Social Security Administration
Agency Is Positioning Itself to Implement Its New Disability Determination Process, but Key Facets Are Still in Development
Gao ID: GAO-06-779T June 15, 2006
In March 2006, the Social Security Administration (SSA) published a rule that fundamentally alters the way claims for disability benefits are processed and considered. The rule establishes the Disability Service Improvement process (DSI)--intended to improve the accuracy, timeliness, consistency, and fairness of determinations. DSI's changes include an opportunity for an expedited decision during the initial determination process and the elimination of the Appeals Council, which had given claimants the right to appeal administrative law judge (ALJ) decisions before pursuing federal court review. DSI replaces the council with a Decision Review Board, which will selectively review ALJ decisions. However, dissatisfied claimants whose cases are not selected for board review must now appeal directly to the federal courts. Based on its ongoing work, GAO was asked to testify on (1) public and stakeholder concerns about the elimination of the Appeals Council and its replacement by the Decision Review Board and SSA's response to these concerns, as well as (2) the steps that SSA has taken to help facilitate a smooth implementation of the DSI process.
Concerns regarding the replacement of the Appeals Council with the Decision Review Board--raised by the public and stakeholder groups, such as claimant representatives--generally fall into two areas: (1) potential for increasing the workload of the federal courts and (2) anticipated hardship for claimants in terms of the loss of an administrative appeal level and difficulties associated with pursuing their claim in federal court. SSA's response to concerns regarding the federal court workload is that all changes associated with the new DSI process--taken together--should reduce the need for appeal to the federal courts; at the same time, SSA plans to implement this final step gradually and with additional safeguards to minimize impact on the courts. In response to concerns about the loss of appeal rights, SSA contends that DSI introduces enhanced levels of federal review earlier in the process and that claimants should experience a decline in the amount of time it takes to receive a final agency decision. SSA has prepared in significant ways for the initial rollout of DSI in its Boston region, but the agency's timetable is ambitious and much work remains. The agency has moved forward in key areas that underpin the new system--human capital development, technical infrastructure, and quality assurance--taking actions consistent with past GAO recommendations for improving the disability determination process. For example, SSA has taken steps to ensure that key technical supports, particularly its electronic disability case processing system, are in place--even though it has allowed itself little time to address and resolve any glitches that may arise prior to implementation. SSA has also taken several steps to lay a foundation for quality assurance by centralizing its quality assurance reviews, establishing a Decision Review Board for reviewing decisions, and developing writing tools that should foster consistency and thorough documentation at all phases of the determination process. Further, we found that SSA's decision to implement DSI first in one small region prior to its introduction nationally is a good change management strategy that reflects our earlier recommendations. Additionally SSA has taken a proactive, collaborative approach to both the design and the implementation of the new determination process. Nevertheless, key facets of SSA's plan to monitor and evaluate the Boston rollout remain to be developed. For example, performance measures for assessing the execution of the rollout are still unclear to us, and mechanisms for delivering feedback to staff on the clarity and soundness of their decision writing have not yet been fully developed.
GAO-06-779T, Social Security Administration: Agency Is Positioning Itself to Implement Its New Disability Determination Process, but Key Facets Are Still in Development
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Testimony:
Before the Subcommittee on Social Security, Committee on Ways and
Means, House of Representatives:
United States Government Accountability Office:
GAO:
For Release on Delivery Expected at 11:00 a.m. EDT:
Thursday, June 15, 2006:
Social Security Administration:
Agency Is Positioning Itself to Implement Its New Disability
Determination Process, but Key Facets Are Still in Development:
Statement of Robert E. Robertson, Director Education, Workforce, and
Income Security Issues:
GAO-06-779T:
GAO Highlights:
Highlights of GAO-06-779T, a report to House Committee on Ways and
Means Subcommittee on Social Security
Why GAO Did This Study:
In March 2006, the Social Security Administration (SSA) published a
rule that fundamentally alters the way claims for disability benefits
are processed and considered. The rule establishes the Disability
Service Improvement process (DSI)”intended to improve the accuracy,
timeliness, consistency, and fairness of determinations. DSI‘s changes
include an opportunity for an expedited decision during the initial
determination process and the elimination of the Appeals Council, which
had given claimants the right to appeal administrative law judge (ALJ)
decisions before pursuing federal court review. DSI replaces the
council with a Decision Review Board, which will selectively review ALJ
decisions. However, dissatisfied claimants whose cases are not selected
for board review must now appeal directly to the federal courts.
Based on its ongoing work, GAO was asked to testify on (1) public and
stakeholder concerns about the elimination of the Appeals Council and
its replacement by the Decision Review Board and SSA‘s response to
these concerns, as well as (2) the steps that SSA has taken to help
facilitate a smooth implementation of the DSI process.
What GAO Found:
Concerns regarding the replacement of the Appeals Council with the
Decision Review Board”raised by the public and stakeholder groups, such
as claimant representatives”generally fall into two areas: (1)
potential for increasing the workload of the federal courts and (2)
anticipated hardship for claimants in terms of the loss of an
administrative appeal level and difficulties associated with pursuing
their claim in federal court. SSA‘s response to concerns regarding the
federal court workload is that all changes associated with the new DSI
process”taken together”should reduce the need for appeal to the federal
courts; at the same time, SSA plans to implement this final step
gradually and with additional safeguards to minimize impact on the
courts. In response to concerns about the loss of appeal rights, SSA
contends that DSI introduces enhanced levels of federal review earlier
in the process and that claimants should experience a decline in the
amount of time it takes to receive a final agency decision.
SSA has prepared in significant ways for the initial rollout of DSI in
its Boston region, but the agency‘s timetable is ambitious and much
work remains. The agency has moved forward in key areas that underpin
the new system”human capital development, technical infrastructure, and
quality assurance”taking actions consistent with past GAO
recommendations for improving the disability determination process. For
example, SSA has taken steps to ensure that key technical supports,
particularly its electronic disability case processing system, are in
place”even though it has allowed itself little time to address and
resolve any glitches that may arise prior to implementation. SSA has
also taken several steps to lay a foundation for quality assurance by
centralizing its quality assurance reviews, establishing a Decision
Review Board for reviewing decisions, and developing writing tools that
should foster consistency and thorough documentation at all phases of
the determination process. Further, we found that SSA‘s decision to
implement DSI first in one small region prior to its introduction
nationally is a good change management strategy that reflects our
earlier recommendations. Additionally SSA has taken a proactive,
collaborative approach to both the design and the implementation of the
new determination process. Nevertheless, key facets of SSA‘s plan to
monitor and evaluate the Boston rollout remain to be developed. For
example, performance measures for assessing the execution of the
rollout are still unclear to us, and mechanisms for delivering feedback
to staff on the clarity and soundness of their decision writing have
not yet been fully developed.
[Hyperlink, http://www.gao.gov/cgi-bin/getrpt?GAO-06-779T].
To view the full product, including the scope and methodology, click on
the link above. For more information, contact Robert E. Robertson at
(202) 512-7215 or robertsonr@gao.gov.
[End of Section]
Mr. Chairman and Members of the Subcommittee:
Thank you for inviting me today to discuss stakeholder concerns about
various aspects of the Social Security Administration's (SSA) new
Disability Service Improvement process (DSI) and the steps that SSA has
taken to address these concerns. SSA is preparing to implement its new
process first in its Boston region for at least 1 year beginning in
August 2006.
