Detailed Information on the
Black Lung Benefits Program Assessment

Establishing performance goals for the OALJ, BRB, and Solicitor that are ambitious and contribute to efficient adjudication of Black Lung claims.

Increasing Responsible Operator and Insurer participation in evidentiary development of Black Lung claims at the District Office level.

Reviewing medical cost containment objectives and the construction of the indicator used to measure results, including the appropriateness of measuring against independent industry benchmarks.

Periodically review actual performance vis-??-vis targets and modify targets to ensure that they remain challenging.

Conduct an independent evaluation of the Black Lung program that includes a comparison of program outcomes and efficiency to other similar programs.

Determine what comparable medical cost trend should be used to evaluate medical cost containment performance.

Track and report on productivity (output per full-time-equivalent employee) in order to gauge efficiency and year-to-year changes.

Re-proposing legislation to refinance and ultimately retire the Trust Fund debt.

Completing review of independent program evaluation recommendations for improved program performance measures and implementing, as appropriate, in the next round of accountability reviews beginning in April 2008.

Revising procedures for beneficiary and representative payee monitoring to better coordinate and further automate.

Measure: Percentage of Black Lung benefit claims decided under the revised regulations where there are no requests for further action from any party pending one year after receipt of claim.

Explanation:

Measure: Average number of days for the Division of Coal Mine Workers' Compensation (DCMWC) to render a decision on a claim for Black Lung benefits.

Explanation:This measure tracks the timeliness of adjudication processes for claims filed by the nation's coal miners and their survivors under the Black Lung Benefits Act. This measure ties to the overarching goal for the Office of Workers' Compensation Programs to reduce the consequences of work-related injuries by accelerating delivery of benefits to eligible claimants. Accelerated adjudication of claims delivers faster compensation to beneficiaries and reduces the likelihood that denied claims will lead to costly litigation. The baseline for this measure was established in 2004.

Measure: Percent increase in Black Lung average medical treatment cost from the previous year is less than the National Health Expenditure Projection

Explanation:This measure compares the Black Lung Program's average medical costs for eligible miners with the National Health Expenditure Projection (NHEP), which is a nationwide index published by the Centers for Medicare and Medicaid Services, Office of the Actuary. The purpose of the measure is to demonstrate the program's success in containing medical treatment costs by keeping the yearly rate of change of average medical costs at or below the NHEP. The NHEP was chosen as the nationwide comparable index because, unlike Medicare, the Black Lung program is not subject to the Sustainable Growth Rate provisions of the Balanced Budget Act of 1997, and the Program's experience tracks more closely to the past projections of the NHEP than to other indices. The NHEP is updated on an annual basis and the program adjusts its targets accordingly. The baseline year for the measure is 2007 and the program will begin reporting results in 2008.

Is the program purpose clear?

Explanation: As defined by its authorizing statute, the program's purpose is to provide benefits, in cooperation with the States, to coal miners who are totally disabled due to pneumoconiosis (black lung disease) and to eligible surviving dependents of such miners; and to ensure the provision of future adequate benefits to coal miners and their dependents in the event of their death or total disability due to black lung disease.

Evidence: The Federal Coal Mine Health and Safety Act of 1969, as amended (30 U.S.C. 901 et seq) and program regulations (20 CFR Part 718).

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

Explanation: Congress created the program in 1969 based on its finding that: "there are a significant number of coal miners . . . who are totally disabled due to pneumoconiosis arising out of employment in one or more of the Nation's underground coal mines; that there are a number of survivors of coal miners whose deaths were due to this disease; and that few States provide benefits for death or disability due to this disease to coal miners or their surviving dependents." While Federal respirable dust control standards and advances in dust suppression technology have helped to reduce the prevalence of occupational black lung disease, it remains a problem. There are anecdotal data suggesting that State coverage of black lung disease remains inadequate.

