Social Security Disability

Social Security Administration (SSA) regulations call for continuing disability reviews to begin as soon as six months after benefits are awarded in some cases or as long as seven years after benefits are awarded in other cases. GAO has reported on several occasions that, because SSA did not consistently perform required reviews when due, hundreds of millions of dollars in unnecessary costs were incurred each year, and program integrity was undermined. About 4.3 million reviews were due or overdue as of fiscal year 1996. In response, SSA developed a plan for a seven-year initiative to conduct about 8.2 million reviews during fiscal years 1996 through 2002. SSA revised that plan in 1998, setting a goal of 8.1 million reviews for fiscal years 1998 through 2002--the last five years of the initiative. Including the 1.2 million reviews already processed, SSA plans to process a total of 9.3 million reviews during the full seven-year period. This report discusses (1) whether SSA's plan to process 8.1 million reviews during fiscal years 1998 through 2002 will result in reviews being done for all beneficiaries for whom reviews are required by law and (2) whether the disability determination services' processing capacity and the continuing disability review funding authorized by Congress through 2002 will be adequate.

GAO noted that: (1) by the end of fiscal year (FY) 2002, if SSA completes its new CDR plan as envisioned, all CDRs required by law will be complete or under way, including those that are overdue and those due to be started by the end of FY 2002; (2) when DDSs award disability benefits, they set due dates for starting CDRs, and every month these prescheduled CDR start dates come due for many beneficiaries; (3) because CDRs can require up to 1 year to complete from the time beneficiaries are selected for CDRs, many CDRs cannot be completed by the end of the fiscal year in which they become due; (4) SSA estimates that about 835,000 of the required CDRs due to be started in FY 2002 will not be completed by yearend; (5) these CDRs will be completed in FY 2003, according to SSA; (6) of the 8.1 million CDRs planned for fiscal years 1998 to 2002, SSA plans to complete 53 percent through brief questionnaires mailed to selected beneficiaries and 47 percent through full medical reviews conducted by DDSs; (7) according to SSA, in formulating its plan, SSA consulted with DDSs to plan caseloads that will not exceed the DDSs' case processing capacity; (8) however, DDSs could potentially encounter additional caseloads not envisioned in SSA's plan; (9) for several beneficiary groups, SSA is still working to develop statistical formulas for selecting appropriate mailer recipients; (10) if DDSs have to conduct more full medical reviews to replace CDR mailers, the authorized funds could prove inadequate because full medical reviews cost significantly more than mailers; (11) if SSA's assumptions about economic growth and unemployment do not prove accurate or if the test results for SSA's disability process redesign plan are not positive, the volume of initial disability applications and requests for reconsideration of denied applications could potentially be larger than assumed by SSA; (12) if so DDSs could face even larger backlogs of these non-CDR cases in order to complete CDR full medical reviews in a timely manner; (13) recognizing the potential uncertainty of the CDR and non-CDR workloads, SSA plans to monitor them closely; (14) SSA acknowledged that its CDR plan may require revisions and that unexpected workload increases, if they occur, could lead SSA to decide to increase the case processing capacity of state DDSs; and (15) potential barriers to the timely expansion of DDS capacity exist as well, such as shortages of qualified applicants and office space, state hiring freezes, and the time required to train and mentor new staff.