Social Security Disability
Better Planning, Management, and Evaluation Could Help Address Backlogs
Gao ID: GAO-08-40 December 7, 2007
For years, the Social Security Administration (SSA) has experienced processing delays and significant backlogs of disability claims. At the end of fiscal year 2006, some 1.5 million disability claims were awaiting a decision. About 576,000 of these claims were backlogged--exceeding the number of claims that should optimally be pending at year-end. In response to the congressional request, GAO (1) examined trends in disability claims backlogs and the time required for SSA to decide a claim, (2) identified key factors contributing to the backlogs and processing times, and (3) described the steps SSA is taking to reduce them. To address these issues, GAO analyzed SSA administrative data, conducted an extensive literature review, interviewed SSA officials as well as key program personnel, and conducted site visits in three SSA regions.
From fiscal year 1997 through 2006, backlogged disability claims in the Social Security Administration's processing system doubled, reaching about 576,000 cases. Backlogs of varying degrees have occurred at most stages of the claims process. The only significant decline occurred at the last stage--the Appeals Council--where fewer cases are processed. At the initial claims level, handled by state Disability Determination Services (DDS), a backlog developed in fiscal year 1998 and grew to about 155,000 claims in fiscal year 2006. At the hearings level, backlogged claims exceeded 415,000 that year and accounted for 72 percent of the total backlog. Insufficient data prevented GAO from identifying trends in backlogs at the reconsideration stage. Processing times, meanwhile, increased with claimants generally waiting significantly longer--for example, an additional 95 days at the hearings level--for a decision. Substantial growth in the numbers of disability claims, staff losses and turnover, and management weaknesses have contributed to the backlog problem. Initial applications for benefits grew more than 20 percent over the period while SSA experienced losses in key personnel: claims examiners in the state determination offices and administrative law judges and support staff in the hearings offices. In addition, management weaknesses evidenced in a number of initiatives to address the backlogs have failed to remedy and sometimes contributed to the problem. In 2006, SSA introduced the Disability Service Improvement initiative (DSI), but suspended national rollout of it in order to concentrate on the hearings backlog and full implementation of SSA's electronic case-processing system. DSI is still underway in the Boston region; though hampered by rushed implementation, poor communication, and a lack of financial planning, DSI has shown mixed results, and SSA has proposed discontinuing certain components because of cost. Thorough evaluations that could help inform decisions about DSI's future have not yet been conducted.
Recommendations
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GAO-08-40, Social Security Disability: Better Planning, Management, and Evaluation Could Help Address Backlogs
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Report to Congressional Requesters:
United States Government Accountability Office:
GAO:
December 2007:
Social Security Disability:
Better Planning, Management, and Evaluation Could Help Address
Backlogs:
SSA Disability Claims:
GAO-08-40:
GAO Highlights:
Highlights of GAO-08-40, a report to congressional requesters.
Why GAO Did This Study:
For years, the Social Security Administration (SSA) has experienced
processing delays and significant backlogs of disability claims. At the
end of fiscal year 2006, some 1.5 million disability claims were
awaiting a decision. About 576,000 of these claims were
backlogged”exceeding the number of claims that should optimally be
pending at year-end. In response to the congressional request, GAO (1)
examined trends in disability claims backlogs and the time required for
SSA to decide a claim, (2) identified key factors contributing to the
backlogs and processing times, and (3) described the steps SSA is
taking to reduce them.
To address these issues, GAO analyzed SSA administrative data,
conducted an extensive literature review, interviewed SSA officials as
well as key program personnel, and conducted site visits in three SSA
regions.
What GAO Found:
From fiscal year 1997 through 2006, backlogged disability claims in the
Social Security Administration‘s processing system doubled, reaching
about 576,000 cases. Backlogs of varying degrees have occurred at most
stages of the claims process. The only significant decline occurred at
the last stage”-the Appeals Council”where fewer cases are processed. At
the initial claims level, handled by state Disability Determination
Services (DDS), a backlog developed in fiscal year 1998 and grew to
about 155,000 claims in fiscal year 2006. At the hearings level,
backlogged claims exceeded 415,000 that year and accounted for 72
percent of the total backlog. Insufficient data prevented GAO from
identifying trends in backlogs at the reconsideration stage. Processing
times, meanwhile, increased with claimants generally waiting
significantly longer”for example, an additional 95 days at the hearings
level”for a decision.
Figure: Total Backlogged Claims, by Level of Adjudication, Fiscal Years
1997 to 2006.
This figure is a shaded bar chart showing total backlogged claims, by
level of adjudication, between fiscal year 1997 and 2006. One color
shows initial claims, another shows hearings, and a third shows appeals
council. The X axis represents fiscal year. The Y axis represents
backlogged claims.
[See PDF for image]
Source: GAO analysis of SSA data.
[End of figure]
Substantial growth in the numbers of disability claims, staff losses
and turnover, and management weaknesses have contributed to the backlog
problem. Initial applications for benefits grew more than 20 percent
over the period while SSA experienced losses in key personnel: claims
examiners in the state determination offices and administrative law
judges and support staff in the hearings offices. In addition,
management weaknesses evidenced in a number of initiatives to address
the backlogs have failed to remedy and sometimes contributed to the
problem.
In 2006, SSA introduced the Disability Service Improvement initiative
(DSI), but suspended national rollout of it in order to concentrate on
the hearings backlog and full implementation of SSA‘s electronic case-
processing system. DSI is still underway in the Boston region; though
hampered by rushed implementation, poor communication, and a lack of
financial planning, DSI has shown mixed results, and SSA has proposed
discontinuing certain components because of cost. Thorough evaluations
that could help inform decisions about DSI‘s future have not yet been
conducted.
What GAO Recommends:
GAO recommends that SSA monitor the reconsideration stage for backlogs
and better plan, execute, and evaluate initiatives to address backlogs.
SSA agreed in part or with the intent of GAO‘s recommendations, but did
not fully agree with some of GAO‘s conclusions. SSA believed GAO did
not sufficiently emphasize the agency‘s funding needs. GAO added data
on SSA funding levels, but continues to believe that the
recommendations are valid.