In July 2005, SSA issued a notice of proposed rule making to obtain
public comment on DSI proposals that would fundamentally redesign the
way claims for disability benefits are processed and considered, with
the purpose of improving the accuracy, consistency and fairness of its
disability decisions, and making correct decisions earlier in the
process. After reviewing comments submitted in response to its notice,
SSA issued its final rule in March 2006, codifying many of its proposed
changes. One of the many changes envisioned under DSI is the
elimination of the Appeals Council, which had afforded claimants the
ability to appeal unfavorable decisions made by administrative law
judges (ALJ) to SSA before filing suit with a federal court. Once DSI
is fully implemented, decisions made by the ALJs become the final
agency decision, unless they are selected for review by a new Decision
Review Board. The cases selected for review will be those identified
through use of a statistical model as claims that are complex or prone
to erroneous decisions. As you know, many have expressed concern over
the elimination of the Appeals Council as a forum that claimants could
avail themselves of before resorting to a federal court.
The information I am providing today is based on work that we conducted
between February 22, 2006, and June 2, 2006, as part of ongoing work in
this area, in accordance with generally accepted government auditing
standards. I will be discussing (1) concerns raised about the
replacement of the Appeals Council with the Decision Review Board and
how SSA has responded to them, and (2) steps SSA has taken to help
facilitate a smooth implementation of the DSI process.
To conduct our work, we reviewed a large sample (252 in total) of the
comment letters that were submitted by the public in response to SSA's
notice of proposed rule making and that focused on the replacement of
the Appeals Council with the Decision Review Board. In addition, we
interviewed 10 stakeholder groups--such as claimant representatives,
employee groups, and disability advocacy organizations that SSA has
previously consulted with--to learn more about their perspectives on
the elimination of the Appeals Council as well as on the near-term
rollout of the DSI process in the Boston region. In addition, we
conducted extensive interviews with SSA officials and reviewed
available agency documents to determine their position on and collect
data relevant to eliminating the Appeals Council, as well as their
efforts and plans related to DSI implementation. Further, we reviewed
our past reports on improving SSA's disability process in a number of
areas, including human capital; its electronic records system--known as
eDib; quality assurance; and implementing change and managing for
success. For a more detailed description of our methodology, please see
appendix I.
In summary, we found that the public and stakeholders expressed two
overriding concerns regarding the replacement of the Appeals Council
with the Decision Review board--that the workload of the federal courts
will rise if the council is eliminated and that this change will
present additional hardship for claimants. In our review of the comment
letters submitted to SSA that specifically addressed the elimination of
the Appeals Council, we found that about half expressed concern that
petitions to federal courts would rise, given the council's
termination, and that claimants would lose an additional level of
administrative review. About 40 percent of comments highlighted recent
improvements in the Appeals Council's processes and noted that
eliminating the council would not improve adjudication. Stakeholder
groups we spoke with basically underscored these same two points--that
eliminating the Appeals Council would result in an increase in
disability claims cases that are appealed in federal district courts
and that some claimants may drop meritorious claims rather than pursue
a seemingly complicated and intimidating federal court appeal.
Acknowledging these concerns, SSA contends that DSI will improve
decision making earlier in the process, decrease the time it takes the
agency to reach a final decision, and reduce the need for appeal. SSA
also maintains that because DSI affords claimants the right to appeal
their initially denied claims to reviewing officials who are now
centrally managed, claimants will not experience an overall loss in
administrative review at the federal level. At the same time, both
stakeholders and SSA believe it will be important for the agency to
closely monitor DSI in order to evaluate its impact on claimants and
the courts.
SSA has made substantial preparation for DSI on all fronts related to
successful implementation--human capital, technical infrastructure, and
quality assurance. However, the timetable is ambitious and much work
remains. While stakeholders have expressed concern that SSA will not be
able to hire and sufficiently train staff in time for the new process
to get under way, we found that the agency has, to date, posted hiring
announcements for new positions and developed training packages for
onboard staff. SSA is also taking steps, as we had previously
recommended, to ensure that key technical supports, particularly the
electronic disability system known as eDib, are in place for Boston
staff to adjudicate claims under the new process. At the same time, the
agency has allowed itself very little time to identify and resolve any
potential glitches that may arise before the Boston rollout in August.
Regarding quality assurance, SSA has taken several steps to lay a
foundation for a more cohesive program, as we had recommended in our
earlier reports. For example, features of the new DSI process--
including centralizing quality assurance reviews of initial state
disability determination service (DDS) decisions, establishing a
Decision Review Board for hearing decisions, and developing several
tools to aid decision writing--may address problems with decisional
consistency that we have identified in the past by allowing for a
cohesive analysis of decisions. In addition, SSA officials plan to
monitor and evaluate the execution of the Boston rollout, although some
performance measures for this initiative, such as for assessing a new
medical expert system that is part of DSI, are still unclear to us, and
mechanisms for delivering feedback to staff on the clarity and
soundness of their decision writing have not yet been fully developed.
Finally, SSA is undertaking other, broad steps that we consider
consistent with effective change management strategies that we have
previously recommended. For example, the decision to implement the new
system first on a small scale--that is, in one small region--before
introducing it elsewhere should allow for careful integration of the
new systems and staff and for working out problems before they become
serious impediments to success. Additionally, SSA has employed a
proactive, collaborative approach with the stakeholder community in
both designing and implementing the new disability determination
process.
Background:
SSA operates the Disability Insurance (DI) and Supplemental Security
Income (SSI) programs--the two largest federal programs providing cash
benefits to people with disabilities. The law defines disability for
both programs as the inability to engage in any substantial gainful
activity by reason of a severe physical or mental impairment that is
medically determinable and is expected to last at least 12 months or
result in death. In fiscal year 2005, the agency made payments of
approximately $126 billion to about 12.8 million beneficiaries and
their families. We have conducted a number of reviews of SSA's
disability programs over the past decade, and the agency's management
difficulties were a significant reason why we added modernizing federal
disability programs to our high-risk list in 2003. In particular, SSA's
challenges include the lengthy time the agency takes to process
disability applications and concerns regarding inconsistencies in
disability decisions across adjudication levels and locations that
raise questions about the fairness, integrity, and cost of these
programs.
The process SSA uses to determine that a claimant meets eligibility
criteria--the disability determination process--is complex, involving
more than one office and often more than one decision maker. Under the
current structure--that is, DSI notwithstanding--the process begins at
an SSA field office, where an SSA representative determines whether a
claimant meets the programs' nonmedical eligibility criteria. Claims
meeting these criteria are forwarded to a DDS to determine if a
claimant meets the medical eligibility criteria. At the DDS, the
disability examiner and the medical or psychological consultants work
as a team to analyze a claimant's documentation, gather additional
evidence as appropriate, and approve or deny the claim. A denied
claimant may ask the DDS to review the claim again--a step in the
process known as reconsideration. If the denied claim is upheld, a
claimant may pursue an appeal with an ALJ, who will review the case. At
this step, the ALJ usually conducts a hearing in which the claimant and
others may testify and present new evidence. In making the disability
decision, the ALJ considers information from the hearing and from the
DDS, including the findings of the DDS's medical consultant. If the
claimant is not satisfied with the ALJ decision, the claimant may
request a review by SSA's Appeals Council, which is the final
administrative appeal within SSA. If denied again, the claimant may
file suit in federal court.