Evidence: The prevalence of pneumoconiosis, as measured by Federal data, declined significantly from 1970 to 1995. More recent data suggest a continued decline for underground miners with over 20 years of experience, but no clear trend for others. 1995-2002 data yielded a crude prevalence of 2.8%, but low participation by contract miners and miners at small operations suggest this may be an underestimate. In FY 2002, the program received about 8,060 new claims and had 117 thousand beneficiaries (including 65 thousand beneficiaries under Part B and 52 thousand under Part C). [Sources: The Federal Coal Mine Health and Safety Act of 1969, as amended; U.S. Centers for Disease Control and Prevention, "Pneumoconiosis Prevalence Among Working Coal Miners Examined in Federal Chest Radiograph Surveillance Programs--United States, 1996-2002," Morbidity and Mortality Weekly Report, No 52 (15), pp. 336-340.]

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

Explanation: The program was established because State workers' compensation rarely assisted victims of black lung disease. Today very few individuals receiving Federal Black Lung benefits also receive state workers' compensation benefits. In cases where an individual receives both State and Federal benefits, the Federal benefit is reduced by the full amount of the State benefit. The Act permits states to petition for exemption from the Federal program, if they have a program that meets or exceeds the Federal benefit standards. No state has ever applied (although there is no incentive for them to do so). DOL and Social Security Administration (SSA) have taken steps to eliminate duplication of effort within the program itself. Social Security Disability Insurance benefits are reduced by the full amount of Black Lung benefits.

Evidence: According to program data as of April 30, 2003, only 8.3% of the miners entitled to benefits under Part C of the Act also received state workers' compensation benefits. Only 1.7% of disabled miners' widows receive such benefits. Program data suggest that most Black Lung do not seek state benefits: of 206 claimants filing between 6/5/03 and 6/13/03, only 40% had filed a State claim. Based on estimates provided in February 2003 by SSA, only about 600 Part C Black Lung beneficiaries (out of approximately 50,000) are eligible for DI. SSA has responsibility for Part B of the Act, which governs claims filed on or before December 31, 1973; and DOL has responsibility for Part C, which governs subsequent claims. Since 1997, DOL has managed Part B claims on SSA's behalf. Administration-proposed legislation to unify program responsibility in DOL was enacted (P.L. 107-275) and will be implemented by the first quarter of FY 2004.

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

Explanation: The Black Lung Trust Fund has a large and mounting debt dating back to the Trust Fund's early years, when excise taxes were inadequate to fund the program and DOL had to borrow from the General Fund to cover the shortfall. Congress subsequently changed the program and since then tax revenues have generally covered program costs, but the interest payments have grown and now exceed Part C benefit and administrative costs. (The FY 2005 Budget includes a proposal to refinance, and ultimately retire, the Trust Fund debt.)

Evidence: At the end of FY 2003, the Black Lung Disability Trust Fund had an outstanding debt of $8.2 billion. FY 2003 Part C costs were distributed as follows: $367 million for benefits, $55 million for administration, and $621 million for interest on Treasury advances.

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

Explanation: OWCP has achieved a relatively low erroneous payment rate for the program (less than 2%), although the FY 2003 overpayment rate is higher than the prior year (when it was less than 1%). Under Part C, 30% of overpayments stem from the statute's unique interim benefits provision, which requires the payment of benefits after an initial OWCP determination of eligibility (versus after resolution of appeals). Congress added interim benefits to provide some monetary relief to typically low-income claimants while their claim was going through the appeals process. If the claimant is ultimately found ineligible, OWCP seeks repayment (but has waiver authority in certain cases, such as economic hardship). DOL recovers about one-third of these costs. To control erroneous payments, the national office collects and tracks monthly data from the nine district offices and conducts bi-yearly accountability reviews that assess district office performance. The program conducts routine audits to identify claimants who die, and dependents who reach age 18 and students who may no longer be eligible for benefits (common sources of erroneous payments).