To view the full product, including the scope and methodology, click on
GAO-08-40.
For more information, contact Daniel Bertoni at (202) 512-7215 or
bertonid@gao.gov.
[End of section]
Contents:
Letter:
Results in Brief:
Background:
Backlogs and Processing Times for SSA's Disability Claims Have
Increased in the Past Decade, with a Particularly Large Backlog at the
Hearings Level:
Growth in Applications, Staffing Losses, and Management Weaknesses Have
Contributed to Backlogs:
SSA Has Introduced a New Set of Comprehensive Reforms, but Suspended
Their Rollout to Concentrate on the Hearings Backlog and on Electronic
Processing:
Conclusions:
Recommendations for Executive Action:
Agency Comments and Our Evaluation:
Appendix I: Objectives, Scope, and Methodology:
Appendix II: Continuing Disability Reviews, Fiscal Years 2004 to July
2007:
Appendix III: Key Aspects of DSI as of August 2006:
Appendix IV: Comments from the Social Security Administration:
Appendix V: GAO Contact and Staff Acknowledgments:
Related GAO Products:
Tables:
Table 1: SSA Annual Full Time Equivalent Employees for Fiscal Years
1997 to 2006:
Table 2: Social Security Administration's Limitation on Administrative
Expenses Account for Fiscal Years 1997 to 2006:
Table 3: Office of Federal Reviewing Official (FedRO) Claims End of
Month Status, October 2006 to March 2007:
Table 4: Fiscal Year 2006 Regional Data on Average Processing Times and
Receipts:
Figures:
Figure 1: SSA's Disability Determination Process:
Figure 2: SSA's Five-Step Sequential Evaluation Process for Determining
Disability:
Figure 3: Total Backlogged Claims, by Level of Adjudication, Fiscal
Years 1997 to 2006:
Figure 4: Average Claims Processing Time for DDS Initial Claims, DDS
Reconsiderations, Hearings, and Appeals Council Decisions, in Days,
Fiscal Years 1997 to 2006:
Figure 5: Total SSA Disability Claims Receipts, Dispositions, and
Backlogs, Fiscal Years 1997 to 2006:
Figure 6: DDS Initial Claims Receipts, Dispositions, Pending, and
Backlog, Fiscal Years 1997 to 2006:
Figure 7: DDS Reconsideration Claims Receipts, Dispositions, and
Pending, Fiscal Years 1997 to 2006:
Figure 8: Initial DDS Disability Insurance Claims Processing Time, by
Age (in Days), Fiscal Year 2006:
Figure 9: Hearings Office Claims Receipts, Dispositions, Pending, and
Backlog, Fiscal Years 1997 to 2006:
Figure 10: Hearings Office Claims Processing Time, by Age (in Days),
Fiscal Year 2006:
Figure 11: Hearings Office Claims Processing Time, Age (in Days) as a
Percentage within a Region, Fiscal Year 2006:
Figure 12: Appeals Council Claims Receipts, Dispositions, Pending, and
Backlog, Fiscal Years 1997 to 2006:
Figure 13: Appeals Council Claims Processing Time, by Age (in Days),
Fiscal Year 2006:
Figure 14: Initial Claims Receipts, Reconsideration Receipts, and DDS
Work Years, Fiscal Years 1997 to 2006:
Figure 15: Hearings Office Claims Backlog and the Ratio of Hearings
Office Support Staff to ALJ, Fiscal Years 1997 to 2006:
Figure 16: Percentage of Hearings Office Claims Pending More Than 270
Days at the End of Year and the Ratio of Hearings Office Support Staff
per ALJ, Fiscal Years 1997 to 2005:
Abbreviations:
ALJ: administrative law judge:
CDR: continuing disability review:
DDS: Disability Determination Services:
DI: Disability Insurance:
DSI: Disability Service Improvement:
eCAT: electronic Case Analysis Tool:
FedRO: federal reviewing official:
FIT: Findings Integrated Template:
HOTS: Hearings Office Tracking System:
IT: Information Technology:
NADE: National Association of Disability Examiners:
ODAR: Office of Disability Adjudication and Review:
OIG: Office of Inspector General:
OMVE: Office of Medical and Vocational Expertise:
QDD: Quick Disability Determination:
SSA: Social Security Administration:
SGA: substantial gainful activity:
SSI: Supplemental Security Income:
United States Government Accountability Office:
Washington, DC 20548:
December 7, 2007:
The Honorable Charles B. Rangel:
Chairman:
The Honorable Jim McCrery:
Ranking Member:
Committee on Ways and Means:
House of Representatives:
The Honorable Michael R. McNulty:
Chairman:
The Honorable Sam Johnson:
Ranking Member:
Subcommittee on Social Security Committee on Ways and Means House of
Representatives:
The Honorable Sander M. Levin House of Representatives:
Each year, millions of Americans who believe that they can no longer
work because of severe physical or mental impairments, apply for cash
benefits through the Social Security Administration's (SSA) two
disability programs--Disability Insurance (DI) and Supplemental
Security Income (SSI). For more than 20 years, SSA has faced challenges
with processing applications for benefits in a timely manner and
overcoming significant backlogs. SSA's data show that there are
disability applicants who wait years for their claims to be resolved at
the final administrative appeals level, which can be a hardship. By the
end of fiscal year 2006, SSA had made about 3.7 million disability
claims decisions, and some 1.5 million disability claims were awaiting
a determination. Meanwhile, new applications for benefits are expected
to increase as the baby boomer generation enters its disability-prone
years. Over the years, SSA has implemented many initiatives aimed at
reducing the backlog in disability claims as well as the time it takes
applicants to obtain a decision on their claims. In light of SSA's
claims processing challenges, you asked us to: (1) examine the trends
for the last several years in the disability claims backlog and the
time required for SSA to decide a claim, (2) identify key factors that
have contributed to the disability claims backlogs and processing
times, and (3) describe the steps SSA is currently taking to reduce the
backlog and claims processing times.
