revised Final Performance Plan for FY 2003.

Are independent and quality evaluations of sufficient scope and quality conducted on a regular basis or as needed to support program improvements and evaluate effectiveness and relevance to the problem, interest, or need?

Explanation: SSA measures decisional accuracy on an ongoing basis and payment accuracy each year. SSA also evaluates policies and processes on a continuing basis. GAO and OIG continually audit the program and make recommendations for change. These evaluations thoroughly assess a wide range of aspects of the DI program and are generally national in scope.

Evidence: SSA measures adjudicative accuracy and payment accuracy of claims. Outside monitoring entities (GAO, OIG, private accounting firm, etc) regularly evaluate the program and make recommendations in such areas as processing of disability claims. Recent reports include: GAO, "Major Management Challenges and Program Risks: SSA," Jan. 2003. OIG, "Status of SSA's Disability Process Improvement Initiatives, "June 2002.

Are Budget requests explicitly tied to accomplishment of the annual and long-term performance goals, and are the resource needs presented in a complete and transparent manner in the program's budget?

Explanation: SSA's budget requests are not explicitly tied to annual and long-term outcome performance goals (i.e. processing times and payment accuracy), such that there is not a direct link between resource requests and these goals; however, SSA does go through an elaborate and extensive process to tie performance to budgeting. Goals are set based on available resources and the need to balance overall performance within those resource limits. SSA tracks the level of performance against the annual and long term targets on an ongoing basis and adjusts resource allocation and level of effort accordingly. SSA can demonstrate that its budget request ties to annual and long-term output goals and can directly link incremental changes in resources to workload performance outputs such as retirement or disability claims processed. In addition, SSA is making progress in relating resources to outcomes such as the relationship between pending workloads and processing time, and the dollars invested in continuing disability reviews and program dollars saved.

Evidence: SSA FY 2005 Budget Submission

Has the program taken meaningful steps to correct its strategic planning deficiencies?

Explanation: SSA constantly assesses, evaluates and improves strategic plans and performance measures. SSA has a limited number of long-term performance goals and a limited number of annual performance targets that help the agency progress toward achieving the long-term goals. As a part of the Annual Performance Plan (APP) preparation, SSA re-evaluates the effectiveness of the agency's long-term strategies and short-term (annual) targets/measures, and adjusts the long-term strategies and annual performance targets as appropriate.

Evidence: SSA's Strategic Plan 2003 - 2008; Performance Plan for FY 2004 and Revised Final Performance Plan for FY 2003. SSA has adopted a revised DDS performance measure, DDS net accuracy rate. From an external standpoint, this new measure more clearly and comprehensively shows whether DDSs are making the right disability determination. Formerly, SSA reported separate allowance and denial accuracy rates for DDSs. Performance Plan for FY 2004 and Revised Final Performance Plan for FY 2003, page 60.

Does the agency regularly collect timely and credible performance information, including information from key program partners, and use it to manage the program and improve performance?

Explanation: Timely and credible performance information is collected through systematic and consistent processes with periodic quality controls to confirm the validity of the data. For example, SSA reviews a sample of initial disability claims each quarter to determine their accuracy. Additional sampling and review is conducted if a specified level of accuracy is not reached.

Evidence: SSA regularly collects payment accuracy, adjudicative accuracy, workload data and myriad of management information from administrative records. (FY 2002 PAR pgs. 32-34, 112-120; Performance Plan for FY 2004 and Revised Final Performance Plan for FY 2003, pages 18-20.

Are Federal managers and program partners (grantees, subgrantees, contractors, cost-sharing partners, etc.) held accountable for cost, schedule and performance results?

Explanation: SSA executives are held accountable for key performance measures. Monthly meetings are held and progress is tracked in the SSA Tracking Report on the Intranet. In FY 2003 SSA has implemented a revised SES Performance Appraisal Plan, which incorporates performance standards for managers, and will implement a revised plan for other employees in the future. In addition, the DDS administrators are held accountable for their performance. When the DDS's accuracy falls below the required range for two consecutive calendar quarters, appropriate performance support is provided.

Evidence: SES Performance Appraisal System Plan. Section 411.250 of the "Ticket to Work and Self-Sufficiency Program" Final Rule. The Code of Federal Regulations for Social Security, sections 404.1645-404.1662.