Evidence: In FY 2003, Parts B and C overpayments represented 1.7% ($13.7 million) of benefits paid (OWCP/Division of Coal Mine Workers' Compensation, overpayment summary report as of 9/30/2003). Part C overpayments were $8.1 million, of which 30% ($2.4 million) were overpayments stemming from interim benefits.

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: The program currently has one long-term GPRA output goal: by FY 2008, to increase the percentage of Black Lung benefit claims for which, following an eligibility decision by the division director, there are no requests for further action from any party pending one year after receipt of the claim. Beginning in FY 2004, the program will add a second long-term goal of reducing the average time for OWCP to make a claims decision. While output goals, they meaningfully reflect OWCP's overarching strategic goal (minimizing the social, human, and economic impact of occupational injury and disease) and the purpose of the program (to provide benefits). Averting resource-intensive appeals and speeding claims processing both serve to minimize the hardship imposed by black lung disease. The program also plans to add, beginning in FY 2005, a third goal of keeping the rate of change in Black Lung medical costs at or below the nationwide comparable trend.

Evidence: DOL FY 2003-2008 Strategic Plan (www.dol.gov/_sec/stratplan/main.htm; see outcome goal 2.2), FY 2005 Budget documents.

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

Explanation: The FY 2008 goal is to increase by 10 percentage points over baseline (66.5%) the percentage of benefit claims for which there are no requests for further action from any party pending one year after receipt of the claim. In FY 2002, the program realized an improvement of 23.4 percentage points (89.9% of claims had no requests for further action)--well above the FY 2008 target. Circumstances during this period (see adjacent column) suggest that the FY 2002 performance level was artificially high, and that future performance levels will drop as claims return to normalcy. The program will monitor actual performance in FY 2003 and adjust this long-term goal as necessary to ensure that it is challenging. The program has added a second long-term goal: to reduce to 300 days the average time for OWCP to make a claims decision. (Currently it takes an average of 455 days from filing to a proposed decision.)

Evidence: Circumstances suggest that the FY 2002 performance level is an anomaly. In January 2001, revised program regulations became effective. Because many claimants believed these regulations would liberalize eligibility, the program received a large volume of new claims--8,988 in FY 2001 and 8,060 in FY 2002 (compared to 6,351 in 2000). When claimants realized the eligibility criteria had not changed, those with manifestly futile claims withdrew them. This contributed to a high number of withdrawals (1,495 in 2002), which inflated the number of claims without further action pending after one year. In addition, there was a judicial stay for half of FY 2001, which prevented all claims adjudication activity. (Department of Labor FY 2003-FY 2008 Strategic Plan.)

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

Explanation: The program has established annual goals that demonstrate progress toward its single GPRA goal of reducing the percentage of claims with requests for action pending one year after filing. The program also has numerous management goals (e.g., measuring the share of specific actions, such as conversion of survivor benefits, completed within target timeframes) that it uses to measure district and overall case processing performance.

Evidence: The FY 2005 goals are to: (1) increase to by 73.5% (one percentage point above the FY 2004 target) the percentage of Black Lung benefit claims for which, following an eligibility decision by the district director, there are no requests for further action from any party pending one year after receipt of the claim; (2) reduce to 315 days the average time for OWCP to render a claims decision (a 2% reduction from the FY 2004 target); and (3) keep the medical cost trend within the comparable nationwide medical cost trend. (Sources: DOL FY 2003-FY 2008 Strategic Plan, Division of Coal Mine Workers' Compensation FY 2003 Operational Plan, FY 2005 Budget documents.)

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

Explanation: Baselines have been established for the current GPRA goal and the new claims processing goal. Targets and baseline for the medical cost containment goals are to be determined--OWCP is seeking a medical cost index to use as a point of comparison. Program managers review the program's performance against GPRA and management goals to ensure they remain appropriate given program performance.

Evidence: The FY 2005 goal is to increase by 7% over the FY 2001 baseline the percentage of Black Lung benefit claims for which, following an eligibility decision by the district director, there are no requests for further action from any party pending one year after receipt of the claim. FY 2001 baseline is 66.5%. Additional claims processing goal for FY 2005 is to render proposed decision on a Black Lung benefits claims within an average of 315 days. (In the second quarter of FY 2003, the average processing time was 455 days--partially a function of the backlog that developed during the court-ordered stay.)