To identify trends in SSI disability and DI claims, we obtained and
analyzed data provided by SSA for fiscal years 1997 to 2006 for the
four levels of adjudication of SSA's disability claims process--initial
claims, reconsiderations, hearings, and final appeals to the Appeals
Council. We received information from SSA on the number of claims
received, the number of claims pending a decision, and other data. We
also obtained data on average processing times. Using these data, we
determined annual backlogs for three of the four levels of the claims
process.[Footnote 1] We measured SSA backlogs in terms of the number of
cases at year-end that exceeded the number of pending claims that the
agency had deemed acceptable.[Footnote 2] We also met with
knowledgeable SSA officials to document the reliability of SSA's data.
We found that limitations exist with respect to hearings data for some
years, and we have noted the limitations where these data are used.
However, we found the data provided by SSA to be sufficiently reliable
for our purposes.
To identify factors that have contributed to SSA's disability claims
backlogs and initiatives that SSA is currently undertaking to address
them, we conducted an extensive literature review, including prior GAO
reports, and position papers and testimonies from national advocacy
groups. In addition, we reviewed agency documents, interviewed key SSA
officials, and conducted site visits to 3 of the 10 SSA
regions.[Footnote 3] During these site visits, we met with management
and staff at the regional Office Center for Disability, the Office of
Disability Adjudication and Review, hearings offices, and state
Disability Determination Services (DDS). For the regions in which we
did not conduct site visits, we conducted telephone interviews with key
officials. We conducted our work between November 2006 and October 2007
in accordance with generally accepted government auditing standards.
For more information on our scope and methodology, see appendix I.
Results in Brief:
Over the last decade, SSA experienced a substantial increase in its
backlog of disability claims, with a particularly severe accumulation
of claims at the hearing level. From fiscal years 1997 through 2006,
the total number of backlogged claims--numbers exceeding the level that
should optimally be pending or in the pipeline at year-end---doubled.
By the end of fiscal year 2006, the total backlog from various levels
of the disability determination process reached about 576,000 claims.
Over the period, backlogs of varying degrees have occurred at each
stage of the claims process where backlogs are calculated. Only at the
Appeals Council, the stage where generally fewer cases are processed,
has the backlog been significantly reduced. At the initial claims level
with the state Disability Determination Services, a backlog developed
in fiscal year 1998 and grew rapidly for a few years before
stabilizing. At the hearing level, although the backlog declined to
about 12,000 claims in fiscal year 1999, it rose dramatically to over
415,000 claims by the close of fiscal year 2006 and constituted about
72 percent of all SSA backlogged claims that year. With regard to
processing times over the last decade, claimants generally waited
longer to receive a final decision. Processing times increased at the
Disability Determination Services and more significantly for cases at
the hearings level. In fiscal year 2006, 30 percent of claims processed
at the hearings stage alone, took 600 days or more.
While backlogs in processing disability claims have plagued SSA for
many years, several factors have contributed to their increase in the
last decade including substantial growth in initial applications, staff
losses, and management weaknesses. Initial applications for DI and SSI
disability benefits have grown more than 20 percent over the past 10
years, enough to challenge an already complex adjudication process,
while staffing at this level increased only 4 percent. This increase in
applications has been spurred by, among other factors, the aging of the
baby boomer generation, downturns in the economy, increased referrals
from other benefit programs, and changes in disability eligibility
requirements in prior years. Over the same period, SSA experienced
losses of key personnel that included disability examiners and medical
or psychological consultants in the DDS offices, and administrative law
judges and support staff in the hearings offices. Finally, management
weaknesses as evidenced by a number of initiatives that were not
successfully implemented have limited SSA's ability to remedy the
backlog. Several initiatives introduced by SSA in the last 10 years to
improve processing times and eliminate backlogged claims have, because
of their complexity and poor execution, actually added to the problem.
For example, the "Hearings Process Improvement" initiative implemented
in fiscal year 2000 significantly increased the days it took to
adjudicate a hearings claim and exacerbated the backlog after the
agency had substantially reduced it.
In 2006, SSA introduced a new set of comprehensive reforms, but
recently suspended national rollout to concentrate on the backlog of
pending hearing requests and on full implementation of its electronic
case processing system. The reforms, known as the Disability Service
Improvement (DSI) initiative, were implemented in the Boston region,
but with mixed results--hampered by rushed implementation, poor
communication, and inadequate financial planning. An automated
screening function designed to identify and expedite disability claims
with a high probability of approval has shortened processing time for
those cases. However, other facets of the initiative have been
problematic, such as a new office to handle first level appeals and
establishing a specialized office to supply medical expertise. As of
June 2007, both offices were only half staffed. In addition, more than
1,800 claims were awaiting a medical review, by either a physician
specialist or a nurse case manager for more than 75 days. We also found
that rollout of the initiative in the Boston region was rushed over a
period of 4 months, with little advance information for those managers
responsible for implementing it. Moreover, the initiative has, as of
June 2007, incurred $24 million in additional administrative costs,
although the agency had envisioned that the initiative would not
increase SSA's existing budget. SSA recently introduced regulations
that will, if finalized, suspend certain portions of the DSI initiative
in Boston pending further evaluation. However, it is not clear what
evaluations will be conducted and if accuracy of disability
determinations will be one of the factors considered when making
decisions about which elements of DSI to continue. The Commissioner of
SSA also recently announced that the agency will concentrate on
clearing out the backlog of pending claims at the hearings level where
it is most severe and bringing SSA's electronic case processing system
into full operation, a step that is expected to facilitate the
processing of disability claims.
We are making recommendations to the Commissioner of the Social
Security Administration to fully monitor backlogs and better execute
and evaluate initiatives to address them. In its comments on a draft of
this report, SSA agreed either in part, or with the intent of our
recommendations, but did not fully agree with a number of our
conclusions. SSA agreed that the agency should track claims at the
reconsideration stage, but believed it should use an alternative
measure as an indicator of performance rather than the measure we
recommended. SSA partially agreed that the agency should conduct a
thorough evaluation of DSI before finalizing the agency's decisions on
implementation and noted that it will continue to collect data and
monitor outcomes to evaluate DSI. SSA agreed that the agency should
take necessary steps to improve the likelihood of the success of future
initiatives and believed the agency is taking steps toward this end.