In March 2006, SSA published a final rule to establish DSI, which is
intended to improve the accuracy, consistency, and fairness of decision
making and to make correct decisions as early in the process as
possible. While DDSs will continue to make the initial determination,
claims with a high potential for a fully favorable decision will be
referred to a new Quick Disability Determination (QDD) process. If the
claimant is dissatisfied with the DDS's initial determination or QDD,
the claimant may now request a review by a federal reviewing official-
-a new position to be staffed by centrally managed attorneys. The
federal reviewing official replaces the reconsideration step at the DDS
level, and creates a new level of federal review earlier in the
process. The claimant's right to request a hearing before an ALJ
remains unchanged. However, the Appeals Council is eliminated under the
new process, and as a result the ALJ's decision becomes the final
agency decision except in cases where the claim is referred to the new
Decision Review Board. Claims with a high likelihood of error, or
involving new areas of policy, rules, or procedures, are candidates for
board review.[Footnote 1] If the board issues a new decision, it
becomes the final agency decision. As before, claimants dissatisfied
with the final agency decision may seek judicial review in federal
court. DSI also includes the introduction of new decision-writing tools
that will be used at each adjudication level, and are intended to
streamline decision making and facilitate training and feedback to
staff. In addition, SSA is creating a Medical and Vocational Expert
System, staffed by a unit of nurse case managers who will oversee a
national network of medical, psychological, and vocational experts,
which are together responsible for assisting adjudicators in
identifying and obtaining needed expertise. In its final rule, SSA
indicated that DSI will further be supported by improvements, such as a
new electronic disability system and an integrated, more comprehensive
quality system.
As noted, the changes introduced by DSI were codified in SSA's final
rule on the subject. Table 1 highlights these new features and
associated elements.
Table 1: Key Aspects of DSI:
New feature: Quick Disability Determinations;
Associated elements: Expedited processing for certain clear-cut cases:
Use of a predictive model to screen for cases that have a greater
likelihood of allowance and to act on those claims within 20 days:
Nationally standardized training for examiners in DDS on this process:
Medical or psychological experts must verify that the medical evidence
is sufficient to determine that the impairment meets the standards.
New feature: Medical and Vocational Expert System;
Associated elements: A national network of medical, psychological, and
vocational experts who will be available to assist adjudicators
throughout the agency:
The national network will be overseen by a new Medical and Vocational
Expert Unit:
All experts affiliated with the network must meet qualifications, which
are still under development.
New feature: Federal reviewing officials;
Associated elements: A cadre of federal reviewing officials--all
attorneys--can affirm, reverse, or modify appealed DDS decisions.
Federal reviewing officials cannot remand cases to the DDSs for further
review, but they can ask that the DDSs provide clarification or
additional information for the basis of their determination:
Reviewing officials may obtain new evidence and claimants can submit
additional evidence at this stage. If necessary, the reviewing official
may issue subpoenas for documents:
If a reviewing official disagrees with the DDS decision, or if new
evidence is submitted, he or she must consult with an expert in the
expert system.
New feature: Decision Review Board;
Associated elements: The Decision Review Board will replace the Appeals
Council. It will be composed of individuals selected by SSA's
Commissioner, and each member will serve a designated term:
The board will review both allowances and denials, and the board has
the ability to affirm, modify, reverse, or remand ALJ decisions:
A new sampling procedure--or predictive model-- will identify ALJ
decisions that are error-prone or complex for the board's review. The
predictive model, which is still under development, is expected to
select 10 to 20 percent of ALJ decisions for the board's review:
The board has 90 days from the date the claimant receives notice of
board review to make its final decision. If it fails to act within that
period, the ALJ decision remains SSA's final decision:
A claimant may submit a written statement to the board within 10 days
of receiving notice that the board will review his or her case,
explaining why he or she agrees or disagrees with the ALJ's decision.
This statement may be no longer than 2,000 words.
Source: GAO analysis.
Note: While DSI does not change the structure or scope of ALJ reviews,
the new process has several elements that affect hearings at the ALJ
level. Namely, SSA will notify claimants at least 75 days prior to the
hearing of the date and time for which the hearing has been scheduled.
Additionally, claimants have to submit evidence at least 5 business
days before the hearing date itself.
[End of table]
Implementation of DSI will begin on August 1, 2006, in the Boston
region, which includes the states of Connecticut, Massachusetts, Maine,
New Hampshire, Rhode Island, and Vermont.[Footnote 2] Therefore, only
those claims filed with SSA in the Boston region on or after August 1
will be subject to the new process.[Footnote 3] All claims currently in
process in the Boston region, and claims filed elsewhere, will continue
to be handled under current procedural regulations until SSA takes
further action.[Footnote 4] In addition, for cases filed in the Boston
region during the first year of DSI implementation, all ALJ decisions-
-both allowances and disallowances--will be reviewed by a new Decision
Review Board with authority to affirm, modify, reverse, or remand
decisions to the ALJ.[Footnote 5] Since DSI will only affect new claims
initiated in the Boston region, claimants whose cases were already in
process before August--as well as those filing outside the Boston
region--will still have access to the Appeals Council.
Concerns Include Fear of Increased Court and Claimant Hardship, while
SSA Believes Its New Process Will Reduce the Need for Appeal:
In their written comments to SSA and discussions with us, public and
stakeholder groups, such as claimant representatives and disability
advocacy groups, expressed two broad areas of concern regarding the
replacement of the Appeals Council with the Decision Review Board: (1)
potential for increasing the workload of the federal courts and (2)
anticipated hardship for claimants in terms of loss of an
administrative appeal level and difficulties associated with pursuing
their claims in federal court. SSA's response to concerns regarding the
federal court workload is that all changes associated with new DSI
process--taken together--should reduce the need for appeal to the
federal courts. At the same time, SSA plans to implement this final
step gradually and with additional safeguards to minimize the impact on
the courts. In response to concerns about the loss of appeal rights,
SSA contends that under the new DSI process, claimants will have a new
level of federal review earlier in the process, and should experience a
decline in the amount of time it takes to receive a final agency
decision without being overly burdened by the Decision Review Board
under the new process.
Public and Stakeholders Anticipate a Larger Caseload for Courts, while
SSA Maintains That Better Decisions Earlier in the Process Will Reduce
the Need for Appeal:
Concerns expressed in comment letters to SSA and in our interviews
revolved largely around the possibility that the replacement of the
Appeals Council with the Decision Review Board would result in rising
appeals to the federal courts. Specifically, more than half of the 252
comment letters we reviewed indicated that the Appeals Council provides
an important screening function for the federal courts, and that its
replacement with the Decision Review Board could result in rising
caseloads at the federal court level. Stakeholder groups with whom we
spoke reiterated this concern. With the imminent rollout in the Boston
region, several stakeholders suggested that SSA closely monitor the
effectiveness of the board and the impact of this change on the federal
courts.