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: The Office of the Administrative Law Judge, Benefits Review Board, and Solicitor play critical roles in resolving Black Lung claims (and account for over 40% of the program's administrative costs), but (with the exception of BRB) have not set performance goals and should be required by the Department to do so. The ALJ and BRB have workload measures, but only the BRB has set performance goals for processing Black Lung claims. The Solicitor has no performance standards or measures. The program has no authority to impose performance goals on its external partners - UMWA Health and Retirement Funds, SSA, and the state workers' compensation programs - but has mechanisms to monitor and document performance. In the case of SSA and UMWA, OWCP establishes activity expectations in memoranda of understanding and similar documents and requires parties to report on their activities. In the case of States (which receive no Black Lung funding) the program has no ability to impose performance goals.

Evidence: The Benefits Review Board has set goals of issuing decisions within one year, issuing reconsideration decisions within 6 months, and issuing decisions on attorneys' fees within 3 months. The Office of the Administrative Law Judge has no internal performance standards, but has a general goal of reducing the Black Lung backlog (1,259 cases at the end of FY 2002). SSA accepts claims under Part C of the program on behalf of DOL and is reimbursed for these services. SSA provides a quarterly statement detailing their activities. Similarly, the United Mine Workers Association (UMWA) Health and Retirement Funds is reimbursed by DOL for medical services provided to Black Lung beneficiaries. UMWA provides a detailed accounting of their activities and OWCP performs audits at least yearly and in response to particular issues to ensure the integrity of the process.

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: In 2001 the program participated in the University of Michigan's American Customer Satisfaction Index survey. The DOL CIO recently conducted a comprehensive review of the program's IT system to ensure alignment with program mission, strategic goals, the e-government initiative, and relevant laws and directives, the results of which are pending. In 2002, DOL hired a contractor to evaluate the effectiveness of pulmonary rehabilitation services reimbursed by the program. The DOL and SSA Inspectors General performed two audits (1999 and 2000) of DOL's Part B activities on behalf of SSA. The program pays more than $700 million in benefits annually. Given this, and the program's fiduciary responsibility for the Black Lung Disability Trust Fund, financial management is a significant portion of the program's activities. Accordingly, the annual OIG financial audits represent an evaluation of a major component of program operations. Audit findings are used to improve program performance and effectiveness.

Evidence: OIG audits, American Customer Satisfaction Index (University of Michigan), December 17, 2001; CIO review scorecard (results pending), DOL OIG, "Review of Cost and Fraud Controls and Allowances for Home Oxygen in the Federal Black Lung Program," Report 2E-04-433-0001 (October 27, 1999); OIG Audit 17-99-008-04-433: "A Joint Assessment of the MOU Between SSA and DOL/ESA's Division of Coal Mine Workers' Compensation Program on Handling Part B Black Lung Claims" (1999); OIG Audit 17-00-009-04-433: "Second Annual Audit of the MOU Between SSA and DOL/ESA/DCMWC's Program on Handling Part B Black Lung Claims" (2000).

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: Like the rest of DOL, OWCP does not have an integrated accounting and performance management system to identify the full cost of achieving this program's performance goals and support day-to-day operations. While the program's budget requests are aligned with the program's strategic and operational goals, they are not based on what is needed to attain specific levels of performance. The FY 2004 Budget for the Black Lung program identified all benefit costs and direct and indirect administrative resources for program activities for FY 2004. Benefit funding trends and the impact of legislative changes on mandatory (benefit) funding are estimated using existing cost models, which an Office of the Inspector General (OIG) actuary reviews on an annual basis.

Evidence: FY 2004 Department of Labor Congressional Justification.