Finally, SSA expressed concern that the draft report did not
sufficiently emphasize SSA's need for additional funding and noted that
the success of future efforts to reduce the disability claims backlog
will depend on adequate and timely agency funding. We have added
additional information on SSA's funding levels for fiscal years 1997
through 2006 and have revised the report as appropriate in response to
SSA's comments. However, we continue to believe that our
recommendations are valid.
Background:
The Social Security Administration (SSA) administers two federal
programs under the Social Security Act that provide benefits to people
with disabilities who are unable to work: Social Security Disability
Insurance (DI) replaces income for those with a Social Security work
record and provides benefits related to their prior earnings levels.
The Supplemental Security Income (SSI) program provides cash benefits
to the elderly and individuals with disabilities who have limited or no
work history.[Footnote 4] In addition, to be eligible for SSI, disabled
individuals must not have income and assets above a certain
level.[Footnote 5]
The process to obtain SSA disability benefits is complex. Several state
and federal offices are involved in determining whether a claimant is
eligible for benefits. Although SSA is responsible for the program, the
law calls for initial determinations of disability to be made by state
agencies--Disability Determination Services (DDS).[Footnote 6] The work
performed at federal and state offices is federally financed and
carried out under SSA disability program regulations, policies, and
guidelines. The application process, which is the same for DI and SSI
claimants, involves an initial decision and an opportunity for
reconsideration at the state level, and up to two levels of
administrative appeal within SSA as shown in figure 1.
Figure 1: SSA's Disability Determination Process:
This figure is a flowchart depicting SSA's five-step sequential
evaluation process for determining disability.
[See PDF for image]
[A] In 1999, SSA eliminated the reconsideration step in 10 states
(Alabama, Alaska, Colorado, Louisiana, Michigan, Missouri, New
Hampshire, New York, Pennsylvania and in the Los Angeles area of
California) as part of the Prototype initiative. In these states,
claimants who wish to appeal their initial DDS determination must
appeal for review before an administrative law judge. As of August
2006, New Hampshire discontinued participation in the Prototype
initiative due to participation in a new initiative in the Boston
region.
[End of figure]
Under the current structure the process begins at a SSA field office,
where an SSA representative determines whether a claimant meets the
programs' non-medical eligibility criteria, such as ensuring that an
SSI applicant does not have excess assets, or determining if a DI
applicant has a sufficient number of work credits. If the applicant
meets the non-medical eligibility criteria, field office personnel will
help claimants complete their applications and obtain claimants'
detailed medical, education, and work histories. The completeness of
the information gathered at this time can affect accuracy and speed of
the decision.
SSA field office staff then forward the application and the supporting
medical evidence to the state Disability Determination Services (DDS)
where a disability examiner, working with medical staff, must make
every reasonable effort to help the claimant get medical reports from
physicians, hospitals, clinics, or other institutions where the
claimant has received past medical treatments. The examiner may also
ask the claimant to take a special examination called a "consultative
examination," where physicians or other medical professionals hired by
SSA gather more information on the claimant's condition. After
developing the case and assembling all medical and vocational
information for the claim, the DDS examiner in consultation with
appropriate medical professionals determines whether the claimant meets
the requirements of the law for being disabled. In doing so, the DDS
examiner conducts up to a five-step, sequential evaluation that
includes a review of the claimant's current work activity, severity of
impairment, and vocational factors. See figure 2.
Figure 2: SSA's Five-Step Sequential Evaluation Process for Determining
Disability:
This figure is a flowchart showing SSA's five-step sequential
evaluation process for determining disability.
[See PDF for image]
Source: GAO analysis of SSA data; images (Art Explosion).
[A] In 2007 the substantial gainful activity (SGA) threshold was $1,500
per month for blind recipients and $900 per month for individuals with
other disabilities.
[End of figure]
Claimants who are dissatisfied with the initial DDS determination may
appeal and request a "reconsideration" of the claim within 60 days of
the notice of decision. The reconsideration review is conducted by DDS
personnel who were not involved in the original decision. If the
reconsideration team concurs with the initial denial of benefits, the
claimant then has 60 days from the time of this decision to appeal and
request a hearing before an administrative law judge (ALJ).
Administrative law judges, who are based in 140 hearing offices located
throughout the nation, can consider new evidence and request additional
information including medical evidence or medical and vocational expert
testimony. A claimant who is dissatisfied with the hearings decision
may request, within 60 days of the administrative law judge's decision,
that the Appeals Council review the claim.
The Appeals Council is SSA's final administrative appeals level and is
comprised of administrative appeals judges. The Appeals Council may
uphold, modify, or reverse the administrative law judge's action, or it
may return the claim back to the administrative law judge for another
hearing and issuance of a new decision. The decision of the Appeals
Council is the Commissioner's final decision. To appeal this decision,
the claimant must file an action in Federal Court.
SSA measures its claims processing performance at each level of the
process in terms of the number of claims pending each year and the time
it takes to issue a decision. Since 1999, the agency has used a
relative measure to determine the backlog by considering how many cases
should optimally be pending at year-end. This relative measure is
referred to as "target pending" and is set for each level of the
disability process with the exception of the reconsideration level.
SSA's target pending is 400,000 for claims at the initial stage and
300,000 and 40,000 for the hearings and Appeals Council stages,
respectively.[Footnote 7] The number of pending claims at year-end that
exceed these numbers represents the backlog.