Data from SSA suggest that the Appeals Council is both screening out a
number of cases that might otherwise have been pursued in the federal
courts and identifying many claims that require additional agency
analysis. Between 2001 and 2005, the number of disability cases
appealed to SSA's Appeals Council rose 13 percent. At the same time,
the number of disability cases filed with the federal courts (both DI
and SSI) declined 9 percent.[Footnote 6] Figure 1 illustrates the
volume of receipts at both the federal court and the Appeals Council
levels during this period.
Figure 1: Federal Court and Appeals Council Receipts between 2001 and
2005:
[See PDF for image]
Sources: SSA and the Administrative Office of the U.S. Courts.
Note: Data on federal court cases are for the 12-month periods ending
March 31 of the named year. Data on Appeals Council cases are collected
on a fiscal year basis.
[End of figure]
Further, the Appeals Council consistently remanded about 25 percent of
the claims it reviewed between 2001 and 2005 for further adjudication
by the administrative law judge--see figure 2--providing more evidence
that the Appeals Council is identifying a significant number of claims
that require additional agency review and modification.
Figure 2: Disposition of Appeals Council Cases, by Fiscal Year, 2001-
2005:
[See PDF for image]
Source: SSA.
Note: The Appeals Council will deny review if cases do not meet the
following criteria--there does not appear to be an abuse of discretion
by the ALJ; there is no error of law; the actions, findings, or
conclusions of the ALJ are supported by substantial evidence; or the
case does not present a broad policy or procedural issue that may
affect public interest. If the Appeals Council denies review, the ALJ
decision stands as the final agency decision.
[End of figure]
SSA believes that the implementation of DSI as an entire process will
help it make the correct disability determination at the earliest
adjudication stage possible and thereby reduce the need for appeal.
According to SSA, several elements of the DSI process will contribute
to improved decision making. These include the federal reviewing
official position, which presents an enhanced opportunity for the
agency to thoroughly review case records--with the assistance of
medical and vocational experts---early in the process, as well as new
online policy guidance and new tools to aid decision writing, which
will be used at each adjudication level to facilitate consistency and
help the agency identify and correct errors more quickly. Last, SSA
believes that the number of requests for voluntary remands that SSA
makes to the federal courts is an indicator that the Appeals Council is
not fully addressing errors in the case or otherwise reviewing the case
effectively so as to prevent the federal courts from reviewing appeals
that should have been handled administratively.[Footnote 7] SSA
believes the Decision Review Board will more effectively screen cases
from federal court review by focusing on error-prone claims identified
through a predictive model.
SSA acknowledges that the agency cannot predict the likely impact on
the federal courts' workload and cannot prevent denied claimants from
filing suit with the federal courts.[Footnote 8] To reduce the
likelihood of too many appeals reaching the federal court level, SSA
stated in its final rule that it is pursuing a gradual rollout by
implementing the DSI process in one small region--the Boston region--
and plans to have the board initially review all of the ALJ decisions
in that region. According to SSA officials, the board's review of all
ALJ decisions will allow them to test the efficacy of the new
predictive model, to help ensure that the model is identifying the most-
error prone cases that might otherwise find their way to federal court.
Further, SSA officials told us that they are working with the federal
court system to develop a way to gauge changes in the court's caseload.
Finally, SSA's internal counsel told us that the agency has begun a
systematic data collection process to better understand the
circumstances surrounding remands from the federal court. To date, SSA
attorneys have analyzed the reasons for federal court remands in more
than 1,600 cases, but they are still working on a quality control
mechanism to ensure that their information has been entered properly
and are therefore unwilling to report on the results of their analysis
at this time.[Footnote 9]
Public and Stakeholders Anticipate Increased Hardship for Claimants,
but SSA Believes the New Federal Reviewing Official Position Will
Improve Decision Making Earlier:
In their comments on the proposed rule and in subsequent conversations
with us, stakeholders expressed concern that eliminating the Appeals
Council would cause claimants hardship both by eliminating the
opportunity to appeal an ALJ decision to the Appeals Council and by
increasing the cost and difficulty associated with pursuing cases in
federal court.
In particular, 48 percent of the 252 comment letters we reviewed
expressed concern that the replacement of the Appeals Council with the
Decision Review Board would represent a loss in claimant appeal rights
within SSA. These letters, as well as subsequent discussions with
stakeholders, emphasized the concern that claimants will not have a say
in which cases are reviewed by the board. Further, stakeholders were
concerned that in the Boston region, claimants whose cases were allowed
at the ALJ level could be overturned by the board, presenting
additional hardship for claimants as they await a decision.
In addition, claimant representatives and disability advocacy
organizations are concerned that appealing at the federal court rather
than Appeals Council level would be costlier and more intimidating for
claimants. For example, there is a filing fee associated with the
federal courts, and stakeholders commenting on SSA's final rule said
that the filing procedure is more complicated than that required for an
appeal before the Appeals Council.[Footnote 10] In addition, claimants
seeking representation must find attorneys who, among other
requirements, have membership in the district court bar in which the
case is to be filed. As a result of these hardships, claimant
representatives and disability advocacy organizations, in particular,
were concerned that claimants would drop meritorious claims rather than
pursue a seemingly complicated and intimidating federal court appeal.
About 40 percent of the comment letters asserted that the amount of
time the Appeals Council spent adjudicating cases--also referred to as
its processing time--has improved recently, and letter writers did not
believe that terminating the Appeals Council would improve the
adjudicative process. Although SSA has contended that the Appeals
Council has historically taken too much time without providing
claimants relief, stakeholders' claims that the Appeals Council
processing time has decreased significantly in recent years was
confirmed by SSA data--see figure 3. In light of these concerns, many
stakeholder groups we spoke with suggested that SSA should roll out the
Decision Review Board carefully and closely evaluate outcomes from
claimants' perspectives.
Figure 3: Appeals Council Processing Time and Volume of Dispositions,
by Fiscal Year, 2001-2005:
[See PDF for image]
Source: SSA.
Note: SSA does not track how many of the cases remanded by the Appeals
Council result in denials that are appealed again to the council.
[End of figure]
In their final rule and in conversations with us, SSA officials stated
that the new process still affords claimants comparable appeal rights
along with the promise of a faster agency decision. Specifically, SSA
stated that DSI includes two federal levels of thorough case
development and administrative review--one by the new federal reviewing
official and another by an ALJ at the hearings level. SSA contends that
the new federal reviewing official position is a marked departure from
the reconsideration step, in that the position will be managed
centrally and staffed by attorneys specifically charged with enhancing
the development of a case and working with a new cadre of medical and
vocational experts to make decisions. SSA believes that this new
position, along with other changes in the new process, will result in
many more cases being correctly adjudicated earlier in the process,
resulting in fewer decisions appealed and reviewed by ALJs at the
hearings level.
SSA also argues--recent improvements in processing time
notwithstanding--that the elimination of the Appeals Council step will
reduce the length of time it takes the agency to reach a final decision
on behalf of the claimant. Further, SSA maintains that the replacement
of the Appeals Council with the board will not be prejudicial to or
complicated for the claimant. SSA indicated that claimants will have an
opportunity to submit written statements to the Decision Review Board,
thus providing another chance to assert their circumstances. SSA
maintains that aside from the written statement, further action is not
required on the part of the claimant until the board issues its
decision.