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

Explanation: The program has added claims processing time and medical cost containment goals, and will begin measuring performance against these goals in FY 2005. DOL is in the process of implementing a managerial cost accounting system. In FY 2005, OWCP will contract with an independent entity to conduct a comprehensive review of the Black Lung program to examine how well the program is accomplishing its mission and meeting its long- term goals. DOL will also ensure that OALJ, BRB, and the Solicitor set ambitious goals that contribute to timely Black Lung claims processing, and report on performance against those goals.

Evidence: The program's new goals are to reduce to 300 days the average time for OWCP to make a claims decision, and keep Black Lung medical cost trends within the trend for comparable populations (comparable trend is to be determined).

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: Every fiscal year OWCP develops operational plans that establish performance standards for each of the district offices, and throughout the year collects and evaluates information measuring performance against these standards. National office managers weekly review key data, such as progress in eliminating claims backlogs, and make adjustments to ensure that goals are met and make adjustments as necessary. Quarterly meetings are held with district offices to their evaluate performance and to initiate corrective actions where necessary. In addition, more detailed accountability reviews of district offices are conducted every other year. Accountability reviews assess performance against 18 quality and timeliness elements, based on a randomly selected sample of cases. The national office also applies a weighted formula to workload projections to determine how to allocate staff among the regional offices. OWCP requires some of its external partners (SSA and the United Mine Workers Association (UMWA)) to report on their activities and works with them to resolve any performance issues.

Evidence: As problems are identified actions are taken to ensure the appropriate distribution of resources to meet performance goals. For example, in May 2003 OWCP noted that the Parkersburg office had a large volume of claims relative to staff, and that processing time was increasing. To address this, OWCP transferred 165 cases from Parkersburg to Johnstown, which did not have as large a backlog of cases. Within six weeks the Johnstown office had dramatically reduced this inherited backlog. UMWA's Health and Retirement Funds, which is reimbursed by DOL for medical services provided to some Black Lung beneficiaries, provides a detailed accounting of its activities to allow DOL to determine whether they are appropriate Black Lung program costs. OWCP performs audits at least yearly and in response to particular issues.

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

Explanation: The Office of the Administrative Law Judge, Benefits Review Board, and Solicitor--which play critical roles in resolving Black Lung claims (and receive over 40% of Black Lung administrative funds)--have workload measures, but only the BRB has set performance goals. OWCP has no authority to impose performance goals on non-DOL partners, but specifies the types of services to be performed in memoranda of understanding and similar documents, and requires parties to report on their activities. The program has a performance-based IT contract, according to which the contractor is held accountable for cost, schedule and performance results. The contractor must submit a monthly report that details performance on numerous factors. Program staff review this report and other data to ensure compliance. DOL ties performance ratings for managers and supervisors to the achievement of Departmental and program-specific goals and outcomes; employees are aligned on a fiscal year cycle to help cascade standards to non-supervisory personnel, and a system accountability review is planned for 2004.

Evidence: Revised Performance Management Plans for Senior Executives (Form DL 1-2059, Rev. 10/2001) and for Supervisors and Managers (Form DL 1-382, Rev. 10/2001); briefings by DOL staff; and DOL goals supporting the Human Capital Initiative of the President's Management Agenda. [Answer was re-ordered to put OALJ/BRB/SOL discussion first.]

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

Explanation: Salaries and expenses funding is obligated in a timely manner, and according to the OWCP spending plan. OWCP monthly monitors status of spending against the plan. An actuarial model, reviewed on an annual basis by OIG, is used to project benefit outlays. The program has a low level of erroneous payments--in FY 2003 data, Parts B and C overpayments represented 1.7% ($13.7 million) of benefits paid.

Evidence: OWCP/Division of Coal Mine Workers' Compensation, overpayment summary report as of 9/30/2002.