Backlogs and Processing Times for SSA's Disability Claims Have
Increased in the Past Decade, with a Particularly Large Backlog at the
Hearings Level:
Over the last decade, SSA experienced a substantial increase in its
backlogs of disability claims with accompanying increases in processing
times for initial claims and even greater increases for claims at the
hearing level.[Footnote 8] From fiscal years 1997 through 2006, the
total number of backlogged claims--the number of pending claims that
exceed the optimal level that should be pending or in the pipeline--
doubled, reaching some 576,000 claims. The number of backlogged claims
grew at both the initial determination and hearings level, though most-
-about 415,000--were backlogged at the hearings level. Meanwhile, for
reconsideration claims, the second stage of review following an initial
determination, the number of claims pending a decision increased about
40 percent over fiscal year 1997 levels. Only at the Appeals Council,
where fewer claims are processed, did SSA experience significant
reductions in both backlogged claims and average processing times.
Since 1997, the Total Backlog in SSA Disability Claims Has Doubled, and
Processing Times Have Increased at Most Levels:
Over the last decade, the total number of backlogged disability claims
in SSA more than doubled, with the greatest accumulation of claims
occurring among those that were awaiting a hearing. By the close of
fiscal year 2006, a total of about 576,000 claims[Footnote 9] were
considered backlogged by SSA's measure,[Footnote 10] which is the
number of pending claims that exceed the number that should be
optimally pending in any one year. The 2006 backlog represented an
overall growth rate of over 120 percent from fiscal year 1997.
Over the decade, backlogs of varying degree have occurred at all stages
of the claims process where backlogs are calculated. However, since
fiscal year 2001, these claims were concentrated most heavily at the
hearings stage of the review process, and also at the initial
processing level with the DDS offices. The hearings level accounted for
the largest share of backlogged claims for 7 of the 10 years of study.
In fiscal years 2000 and 2001, the DDS, which handles new claims,
accounted for the largest share of the backlog. The Appeals Council,
the last stage of appeal within SSA, had the largest backlog in fiscal
year 1999, but dramatically reduced these numbers by 2006. See figure
3.
Figure 3: Total Backlogged Claims, by Level of Adjudication, Fiscal
Years 1997 to 2006:
This figure is a shaded bar graph showing total backlogged claims, by
level of adjudication, fiscal years 1997 to 2006. The X axis represents
fiscal year while the Y axis represents backlogged claims. The colors
represent appeals council, hearings, and initial claims.
[See PDF for image]
Source: GAO analysis of SSA data.
[End of figure]
Not surprisingly, the average processing times for claims at the
hearings and appeals levels tended to increase or decrease in concert
with changes in the backlogs. Processing times for claims have
increased significantly over time at the hearings level and somewhat so
for initial determinations and reconsiderations at the DDS.[Footnote
11] For example, processing times increased about 20 days for claims at
both the DDS initial and reconsideration levels and about 95 days at
the hearings level over this period.[Footnote 12] See figure 4. On the
other hand, average processing time dramatically decreased at the
Appeals Council. In fiscal year 2006, it took almost 140 days less to
reach a decision at this level than in fiscal year 1997.[Footnote 13]
Figure 4: Average Claims Processing Time for DDS Initial Claims, DDS
Reconsiderations, Hearings, and Appeals Council Decisions, in Days,
Fiscal Years 1997 to 2006:
This figure is a combination line graph showing average claims
processing time for DDS initial claims, DDS reconsiderations, hearings,
and appeals council decisions, in days, for fiscal years 1997 to 2006.
The X axis represents the fiscal year, and the Y axis represents the
days. One line represents initial claims, another represents
reconsiderations, another represents hearings, and another represents
appeals council.
[See PDF for image]
Source: GAO analysis of SSA data.
[End of figure]
The growth in the disability claims backlog also generally coincides
with increases in the total number of disability claims received by the
agency.[Footnote 14] Over the 10-year period, the agency experienced a
21 percent increase in the number of initial claims and a somewhat
smaller increase in the number of requests for a hearing. Despite some
increases in the number of dispositions issued annually, the backlog of
claims waiting to be adjudicated has continued to grow. See figure 5.
Figure 5: Total SSA Disability Claims Receipts, Dispositions, and
Backlogs, Fiscal Years 1997 to 2006:
This figure is a combination line graph showing total SSA disability
claims receipts, dispositions, and backlogs, between fiscal years 1997
and 2006. The X axis represents fiscal year, and the Y axis represents
number of claims. One line represents total receipts, another
represents total dispositions, and another represents total backlogs.
[See PDF for image]
Source: GAO analysis of SSA data.
[End of figure]
Backlog at the DDS Level Grew Substantially:
Having begun the 10-year period without a backlog, the DDS offices
experienced a rapid growth in backlogs from 1998 through 2004.
Subsequently they made some small gains and ended fiscal 2006 with
about 155,000 backlogged claims. Also, over the 10-year period, the DDS
offices saw an increase almost every year in new initial claims, which
constituted an overall increase of 21 percent by fiscal year 2006. DDSs
have not been able to keep pace with these rising receipts despite
increases in dispositions and some additional staffing.[Footnote 15]
Thus, annual receipts outpaced annual dispositions in 6 of the 10 years
we examined. See figure 6. SSA anticipates that the number of new
claims requiring DDS processing will continue to grow.
The increase in the numbers of initial claims has also affected the DDS
offices' ability to process other workloads such as continuing
disability reviews or CDRs. We found, for example, that the DDS offices
conducted about one-half the number of CDRs, which are evaluations
conducted by SSA to assess beneficiaries' continued eligibility for
benefits, in fiscal year 2006 than they did in fiscal year 2004. (See
app. II):
Figure 6: DDS Initial Claims Receipts, Dispositions, Pending, and
Backlog, Fiscal Years 1997 to 2006:
This figure is combination bar chart showing DDS initial claims
receipts, dispositions, pending, and backlog, between fiscal years 1997
and 2006. The X axis represents the number of DDS initial claims (in
thousands), and the Y axis represents the fiscal year. One bar
represents receipts, one represents dispositions, one represents
pending, and one represents backlog.
[See PDF for image]
Source: GAO analysis of SSA data.