SSA has told us that it plans to monitor stakeholder concerns in
several ways. For example, SSA plans to track the length of time it
takes to reach final decisions as well as the allowance rate. SSA also
plans to review written statements submitted by claimants to help
assess the validity of the board's predictive model.[Footnote 11]
SSA Has Taken Constructive Steps to Implement the New DSI Process, but
Its Schedule Is Ambitious and Many Details Are Not Yet Finalized:
SSA has prepared in significant ways for DSI, but the agency's
timetable is ambitious and substantive work remains. SSA has moved
forward in key areas that should underpin the new system--human capital
development, technical infrastructure, and quality assurance. However,
some essential measures remain under development, particularly for
quality assurance. Nevertheless, on balance, the agency has begun to
employ a number of change management strategies we recommended earlier
for successful transitioning.
SSA Has Moved to Hire and Train Staff, but It Faces Short Timetables:
While stakeholders have expressed concern that SSA will not be able to
hire and sufficiently train staff in time for the new process, we found
that the agency has taken a number of steps in this area. With respect
to hiring for new positions, the agency has already developed position
descriptions and posted hiring announcements for nurse case managers,
who will work in the new Medical and Vocational Expert Unit, as well as
for federal reviewing officials. To date, SSA officials have begun
assessing more than 100 eligible applicants for the reviewing official
slots, and expect to hire 70 by late June and another 43 in early 2007.
SSA officials also said they posted announcements to hire nurse case
managers, and that they expect to hire as many as 90 before the end of
the rollout's first year in the Boston region.
SSA officials also said that the agency has posted announcements to
hire support staff for both the reviewing officials and nurse case
managers, but the exact number SSA is seeking to hire has not been
decided. Several stakeholders we spoke with were particularly concerned
that SSA will need to hire or otherwise provide adequate support staff
for reviewing officials to ensure their effectiveness. Specifically,
several of the ALJs we interviewed told us that at the hearings level,
judges and their staff currently spend significant time developing case
files. They noted that if the reviewing official position is designed
to focus on case development, then attorneys in this role will need
support staff to help them with this time-consuming work.
With respect to training, the agency has been creating a variety of
training materials for new and current staff, with plans to deliver
training at different times, in different ways. SSA officials reported
working on development of a uniform training package for all staff with
some flexible components for more specialized needs. Specifically,
about 80 percent of the package is common content for all employees,
and 20 percent will be adaptable to train disability examiners, medical
experts, ALJs, and others involved in the adjudication process. SSA
officials said they developed the package with the federal reviewing
officials in mind, but also with an eye toward a centralized training
content that could apply to current and new staff down the line. SSA
plans to provide the full training package, which constitutes about 8
weeks of course work and 13 modules, to reviewing officials in late
June, once all attorneys for that position are hired. Among the
sessions included are the basics of the disability determination
process, eDib and its use, medical listings and their application, and
decision writing.
Given that the rule was finalized in March and rollout is set for
August, agency timetables for hiring, training, and deploying more than
100 new staff--as well as for training existing examiners--in the six
states in the Boston region are extremely short. SSA officials have
acknowledged the tight time frame, but hope to deliver training by
using more than one medium--in person, online, or by video. SSA still
expects to accomplish all hiring and training for the Boston region
staff in time for an August 1 launch of the new process.
SSA Has Readied eDib for the Boston Region, but Time for Resolving Last-
Minute Glitches before Rollout Will Be Limited:
SSA has also taken steps, as we had previously recommended, to ensure
that key technical supports, particularly an electronic disability case
recording and tracking system known as eDib, are in place in time for
Boston staff to adjudicate claims under DSI electronically. The agency
has made a variety of efforts to familiarize employees with the system
and facilitate their ability to use it as early as possible. First, SSA
positioned the Boston region for a fast transition to eDib by reducing
the region's paper case backlog. According to a Boston region ALJ,
pending case records are being converted now to familiarize judges and
decision writers with the eDib system so they will be comfortable with
it when new cases reach that level after August 1. Then SSA worked with
Boston region staff to certify that the region's DDS offices were ready
for full eDib implementation.
According to claimant representatives, SSA has also worked to
facilitate their transition to eDib, and according to SSA officials,
the agency has developed a system called Electronic Records Express to
facilitate medical providers' submission of records to SSA. A
stakeholder group of claimant representatives told us that SSA has
offered them training and that they have met regularly with agency
staff to smooth out eDib issues, such as difficulties associated with
the use of electronic folders--electronic storage devices that replace
paper folders as the official record of evidence in a claimant's case
file. This stakeholders group also reported that its members have
voluntarily coordinated with SSA to test new techniques that might
further facilitate eDib implementation.
SSA has also been developing electronic templates to streamline
decision writing. ALJs have already received some training on theirs,
which is known as the Findings Integrated Template. According to SSA
officials, this template is now used, voluntarily, by ALJs nationwide,
after months of extensive testing and refinement. For DDS-level
decisions, SSA is designing a template--called the Electronic Case
Analysis Tool (E-CAT)--which it expects to be partially operational by
July and fully implemented by November. DDS examiners in the Boston
region will receive training on the tool in July and will also receive
training prior to then on the elements of sound decision making. A
similar tool is in development for the reviewing officials.
While SSA officials expressed confidence in having technical supports
sufficiently in place in time for implementation of DSI in August,
unanticipated problems associated with new technology may challenge
their ability to do so. In addition to eDib and E-CAT, SSA is
implementing other new software systems to support the rollout (such as
the predictive models and electronic medical records transmission)--any
one of which may involve unexpected problems. For example, in 2005 we
reported that a number of DDSs were experiencing operational slowdowns
and system glitches associated with the new eDib system.[Footnote 12]
It remains to be seen whether the Boston region experiences similar
problems with eDib, or problems with other new systems, and whether SSA
will be able to resolve technical issues that may arise before
implementation begins in August.
SSA Is Improving Its Quality Assurance System as Part of DSI Rollout,
although Key Elements Have Yet to Be Revealed:
SSA is taking steps to improve its quality assurance system that have
potential for improving the accuracy and consistency of decisions among
and between levels of review, in a manner that is consistent with our
past recommendations. As early as 1999, GAO recommended that in order
to improve the likelihood of making improvements to its disability
claims process, SSA should focus resources on initiatives such as
process unification and quality assurance, and ensure that quality
assurance processes are in place that both monitor and promote the
quality of disability decisions.[Footnote 13] Consistent with these
recommendations, many of SSA's current efforts involve adding steps and
tools to the decision-making process that promote quality and
consistency of decisions and provide for additional monitoring and
feedback. While these developments are promising, many important
details of SSA's quality assurance system have yet to be finalized or
revealed to us.
SSA has recently elevated responsibility for its quality assurance
system to a new deputy-level position and office--the Office of Quality
Performance. This office is responsible for quality assurance across
all levels of adjudication. Listed below are new aspects of the quality
assurance system that this office oversees and that hold promise for
promoting quality and consistency of decisions.
* SSA will continue to provide accuracy rates for DDS decisions, but
these accuracy rates will be generated by a centralized quality
assurance review, replacing the agency's older system of regionally
based quality review boards and thereby eliminating the potential
differences among regional reviews that were a cause for inconsistent
decisions among DDSs.