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: The Black Lung program has no cost effectiveness goals, but has added a goal of reducing the average claims processing time and has committed to tracking and reporting in the Budget productivity data (specifically output-per-FTE) data. In addition, program managers numerous management goals and track district office case processing performance against them. For example, as part of its FY 2003 operational plan, the program has established overall performance goals (and district office goals that contribute to them): (1) to issue a schedule for the submission of additional evidence (SSAE) within 180 days from filing, (2) issue a proposed decision and order within an average of 140 days after SSAE; and (3) process 98% of Part B maintenance actions within 30 days. The program establishes targets each year.

Evidence: For example, a decision to integrate program networks with the common ESA platform in FY 2002 resulted in a bottom line reduction of $700,000 in projected system expenditures, based on economies of scale, from FY 2002 to FY 2003. Division of Coal Mine Workers' Compensation, FY 2003 Operational Plan.

Does the program collaborate and coordinate effectively with related programs?

Explanation: OWCP has cultivated a close working relationship with SSA, which shares statutory responsibility for the Black Lung program. SSA has responsibility for Part B of the Act, which governs claims filed on or before December 31, 1973; and DOL has responsibility for Part C, which governs subsequent claims. Since 1997, DOL has managed Part B claims on SSA's behalf under a reimbursable agreement. Legislation to unify program responsibility in DOL was enacted (P.L. 107-275) and will be implemented by the first quarter of FY 2004. OWCP and SSA share claims data (e.g., benefit payments, death reports) to prevent duplicate and erroneous payments. The program also works with managers of the United Mine Workers of America (UMWA) Health and Retirement Fund, which the Black Lung program reimburses for appropriate medical payments to certain miners. OWCP also consults with States before paying claims to ensure that there are no State benefits (which would reduce the Federal benefit).

Evidence: Agreement between DOL and the UMWA Health and Retirement Funds for the Reimbursement of Qualified Medical Expenses paid to Miners Eligible for benefits under the Black Lung Benefits Act (originally signed in 1980 and modified as necessary); DOL and SSA--Agreement Covering Reimbursable Services: Request for Duplication of the Death Master File (VDMAS); DOL and SSA--Agreement Covering Reimbursable Services: Taking miners and survivors claims for Black Lung Benefits under DOL jurisdiction and searching earnings records for coal miner employment.

Does the program use strong financial management practices?

Explanation: The most recent audit of the Department of Labor (FY 2002) revealed no material or reportable weaknesses pertaining to the Black Lung program. The Black Lung accounting system substantially complies with Federal accounting requirements (the exception is managerial cost accounting). To control erroneous payments, the national office collects and tracks monthly data from the nine district offices and conducts bi-yearly accountability reviews that assess district office performance. The program conducts routine audits to identify claimants who die, and dependents who reach age 18 and students who may no longer be eligible for benefits (common sources of erroneous payments). The program has a low rate of erroneous payments (less than 2%).

Evidence: In FY 2003, Parts B and C overpayments represented 1.7% ($13.7 million) of benefits paid (OWCP/Division of Coal Mine Workers' Compensation, overpayment summary report as of 9/30/2003). See also the Department of Labor's FY 2003 Report on Performance and Accountability.

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

Explanation: The program has added a long-term goal of reducing to 300 days the average time for OWCP to make a claims decision (the current average is 455 days). The program has also agreed to track and provide in the Budget output-per-FTE data to demonstrate efficiency and productivity improvements from year to year. DOL will also ensure that OALJ, BRB, and the Solicitor set ambitious goals that contribute to timely Black Lung claims processing, and report on performance against those goals.

Evidence:  

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

Explanation: Because the program's goals are new, there are limited data upon which to judge progress toward the long-term goals. The first year of performance data for increasing the percentage of claims without requests for further action at one year showed performance well beyond the FY 2008 targeted level and a promising trend. However, circumstances suggest that the FY 2002 level is artificially high (see response to question 2.2, evidence/data), and that the percentage will drop in subsequent years. The claims processing and medical cost trend goals are new for FY 2005, so progress against them cannot be judged. The program had no prior GPRA goals. The ALJ, BRB, and Solicitor do not have long-term goals, so progress against them cannot be evaluated.