[End of figure]
We were unable to determine from SSA data whether DDS offices also have
a backlog in claims awaiting reconsideration reviews since the agency
does not establish criteria that would allow measurement of backlogs at
this stage of the process. However, it does track pending claims and by
2006 these numbers had grown by 40 percent over 1997 levels--even
though the number of claims received over this period dropped 25
percent. This amounted to some 137,000 reconsideration claims pending
at the end of fiscal year 2006. Contributing to this increase in
pending claims was a reduction in the number of reconsideration
dispositions issued--almost a third fewer than in fiscal year 1997. See
figure 7. In fact, fewer dispositions were completed in fiscal year
2006 than in 1990. The decline in reconsideration dispositions are
attributed, at least in part to the initial claims workload. For
example, a DDS official in one region we visited told us that several
DDSs had either slowed or temporarily stopped conducting
reconsideration reviews in order to concentrate on reviewing initial
claims. In addition, other factors such as participation in the
Prototype initiative, which eliminated the reconsideration stage in 10
states, may have also contributed to the reduction in reconsideration
dispositions.
Figure 7: DDS Reconsideration Claims Receipts, Dispositions, and
Pending, Fiscal Years 1997 to 2006:
This figure is a combination bar chart showing DDS reconsideration
claims receipts, dispositions, and pending, fiscal years 1997 to 2006.
The X axis represents number of DDS reconsideration claims (in
thousands. The Y axis represents fiscal year. One bar represents
receipts, one represents dispositions, and another represents pending.
[See PDF for image]
Source: GAO analysis of SSA data.
Note: This graphic does not include backlogs. We were unable to
calculate backlogs at the reconsideration stage because SSA has not
established an optimal level of pending claims that would allow its
computation.
[End of figure]
Regarding average processing time, it took longer on average to
adjudicate initial and reconsideration disability claims in fiscal year
2006 than in 1997. The average processing time at the initial level was
89 days in fiscal year 2006, compared to 70 days in fiscal year 1997.
Moreover, 17 percent of initial DI claims (about 230,000 claims) took
between 121 and 180 days to adjudicate; 6 percent (about 78,000 claims)
required over 180 days. See figure 8. At the reconsideration stage, the
average processing time for all claims increased from 51 to 72 days.
Figure 8: Initial DDS Disability Insurance Claims Processing Time, by
Age (in Days), Fiscal Year 2006:
This figure is a pie chart showing initial DDS disability insurance
claims processing time, by age (in days), during fiscal year 2006.
Over 180 days: 6%;
121-180 days: 17%;
91-120 days: 19%;
61-90 days: 25%;
31-60 days: 24%;
0-30 days: 9%.
[See PDF for image]
Source: GAO analysis of SSA data.
[End of figure]
The Largest Backlog in Disability Claims Has Been among Those Awaiting
Hearings:
Although backlogged claims were almost eliminated at the hearings level
from fiscal 1997 through 1999, they grew unabated and reached over
415,000 cases by fiscal year 2006--accounting for 72 percent of SSA's
total disability backlog. This was more than twice the number of claims
backlogged in fiscal year 1997. Meanwhile, the number of requests for
hearings fluctuated considerably from year to year, and in one year,
exceeded 1997 levels by as much as about 21 percent. On the other hand,
the number of dispositions issued over the period declined slightly.
See figure 9.
Figure 9: Hearings Office Claims Receipts, Dispositions, Pending, and
Backlog, Fiscal Years 1997 to 2006:
This figure is a combination bar graph showing hearings office claims
receipts, dispositions, pending and backlog, fiscal years 1997 through
2006. The X axis represents number of claims, and the Y axis represents
fiscal year. One bar represents receipts, one represents dispositions,
one represents pending, and one represents backlog.
[See PDF for image]
Source: GAO analysis of SSA data.
[End of figure]
Although SSA was able to reduce average processing times at the
hearings level in some years, by the end of fiscal year 2006, the time
required to reach a decision had increased dramatically.[Footnote 16]
In fiscal year 2000, SSA's average processing time was 274 days.
However, by fiscal year 2006, this average had increased to 481 days,
with many cases taking much longer. For example, 30 percent (about
170,000) of the decisions issued in fiscal year 2006 took 600 days or
more; about 2 percent (12,000) took over 1,000 days. See figure 10.
Recently, SSA concentrated on reducing the number of cases pending over
1,000 days. From September 2006 to the close of fiscal year 2007, SSA
reduced the number of these cases from 63,770 to 108.
Figure 10: Hearings Office Claims Processing Time, by Age (in Days),
Fiscal Year 2006:
This figure is a pie chart showing hearing office claims processing
time, by age, (in days), during fiscal year 2006.
Over 1,000 days: 2%;
600-999 days: 28%;
365-599 days: 39%;
270-364 days: 11%;
180-269 days: 8%;
Under 180 days: 12%.
[See PDF for image]
Source: GAO analysis of SSA data.
[End of figure]
Lengthy processing times were particularly evident in two regions--
namely regions 5 (Chicago) and 10 (Seattle).[Footnote 17] See figure
11. For these regions, about half of the decisions rendered in fiscal
year 2006, took on average between 600 and 999 days.[Footnote 18]
Figure 11: Hearings Office Claims Processing Time, Age (in Days) as a
Percentage within a Region, Fiscal Year 2006:
This figure is a combination bar chart showing hearings office claims
processing time, age (in days) as a percentage within a region, fiscal
year 2006. The X axis represents the region, and the Y axis represents
the percentage of hearings dispositions. Each shaded bar chart
represents a different time frame. One represents under 180 days. One
represents 180-269 days. One represents 270-364 days. One represents
365-599 days. One represents 600-999 days, and one represents over
1,000 days.
[See PDF for image]
Source: GAO analysis of SSA data.
Note: National totals include processing times for SSA's Central
Screening Division.
[End of figure]
At the Appeals Council, Where Significantly Fewer Claims Are
Adjudicated, Backlogged Disability Claims and Processing Times Were
Dramatically Reduced:
Between 1997 and 2006 the disability claims backlog and average
processing time at the Appeals Council, which handles relatively fewer
claims (less than 3 percent of all processed claims in 2006), decreased
dramatically. By fiscal 2006, the backlog dropped from more than 74,000
claims in 1997 to fewer than 6,000 claims--less than a tenth of the
fiscal year 1997 backlog. Also over the period, the number of Appeals
Council claims received declined by about 17 percent, and the number of
dispositions issued generally increased over the number issued in
fiscal year 1997.[Footnote 19] See figure 12.