* As part of the DSI rollout, SSA plans to incorporate new electronic
tools for decision writing to be used by disability examiners, federal
reviewing officials, and ALJs. The tools are intended to promote
quality in two ways. First, the tools will require decision makers to
document the rationale behind decisions in a consistent manner while
specifically addressing areas that have contributed to errors in the
past, such as failing to list a medical expert's credentials or
inaccurately characterizing medical evidence. Second, the tools will
help provide a feedback loop, by which adjudicators and decision
writers can learn why and under what circumstances their decisions were
remanded or reversed. SSA officials told us that once the tools are in
full use, the Office of Quality Performance will collect and analyze
their content to identify errors or areas lacking clarity. They also
plan to provide monthly reports to regional managers in order to help
them better guide staff on how to improve the soundness of their
decisions and the quality of their writing.[Footnote 14]
* The establishment of the Decision Review Board, with responsibility
for reviewing ALJ decisions, is intended to promote quality and
consistency of decisions in two ways. First, once DSI is rolled out
nationwide, the board will be tasked to review error-prone ALJ
decisions with the intent of further ensuring the correctness of these
decisions before they are finalized. Second, during the initial rollout
phase, SSA plans to have the board review all ALJ decisions to verify
that the predictive model used to select error-prone cases is doing so
as intended. Importantly, both the tools and the board's assessment are
consistent with our prior recommendations that SSA engage in more
sophisticated analysis to identify inconsistencies across its levels of
adjudication and improve decision making once the causes of
inconsistency among them have been identified.[Footnote 15]
In addition to these actions, SSA told us it plans to measure outcomes
related to how DSI is affecting claimants, such as allowance rates and
processing times at each adjudication stage, and the proportion of
cases remanded from the federal courts and the rationales for these
remands. Further, officials told us they will work with the federal
courts to track changes in their workload. SSA officials also told us
they are working to monitor changes in costs associated with the new
DSI process, in terms of both the administrative costs of the process,
as well as its overall effect on benefit payments. Officials also said
that SSA will track the length of time it takes the agency to reach a
final decision from the claimant's perspective, which we have
recommended in the past.[Footnote 16] Although SSA officials told us
that ALJ accuracy rates will be generated from the board's review of
all ALJ decisions, they said they were not yet certain how they will
measure these rates once DSI is rolled out nationwide and the board is
no longer reviewing all ALJ decisions.
While these developments are promising, aspects of these changes and of
SSA's plans to monitor the DSI implementation have either not been
finalized or not been revealed to us. For example, SSA has not yet
revealed the types of reports it will be able to provide decision
makers based on the decision-writing tools. In addition, while SSA
plans to measure the effectiveness of the new process, its timeline for
doing so and the performance measures it plans to use have not been
finalized. According to SSA officials, potential measures include how
well the predictive models have targeted cases for quick decisions at
the initial DDS level or error-prone cases for the board, and whether
feedback loops are providing information that actually improves the way
adjudicators and decision writers perform their work.
SSA Has Employed Other Change Management Practices to Implement DSI:
SSA's efforts and plans show commitment to implementing DSI gradually,
using tested concepts, involving top-level management, and
communicating frequently with key stakeholders--practices that adhere
closely to our prior recommendations on effective change management
practices.
With regard to gradual implementation, we had previously suggested that
SSA test promising concepts in a few sites to allow for careful
integration of the new processes in a cost-effective manner before
changes are implemented on a larger scale.[Footnote 17] SSA's decision
to implement DSI in one small region is consistent with this
recommendation. SSA officials told us they selected Boston because it
represents the smallest share of cases reviewed at the hearings level
and because it is geographically close to SSA's headquarters to
facilitate close monitoring. While SSA officials acknowledged that
unanticipated problems and issues are likely to arise with
implementation, they assert that they will be able to identify major
issues in the first 60 to 90 days. SSA officials believe this will give
them plenty of time to make changes before rollout begins in a second
region. SSA has also indicated that it plans to roll DSI out next in
another relatively small region.
Also consistent with our past recommendations, SSA officials noted that
some new elements of DSI have been tested prior to integration. For
example, the ALJ tool for decision writing has been tested extensively
during development, and they anticipate having fewer challenges when
similar tools are used more widely. In addition, SSA has said that it
has rigorously tested its model related to the Quick Disability
Determination System and that it will continue to check the selection
of cases and monitor the length of time it takes for quick decisions to
be rendered.
SSA's efforts and plans are also consistent with effective change
management practices in that they ensure the commitment and involvement
of top management.[Footnote 18] Specifically, SSA's Commissioner first
proposed DSI-related changes in September 2003, and the agency began
restructuring itself soon after the rule was finalized. In addition,
SSA created a deputy-level post for its new Office of Quality
Performance and appointed a new Deputy Commissioner in its newly
created Office of Disability Adjudication and Review, which oversees
the hearing and appeals processes.
We have also encouraged top managers to work actively to promote and
facilitate change, and SSA appears to be adhering to these principles
as well.[Footnote 19] For example, SSA officials told us that the
Deputy Commissioners from SSA's offices of Personnel and Human Capital
have collaborated with their counterparts in policy units to develop
position descriptions and competencies for nurse case managers and
federal reviewing officials. According to SSA officials, these leaders
are also collaborating to develop interview questions for eligible
candidates. Further, SSA officials told us their new human capital plan
will be released sometime in July and that it will emphasize the goals
of DSI, as well as the personnel changes that will accompany it.
Finally, SSA's communication efforts with stakeholders align with
change management principles in several respects. For example, SSA has
employed a proactive, collaborative approach to engaging the
stakeholder community both during DSI's design and in its planning for
implementation in order to explain why change is necessary, workable,
and beneficial. Even before the notice of proposed rule making on DSI
was published, SSA began to meet with stakeholder groups to develop the
proposal that would eventually shape the new structure. Then, once the
proposed rule was issued, SSA officials told us they formed a team to
read and analyze the hundreds of comment letters that stakeholders
submitted. In addition, they conducted a number of meetings with
external stakeholders to help the agency identify common areas of
concern and develop an approach to resolving the issues stakeholders
raised before rollout began. According to SSA officials responsible for
these meetings, the Commissioner attended more than 100 meetings to
hear stakeholder concerns directly. Further, SSA recently scheduled a
meeting for early July with claimant representatives to discuss that
group's particular concerns about how the new process will affect their
work and their disability clients. SSA officials told us that senior-
level staff will lead the meeting and that about 100 claimant
representatives from the Boston region will attend.
In addition, SSA officials have also worked to ensure that there are
open lines of communication with its internal stakeholders, thereby
ensuring that disability examiners and staff in the Boston region are
knowledgeable about DSI-related changes. For example, SSA solicited
comments and questions from the Boston region's staff about the
specifics of the rollout and held a day-long meeting in the region, led
by Deputy Commissioners, to respond to these concerns.
Concluding Observations:
For some time, SSA has been striving to address long-standing problems
in its disability claims process. From our perspective, it appears that
SSA is implementing the new claims process by drawing upon many lessons
learned from past redesign efforts and acting on, or at least aligning
its actions with, our past recommendations. For example, significant
aspects of the DSI rollout are consistent with our recommendations to
focus resources on what is critical to improving the disability claims
process, such as quality assurance and computer support. SSA's
incremental approach to implementing DSI--taking a year to monitor the
process and testing new decision-writing tools, for example--is also
consistent with our recommendation to explore options before committing
significant resources to their adoption. Thus, the agency is
positioning itself to make necessary modifications before implementing
the new process in subsequent locations. Finally, and fundamental to
all of this, SSA's top leadership has shown a commitment to informing
affected stakeholders and listening to their advice and concerns with
respect to the development and implementation of this process.