Are all funds (Federal and partners') obligated in a timely manner and spent for the intended purpose?

Explanation: Program funds are obligated consistent with the rules of the program. Procedures exist for reporting actual expenditures.

Evidence: SF-133; FY02 PAR, pages. 50 ff.

Does the program have procedures (e.g., competitive sourcing/cost comparisons, IT improvements, approporaite incentives) to measure and achieve efficiencies and cost effectiveness in program execution?

Explanation: SSA continually looks for means to achieve cost efficiencies in managing the DI program. The budget process in general looks to identifying improvements in the processing of disability claims. As an example, SSA is implementing the first steps to improving the disability process and is assessing additional ways to improve it (Service Delivery Plan, APP). SSA's information technology (IT) capital planning process provides the operational IT plans required to provide the technology and other IT resources needed to achieve the agency's strategic goals and performance objectives. IT resources are used to invest in more efficient customer responsive processes. SSA's IT plan includes financial systems replacement (FACT and MCAS), Electronic Service Delivery and Accelerated Electronic Disability folder (Aedib).

Evidence: SSA's FY 03 Budget Submission pgs 11-15, 31-42; memorandum did 5/23/02 to OMB; FY 2001 PAR, page 66; Exhibit 300 - 016-00-01-02-01-2060-01; FY 2004 Budget Submission; FY 2002 PAR, page 52 .

Does the program collaborate and coordinate effectively with related programs?

Explanation: The DI program is effective in working with other related programs such as Vocational Rehabilitation facilities. The Ticket to Work provisions have led to coordination of employment initiatives with the Department of Labor (DOL) and private industry. SSA works with the Centers for Medicare and Medicaid Services (CMS) to provide Medicare coverage for beneficiaries who return to work, and will be sharing data with CMS to identify continuing disability review (CDR) mailer candidates. SSA coordinates with State workers' compensation agencies and the DOL to ensure that beneficiaries are paid correctly. SSA works with the Veteran's Administration to secure medical evidence for veterans who have applied for disability benefits. In the near future, SSA will be working closely with other agencies to coordinate efforts related to the President's New Freedom Initiative.

Evidence: 1) Coordination with CMS: Interagency Agreement between SSA and CMS providing SSA with Medicare utilization data. 2) Coordination with the State's worker's Compensation (WC) agencies: SSA's Program Operation's Manual (Pomes) DI 52001.150 discusses WC verification; several references describing SSA's procedures in providing its data to States that offset the WC due to receipt of disability benefits including, Colorado (DI 52001.204), Florida (DI 52001.211), Massachusetts (DI 52001.905), Ohio (DI 52001.239), and Washington (DI 52001.253). 3) FY04 Budget Justification details forthcoming coordination efforts related to the New Freedom Initiative.

Does the program use strong financial management practices?

Explanation: SSA's financial statements received an unqualified audit opinion in FY 2002 for the ninth consecutive year. In the past SSA has conducted Continuing Disability Reviews (CDRs) based on a special funding mechanism and has proposed earmarking funding for CDRs and data matches (WC cleanup, Office of Child Support Enforcement match) to increase payment accuracy.

Evidence: FY 2002 PAR pgs 42-45; pages 175-182.

Has the program taken meaningful steps to address its management deficiencies?

Explanation: SSA integrates management controls into process and financial management systems at all levels to identify control weaknesses. Once identified, SSA develops corrective action plans, implements them, and reviews the controls of the new or changed processes to ensure they remain effective. Reviews encompass processes such as earnings, claims and postentitlement events, and debt management. Through its service delivery assessment of the disability program, SSA has identified problems with the disability claims process and is taking steps to address them. These steps include: eliminating backlogs as a prerequisite to reducing processing time; accelerating the development of a paperless disability process that includes sharing of information through an electronic folder; updating medical listings to reflect advances in medical knowledge, diagnosis, and treatment. SSA is also taking steps to improve the appeals process, including: improving all facets of training for disability adjudicators; developing a case management processing system; issuing bench decisions, expanding the use of technology; and contracting outfile assembly.

Evidence: SSA's Strategic Plan 2003 - 2008; Performance Plan for FY 2004 and Revised Final Performance Plan for FY 2003 pages 18-20.