Evidence: For FY 2002, 89.9% of claims had no requests for further action after one year (versus the FY 2002 goal of 68.5% and the FY 2008 goal of 76.5%) .

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

Explanation: The first year of performance data for increasing the percentage of claims without requests for further action at one year showed performance well beyond the FY 2002 targeted level. However, circumstances suggest the performance level is artificially high (see response to question 2.2, evidence/data). The claims processing and medical cost trend goals are new for FY 2005, so progress against them cannot be judged. The program had no prior GPRA goals. Some ALJ and BRB workload data are available and indicate progress in claims processing (although the ALJ does not have performance goals and no data were available to track performance against BRB goals). The Solicitor has not committed to performance goals.

Evidence: For FY 2002, 89.9% of claims had no requests for further action after one year (versus the FY 2002 goal of 68.5%). OWCP has reduced its aged SSAE inventories from 1096 to 530 and PDO inventories from 787 to 341 during FY 2003 (through June 13, 2003), indicating progress in terms of claims processing timeliness. From FY 2001 to FY 2002, the ALJ reduced the number of Black Lung claims pending at the end of the year, from 1417 to 1259, and the backlog from 14 months to 12 months.

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

Explanation: The program has no cost-effectiveness performance goals, but has provided data that shows some efficiency improvements over time and will begin tracking and reporting these data in the Budget. The program has also agreed to add a performance goal pertaining to OWCP's average claims processing time. Current management goals assess the share of claims processed in a timely manner (and show a consistently high percentage of claims actions meeting the targeted time frames).

Evidence: From FY 2001 to FY 2003 (Q1 and Q2), adjudications per FTE increased from 16 to almost 38 (2001 was affected by the judicial stay). During the same period, claims managed per FTE dropped from 598 to 496. The number of claims managed per FTE, which increased dramatically (to 710) when DOL in 1998 assumed responsibility for SSA Part B claims, has declined since then (a factor of declining caseloads). Number of schedules for submission of additional evidence (a new work product under the revised regulations) per FTE increased from 37 to 39 from 2002 to 2003. "YES" is contingent on agreement to report productivity data, as per 3.4.

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

Explanation: In FY 2001 OWCP participated in the University of Michigan's American Customer Satisfaction Index, which assesses programs government-wide based on customer surveys. Based on feedback from a subset of Black Lung program Part B beneficiaries, the program received an index score of 93--higher than the national average for private and public-sector entities providing goods and services, and the highest score among benefit programs. No data are available to compare the program's outputs, outcomes, cost-effectiveness, or efficiency with those of other similar programs.

Evidence: University of Michigan Business School, American Society for Quality, "American Customer Satisfaction Index: Report on Employment Standards Administration Division of Coal Miners Compensation (ESA)", May 2001.

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

Explanation: Two joint DOL/SSA Office of the Inspector General audits (1999 and 2000) concluded that DOL was providing "high quality services" in processing Part B claims on SSA's behalf, and recommended the transfer of the program to DOL. In 2001, the Black Lung program received an American Customer Satisfaction Index score of 93, the highest score among benefit programs. The final report on the effectiveness of Black Lung-reimbursed pulmonary rehabilitation services is expected shortly (difficulties in assembling data delayed and limited the scope and generalizability of the study).

Evidence: University of Michigan Business School, American Society for Quality, "American Customer Satisfaction Index: Report on Employment Standards Administration Division of Coal Miners Compensation (ESA)", May 2001; OIG Audit 17-99-008-04-433: "A Joint Assessment of the MOU Between SSA and DOL/ESA's Division of Coal Mine Workers' Compensation Program on Handling Part B Black Lung Claims" (1999); OIG Audit 17-00-009-04-433: "Second Annual Audit of the MOU Between SSA and DOL/ESA/DCMWC's Program on Handling Part B Black Lung Claims" (2000); OCIO ASP Review (04/2003); OIG Consolidated financial Statement Audits.