While SSA's steps and plans look promising, we want to stress the
importance of diligence and follow-through in two key areas. The first
is quality assurance, which entails both effective monitoring and
evaluation. A solid monitoring plan is key to helping SSA quickly
identify and correct problems that surface in the Boston rollout,
because any failure to correct problems could put the entire process at
risk. An evaluation plan is critical for ensuring that processes are
working as intended and that SSA is achieving its overarching goals of
making accurate, consistent decisions as early in the process as
possible. The second key area is communication. It is important for
SSA's top leadership to support open lines of communication throughout
implementation if the agency is to facilitate a successful transition.
Failure to, for example, provide useful feedback to staff--many of whom
will be new to the agency or at least to the new tools--could
significantly jeopardize opportunities for improvement. Just as
important, SSA's top management needs to ensure that the concerns and
questions of stakeholders affected by the new process are heard, and
that concerned parties are kept apprised of how SSA intends to respond.
The eventual elimination of the Appeals Council and its replacement
with the Decision Review Board with a very different purpose has been a
great cause of concern for a number of stakeholders. SSA appropriately
has plans to assess its impact by tracking decisions resulting from
each stage of the new process, as well as the effect of the process on
the federal courts' caseloads and claimants at large. To its credit,
SSA plans to reduce any immediate impact on the courts by requiring
that the board initially review all ALJ decisions in the Boston region.
However, given that the agency plans to rely heavily on new positions,
such as the federal reviewing official, and on new technology, SSA will
need to ensure that staff are well trained, and that each adjudicator
has the support staff needed to work effectively. Focusing on one small
region will, it is hoped, allow the agency to ensure that training,
technology, and other resources are well developed to achieve expected
goals before DSI is expanded to other parts of the country.
Mr. Chairman, this concludes my prepared remarks. I would be happy to
answer any questions that you or other members of the subcommittee may
have.
GAO Contact:
For future contacts regarding this testimony, please contact me at
(202) 512-7215 or RobertsonR@gao.gov. Contact points for our Offices of
Congressional Relations and Public Affairs may be found on the last
page of this testimony.
Staff Acknowledgments:
The following individuals have made major contributions to this
statement--Susan Bernstein, Candace Carpenter, Joy Gambino, Michele
Grgich, Luann Moy, Daniel Schwimer, and Albert Sim.
[End of section]
Appendix I: Objectives, Scope, and Methodology:
To learn more about the public's and stakeholders' views with regard to
the Appeals Council and the Decision Review Board, we reviewed and
analyzed a large sample of comment letters they submitted to the Social
Security Administration (SSA) in response to its July 2005 notice of
proposed rule making on the Disability Service Improvement process
(DSI) that were related to these topics. We also interviewed a number
of key stakeholder groups to solicit their opinions once the rule had
been finalized.
Reviewing and Analyzing Comment Letters:
To review and analyze the comment letters, we first downloaded all
1,143 comments that SSA had received and posted to its public Web site.
In order to focus our review on only those letters that related to the
Appeals Council and the Decision Review Board, we then applied a word
search to restrict our analysis to the responses that used the terms
"Decision Review Board," "DRB," and "Council."[Footnote 20] Applying
these search terms reduced the number of comment letters for review to
683. We discarded 43 of these 683 letters over the course of our review
because they were duplicates of letters by the same authors or did not
contain relevant comments. As a result, our final analysis was based on
the remaining 640 letters.
To classify the nature of the comments contained in these 640 letters,
we coded the opinions as related to one of more of the following
concerns:
* The Appeals Council is improving, and its termination will not
improve the disability determinations process.
* There is a risk that the Decision Review Board may not select the
most appropriate cases for review.
* There is a risk that Decision Review Board could unfairly evaluate or
influence administrative law judge decisions.
* In the absence of an Appeals Council, the claimant no longer has the
right to initiate subsequent case review.
* There is no opportunity for the claimant or his or her representative
to argue before the Decision Review Board.
* A claimant's benefit might be protracted or delayed during Decision
Review Board assessment.
* Petitions to the federal court are likely to increase.
* Appeals to the federal court are costly or intimidating, and
claimants may not have the wherewithal to pursue the claim at this
level.
Of the 640 letters in our review, we initially identified 388 as form
letters, or letters containing identical comments, even though they had
different authors. To simplify our review, we coded these form letters
separately from the other letters. For the 252 letters that we did not
initially identify as form letters, one analyst reviewed and coded each
letter, while a second analyst verified that he or she had coded the
statements appropriately. If the first and second analysts did not come
to an agreement, a third analyst reviewed the comment and made the
final decision for how the content should be classified. Table 2 below
indicates the percentage of the 252 letters citing one or more of the
above concerns.
Table 2: Share of Comment Letters Including Each of the Concern
Categories Included in This Study:
Concern category: Petitions to the federal court are likely to
increase;
Percentage of comment letters expressing concern (n = 252): 53.
Concern category: In the absence of an Appeals Council, the claimant no
longer has the right to initiate subsequent case review;
Percentage of comment letters expressing concern (n = 252): 48.
Concern category: The Appeals Council is improving, and its termination
will not improve the disability determinations process;
Percentage of comment letters expressing concern (n = 252): 38.
Concern category: Appeals to the federal court are costly or
intimidating, and claimants may not have the wherewithal to pursue the
claim at this level;
Percentage of comment letters expressing concern (n = 252): 37.
Concern category: There is no opportunity for the claimant or his or
her representative to argue before the Decision Review Board;
Percentage of comment letters expressing concern (n = 252): 28.
Concern category: There is a risk that the Decision Review Board may
not select the most appropriate cases for review;
Percentage of comment letters expressing concern (n = 252): 25.
Concern category: There is a risk that Decision Review Board could
unfairly evaluate or influence administrative law judge decisions;
Percentage of comment letters expressing concern (n = 252): 22.
Concern category: A claimant's benefit might be protracted or delayed
during Decision Review Board assessment;
Percentage of comment letters expressing concern (n = 252): 18.
Source: GAO analysis.
[End of table]
For the 388 form letters, we coded one letter according to the process
described above. Because the text of the form letters was identical for
each, we then applied the same codes to each of the other form letters.
All 388 form letters expressed each of the concerns above.
Identifying and Interviewing Stakeholders:
To identify key stakeholders, we first referenced the list of
organizations that SSA included in its notice of proposed rule making
as having met with the agency during its development of the final rule.
We then narrowed this list by obtaining suggestions from SSA officials
about organizations that are the most active and cover a broad spectrum
of disability issues. In total, we spoke with representatives from 10
groups:
* Administrative Office of the U.S. Courts' Judicial Conference
Committee on Federal-State Jurisdiction,
* Association of Administrative Law Judges (AALJ),
* Consortium for Citizens with Disabilities' Social Security Task Force
(CCD),
* National Association of Councils on Developmental Disabilities
(NACDD),
* National Association of Disability Examiners (NADE),
* National Association of Disability Representatives (NADR),
* National Council of Disability Determination Directors (NCDDD),
* National Council of Social Security Management Associations (NCSSMA),
* National Organization of Social Security Claimants' Representatives
(NOSCCR), and:
* Social Security Advisory Board.