Has the program demonstrated adequate progress in achieving its long-term outcome performance goals?

Explanation: SSA has made adequate progress in improving DDS processing time and hearings processed per workyear (PPWY) over the prior year. However, the agency has not yet made sufficient progress in achieving goals with respect to hearings processing time and long-term decisional accuracy. As stated in Question 2.2, the long-term DDS PPWY goal is not ambitious.

Evidence: Performance Plan for FY 2004 and Revised Final Performance Plan for FY 2003 pages 59-61 for target goals. The Performance and Accountability Report for FY 2002, pages 32, 33, 112, & 118 for actual results.

Does the program (including program partners) achieve its annual performance goals?

Explanation: SSA has exceeded its targets for average initial processing time and hearing decisions issued per workyear; and improved in DDS PPWY over the prior year. In addition, the Agency almost met its annual goal for hearings processing time. However, the agency did not meet its annual goal for decisional accuracy for denials.

Evidence: The Performance and Accountability Report (PAR) for FY 2002, pages 32, 33, 112 & 118.

Does the program demonstrate improved efficiencies or cost effectiveness in achieving program performance goals each year?

Explanation: SSA relies heavily on continuing disability reviews and data matches (Medicare Non-Utilization, WC match) to make the program as efficient and cost effective as possible. SSA is currently taking steps to improve the disability process. The Old Age Survivors and Disability Insurance (OASDI) and Hospital Insurance/Supplemental Medical Insurance program benefits from doing Continuing Disability Reviews (CDRs) decreased slightly from $2.4 billion in FY 2000 to $2.3 billion in FY 2001. DI actual overpayment collections for FY 2002 are expected to exceed both the FY 2002 estimate and the actual for FY 2001.

Evidence: FY 2001 PAR pg 66; memorandum did 5/23/02 to OMB; SSA FY 1999 and FYs 2000 and 2001. Reports to Congress on the processing of CDRs; FY 2004 OMB Submission pg 95. FY 2002 PAR, page 52.

Does the performance of this program compare favorably to other programs, including government, private, etc., that have similar purpose and goals?

Explanation: While private and public disability programs can offer lessons on isolated process components, differences in the programs being compared limit the relevance of direct comparisons. Private disability insurers generally assess only whether a claimant can no longer do the same job. They rely heavily on SSA's determinations to decide the more difficult question of whether a claimant is unable to work at all. Among public programs, variations in program requirements limit the usefulness of direct performance comparisons of aggregate measures such as total processing times. Payments from these other programs may be offset by any Social Security benefits.

Evidence: Testimony by UnumProvident to the U.S. House Ways and Means, Social Security Subcommittee, July 2002. UnumProvident is the largest private disability insurer in the U.S. and provides specialized return-to-work services early in the disability claims process. GAO Testimony to the U.S. House Ways and Means, Social Security Subcommittee of Ways and Means, July 2000. GAO's assessment found that private disability insurers incorporate return-to-work efforts from the beginning of the assessment process.

Do independent and quality evaluations of this program indicate that the program is effective and achieving results?

Explanation: While the program does achieve the objective of providing income support to disabled individuals, problems in the program design limit its effectiveness in other ways. Reports from the GAO, Social Security Advisory Board and others have repeatedly noted that significant program improvements are necessary if SSA is to improve its productivity and processing times. The problems that SSA, GAO, and others have identified include: inconsistency in claims decisions made by state Disability Determination Services and Office of Hearings and Appeals across States; long delays in processing claims; and the failure to adapt the disability definition to changing medical technology, vocational options, and social attitudes toward disability. Court decisions have also increased the difficulty of deciding disability claims.

Evidence: SSAB, "How SSA's Disability Programs Can Be Improved," August 1998. SSAB, "Charting the Future of Social Security's Disability Programs: The Need for Fundamental Change," January 2001. GAO, "SSA Has Had Mixed Success in Efforts to Improve Caseload Management," Oct. 1999. GAO, "Disappointing Results From SSA's Efforts to Improve the Disability Claims Process Warrant Immediate Attention," Feb.2002. GAO, "Efforts to Improve Claims Process Have Fallen Short and Further Action Is Needed," June 2002. GAO, "High Risk Series, An Update," January 2003.