Figure 12: Appeals Council Claims Receipts, Dispositions, Pending, and
Backlog, Fiscal Years 1997 to 2006:
This figure represents the appeals council claims receipts,
dispositions, pending, and backlog, between fiscal years 1997 to 2006.
The X axis represents the number of claims (in thousands), and the Y
axis represents the fiscal year. One bar represents receipts. One
represents dispositions. One represents pending, and one represents
backlog.
[See PDF for image]
Source: GAO analysis of SSA data.
[End of figure]
Accompanying the reduction in the Appeals Council's backlogged claims
over the period was a dramatic 40 percent reduction in the average time
that it took to reach a decision on a claim. In fiscal year 2006, the
average time for the Appeals Council to process a claim was 201 days,
down from 340 days in fiscal year 1997 and the 495 days it took in
fiscal year 2000. While on average, it required fewer than 180 days for
the Appeals Council to process most of the decisions in fiscal year
2006, 16 percent of these decisions took 365 days or more. See figure
13.
Figure 13: Appeals Council Claims Processing Time, by Age (in Days),
Fiscal Year 2006:
This figure is a pie chart showing appeals council claims processing
time, by age (in days) during fiscal year 2006.
Over 1,000 days: 1%%;
600-999 days: 5%;
365-599 days: 10%;
270-364 days: 7%;
180-269 days: 13%;
Under 180 days: 64%.
[See PDF for image]
Source: GAO analysis of SSA data.
[End of figure]
Growth in Applications, Staffing Losses, and Management Weaknesses Have
Contributed to Backlogs:
While backlogs in processing disability claims have plagued SSA for
many years, several factors may have contributed to their increase in
the last decade: a substantial growth in initial applications, staff
losses, and management weaknesses. Staffing losses and turnover have
reduced the number of experienced personnel available to process rising
numbers of claims. Management problems have been manifested in a number
of initiatives that were not well planned and implemented. That is,
several initiatives introduced by SSA in the last 10 years to improve
processing times and eliminate backlogged claims have, because of their
complexity and poor execution, had mixed results.
In the Past Decade, Disability Applications Increased Over 20 Percent
while Staffing Increased 4 Percent at DDSs:
As we noted earlier in this report, the number of initial applications
for DI and SSI benefits increased by 21 percent overall from fiscal
years 1997 to 2006; meanwhile, DDS staffing levels increased about 4
percent. See figure 14. The increase in new applications can be
attributable to a number of influences: periodic downturns in the
economy, the aging of the baby boomer population, increased referrals
from other programs, previous changes in program eligibility
requirements and regulations, and increased program outreach. With
respect to the economy, SSA officials, DDS senior managers, and prior
work by GAO all attest to the fact that economic downturns from a
failing industry or natural disaster can precipitate new disability
applications.
Figure 14: Initial Claims Receipts, Reconsideration Receipts, and DDS
Work Years, Fiscal Years 1997 to 2006:
This figure is a combination bar and line graph showing initial claims
receipts, reconsideration receipts, and DDS work years, between fiscal
years 1997 to 2006. The X axis represents the fiscal year, the left Y
axis represents the claims receipts (in thousands), and the right Y
axis represents DDS work years (in thousands). One bar represents
initial claims receipts, another represents reconsideration receipts,
and the line represents DDS work years.
[See PDF for image]
Source: GAO analysis of SSA data.
[End of figure]
Many SSA regional officials we spoke with said that increased program
referrals from state and federal programs have also increased the
volume of applications. Also, SSA officials and DDS senior managers
cited a change in prior disability claims regulations that has
effectively expanded eligibility for certain cases. Additionally,
enhanced outreach efforts over the years have likely increased the
filing of applications for benefits, according to senior managers we
spoke with in two SSA regions. Officials in one region recounted one
initiative that targeted outreach to the homeless, which increased
applications and also added to processing times. They also attributed
some processing delays to the time required to track homeless
candidates and help them document their disabilities.
SSA Has Experienced Substantial Turnover and Losses in Personnel
throughout the Disability Claims Process:
Over the past decade, the growth in the disability claims backlogs has
coincided with a period of staff turnover and losses throughout the
disability claims process. At the Disability Determination Services
(DDS), where the initial and reconsideration decisions are made, in
particular, there has been a high rate of turnover and attrition.
Disability Examiners and Medical Staff for the Disability Determination
Services. Attrition rates for DDS disability examiners, who are state
employees, are almost double that of SSA federal staff. An interim June
2007 report by SSA officials and DDS senior managers cited an attrition
rate of 12.7 percent among disability examiners, which was
significantly higher than the attrition rate of 6.8 percent among SSA
federal staff for fiscal year 2006.[Footnote 20] In the course of our
work and in prior reports, DDS officials have attested to the impact of
staff losses on work flow.
Many DDS senior managers we recently spoke with said that turnover of
experienced disability examiners has affected productivity. In one
state office, for example, senior managers told us they have had
difficulty retaining experienced disability examiners and said that
many leave after their first year of training. These senior managers
also noted an overall attrition rate of 22.3 percent for DDS disability
examiners who completed their first year of training from September
1998 to January 2006. Further, about 130 of the approximately 600
disability examiners hired during that period left or were terminated
within the first year. DDS officials said the loss of experienced staff
affects their ability to process disability claims workloads because it
generally takes newly hired examiners about 2 years to become
proficient in their role.
These accounts of difficulty in retaining key staff are consistent with
a 2004 GAO study, where we reported that over half of the DDS directors
stated that claims examiner turnover had increased DDS claims
processing times and backlogs and that the remaining examiners had to
assume higher caseloads.[Footnote 21] Almost all of those directors
reported that the number of examiners in their DDSs had not been
sufficient for their workloads in at least one fiscal year between 2000
and 2002. We also reported that many DDS directors believed that their
examiners needed additional training.