[End of section]
Related GAO Products:
Social Security Administration: Administrative Review Process for
Adjudicating Initial Disability Claims. GAO-06-640R. Washington, D.C.:
May 16, 2006:
Electronic Disability Claims Processing: SSA Is Proceeding with Its
Accelerated Systems Initiative but Needs to Address Operational Issues.
GAO-05-97. Washington, D.C.: September 23, 2005:
Managing for Results: Enhancing Agency Use of Performance Information
for Management Decision Making. GAO-05-927. Washington, D.C. September
9, 2005:
High-Risk Series: An Update. GAO-05-207. Washington, D.C.: January
2005:
SSA's Disability Programs: Improvements Could Increase the Usefulness
of Electronic Data for Program Oversight. GAO-05-100R. Washington,
D.C.: December 10, 2004:
Social Security Administration: More Effort Needed to Assess
Consistency of Disability Decisions. GAO-04-656. Washington, D.C.: July
2, 2004:
Electronic Disability Claims Processing: SSA Needs to Address Risks
Associated with Its Accelerated Systems Development Strategy. GAO-04-
466. Washington, D.C.: March 26, 2004:
Human Capital: A Guide for Assessing Strategic Training and Development
Efforts in the Federal Government. GAO-04-546G. March, 2004:
Social Security Administration: Strategic Workforce Planning Needed to
Address Human Capital Challenges Facing the Disability Determination
Services. GAO-04-121. Washington, D.C.: January 27, 2004:
Results-Oriented Cultures: Implementation Steps to Assist Mergers and
Organizational Transformations. GAO-03-669. Washington, D.C.: July 2,
2003:
Highlights of a GAO Roundtable: The Chief Operating Officer Concept--A
Potential Strategy to Address Federal Governance Challenges. GAO-03-
192SP. Washington, D.C.: October 4, 2002:
Social Security Disability: Disappointing Results from SSA's Efforts to
Improve the Disability Claims Process Warrant Immediate Attention. GAO-
02-322. Washington, D.C.: February 27, 2002:
Observations on the Social Security Administration's Fiscal Year 1999
Performance Report and Fiscal Year 2001 Performance Plan. GAO/HEHS-00-
126R. Washington, D.C.: June 30, 2000:
Management Reform: Elements of Successful Improvement Initiatives. GAO/
T-GGD-00-26. Washington, D.C.: October 15, 1999:
SSA Disability Redesign: Actions Needed to Enhance Future Progress.
GAO/HEHS-99-25. Washington, D.C.: March 12, 1999:
Business Process Reengineering Assessment Guide. GAO/AIMD-10.1.15.
Washington, D.C.: May 1997:
SSA Disability Redesign: Focus Needed on Initiatives Most Crucial to
Reducing Costs and Time. GAO/HEHS-97-20. Washington, D.C.: December 20,
1996:
SSA Disability Redesign: More Testing Needed to Assess Feasibility of
New Claim Manager Position. GAO/HEHS-96-170. Washington, D.C.:
September 27, 1996:
FOOTNOTES
[1] According to SSA, for the first year of implementation in the
Boston region, the board will review all ALJ decisions.
[2] According to these regulations, SSA will publish a notice in the
federal register when it decides to roll out DSI in another region, but
this notice will not be subject to the formal rule-making process.
[3] If a claimant moves to another region from the Boston region, and
initially filed the claim in the Boston region on or after August 1,
2006, the conditions of the DSI process will apply to that claimant no
matter where he or she moves. If a claimant initially filed elsewhere
and then moves to the Boston region, the DSI process will not apply to
him or her.
[4] These procedures can be found in the Code of Federal Regulations,
20 CFR 404.900-404.999d and 416.1400-416.1499.
[5] According to SSA, the predictive model used to identify cases that
are complex or error-prone will be tested against the board's review of
all cases during the rollout in Boston. The model will be tested
continually until it has been proven reliable.
[6] According to data from the U.S. District Courts, claims from 15,416
disability insurance cases (both DI and SSI), or 6 percent of the
court's total workload, were filed during the 12-month period ending
March 31, 2005--down from 16,921 in 2001.
[7] According to SSA officials, request for voluntary remands occur
when a claimant files an appeal with the federal court and SSA's Office
of General Counsel determines that the case is not defensible.
[8] In the 1990s, SSA conducted a pilot--the Full Process Model--which
included, among other changes, eliminating the Appeals Council.
According to SSA officials, although they collected some data on the
number of direct appeals from the ALJ level to the federal courts, the
agency discontinued its pilot before collecting sufficient data for a
complete assessment of the model's impact.
[9] SSA officials also indicated that they intend to develop a
predictive model, to build on current efforts, that identifies error-
prone cases among those denied by ALJs that are subsequently remanded
by the federal courts back to SSA for further adjudication.
[10] To appeal to the Appeals Council, applicants need only complete a
one-page form and return it to SSA. For the federal courts, there is a
$250 filing fee. Although this fee can be waived (based on need),
claimant representatives and disability advocates assert that the fee
may be cost-prohibitive for some claimants, and representing oneself at
the federal court level is challenging.
[11] Specifically, SSA plans to compare the contents of these
statements to the results of the predictive model. If SSA determines
that using claimant statements will improve the model, SSA would
consider revising the model to incorporate information from these
documents.
[12] GAO, Electronic Disability Claims Processing: SSA Is Proceeding
with Its Accelerated Systems Initiative but Needs to Address
Operational Issues, GAO-05-97 (Washington, D.C.: Sept. 23, 2005).
[13] GAO, SSA Disability Redesign: Actions Needed to Enhance Future
Progress, GAO/HEHS-99-25 (Washington, D.C.: Mar. 12, 1999).
[14] The purpose of this tool is consistent with GAO's prior
recommendations that SSA develop a more focused and effective strategy
for ensuring uniform application of SSA's guidance and to improve
consistency of decisions. GAO, Social Security Administration: More
Effort Needed to Assess Consistency of Disability Decisions, GAO-04-656
(Washington, D.C.: July 2, 2004).
[15] GAO-04-656.
[16] GAO, Observations on the Social Security Administration's Fiscal
Year 1999 Performance Report and Fiscal Year 2001 Performance Plan,
GAO/HEHS-00-126R (Washington, D.C.: June 30, 2000).
[17] GAO, SSA Disability Redesign: Actions Needed to Enhance Future
Progress, GAO/HEHS-99-25 (Washington, D.C.: March 12, 1999) and GAO,
Correspondence to Jo Anne Barnhart, Commissioner of the Social Security
Administration. (Washington, D.C.: Dec. 19, 2003).
[18] GAO, Business Process Reengineering Assessment Guide, GAO/AIMD-
10.1.15 (Washington, D.C.: May 1997).
[19] GAO/AIMD-10.1.15 and GAO, Results-Oriented Cultures:
Implementation Steps to Assist with Mergers and Organizational
Transformations, GAO-03-669 (Washington, D.C.: July 2, 2004).
[20] It is possible that statements could have been made about the
Appeals Council and Decision Review Board that did not use these terms,
and that we could have missed. If so, the number of responses related
to these two entities could be greater than we are reporting.
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