Finally, DDS managers and staff we spoke with said that not having
sufficient medical and vocational experts available to review
examiners' work also extended the time it generally takes to process
and review an application. For example, at one location, disability
examiners told us that it took 2 months to review some claims that
involved mental health issues.
Administrative Law Judges and Support Staff for Hearings. For much of
the period under study, SSA experienced reductions in administrative
law judges (ALJs) and support staff--decision writers, staff that
prepare case files for review, attorneys, and claims technicians--who
process disability claims.[Footnote 22]
The number of ALJs available to conduct hearings fluctuated annually,
ranging from a high of 1,087 in fiscal 1998 to a low of 919 in fiscal
year 2001 and rebounding somewhat in 2006, to 1,018.[Footnote 23] Many
senior SSA management staff and ALJs with whom we spoke cited the
number of administrative law judges available to conduct hearings as a
major contributor to backlogged claims.[Footnote 24] In May 2006, the
Commissioner of SSA said that the agency would require no fewer than
1,250 administrative law judges along with sufficient numbers of
support staff to properly manage the claims currently pending at the
hearings level. Even at these staffing levels, the Commissioner said
the agency does not expect to immediately reduce the backlog.
Both the number of support staff and the ratio of support staff to ALJ
fluctuated considerably in the hearings offices between fiscal years
1997 and 2006. Support staff levels peaked at over 5,500 in 1999 and in
2006, bottomed out at about 4,700. While SSA senior managers and ALJs
have recommended a staffing ratio of 5.25 support staff to
administrative law judge for effective processing of claims, the actual
ratio has more often been lower, ranging from a ratio 4.59 in 1997 to
4.12 in 2006.[Footnote 25] Only in fiscal year 2001 did the ratio of
support staff to administrative law judge meet the staffing levels
recommended by SSA's senior management.
The backlog decreased when the ratio of support staff to ALJs increased
in some years, but not in others; perhaps because of other intervening
factors such as the implementation of new initiatives and the
elimination of others such as the Hearings Process Improvement
initiative and the Senior Attorney program, respectively.[Footnote 26]
See figure 15. By the close of fiscal year 2006, SSA saw the highest
level of backlogged claims and the lowest ratio of support staff to
ALJs over this period. As shown in figure 16, the number of pending
cases that were older than 270 days decreased significantly when the
support staff to ALJ ratio was higher in fiscal years 1999 through
2001.
Figure 15: Hearings Office Claims Backlog and the Ratio of Hearings
Office Support Staff to ALJ, Fiscal Years 1997 to 2006:
This figure is a combination bar and line graph showing hearings office
claims backlog and the ratio of hearings office support staff to ALJ,
fiscal years 1997 to 2006. The X axis represents the fiscal year, the
left Y axis represents the number of backlogged hearings claims, and
the right Y axis represents support staff ratio. The bars represent
backlogs, and the line represents support staff to ALJ ratio.
[See PDF for image]
Source: GAO analysis of SSA data.
[End of figure]
Figure 16: Percentage of Hearings Office Claims Pending More Than 270
Days at the End of Year and the Ratio of Hearings Office Support Staff
per ALJ, Fiscal Years 1997 to 2005:
This figure is a combination bar and line graph showing percentage of
hearings office claims pending more than 270 days at the end of the
year and the ration of hearings office support staff per ALJ, fiscal
years 1997 to 2005. The X axis represents the year, the left Y axis
represents the support staff ratio, and the right Y axis represents the
percentage of claims older than 270 days. The bars represent the
support staff ratio, and the line represents the percentage of claims.
[See PDF for image]
Source: GAO analysis of SSA data.
[End of figure]
SSA experienced staffing challenges agencywide. For example, the agency
experienced a reduction of more than 1,700 annual full time equivalent
employees from fiscal years 1997 to 2006. See table 1.
Table 1: SSA Annual Full Time Equivalent Employees for Fiscal Years
1997 to 2006:
Fiscal Year: 1997;
Full time equivalent: 64,904.
Fiscal Year: 1998;
Full time equivalent: 63,621.
Fiscal Year: 1999;
Full time equivalent: 62,544.
Fiscal Year: 2000;
Full time equivalent: 61,931.
Fiscal Year: 2001;
Full time equivalent: 62,189.
Fiscal Year: 2002;
Full time equivalent: 62,563.
Fiscal Year: 2003;
Full time equivalent: 62,521.
Fiscal Year: 2004;
Full time equivalent: 63,300.
Fiscal Year: 2005;
Full time equivalent: 63,949.
Fiscal Year: 2006;
Full time equivalent: 63,131.
Source: Data provide by SSA.
Note: Does not include the Office of the Inspector General.
[End of table]
In addition to staffing levels, senior SSA officials said the overall
performance of administrative law judges in adjudicating disability
cases at the hearings level has a substantial impact on the time it
takes to render a disability decision. For example, they said average
productivity would increase if the performance of the bottom 17 percent
of their duty ALJs--ALJs whose responsibility is to primarily review
cases--improved.[Footnote 27] According to SSA, the average number of
hearings processed per duty ALJ is currently around 515 per year, while
17 percent of duty ALJs process fewer than 350 cases per year.
Further, SSA officials told us that in the past several years, the
agency has received appropriated amounts below the President's budget
request. (See table 2) As a result, the agency has not had sufficient
resources and has encountered challenges balancing its many workloads.
In commenting on a draft of this report, SSA indicated that despite
budget shortfalls, since 2001, through innovation, automation, and
dedicated staff, the agency has improved productivity on average, by
2.5 percent each year. However, according to SSA, the success of future
efforts to reduce the disability claims backlog will depend on adequate
and timely agency funding.
Table 2: Social Security Administration's Limitation on Administrative
Expenses Account for Fiscal Years 1997 to 2006:
Dollars in millions.
Fiscal year: 1997;
Commissioner's Request: 6,239;
President's Budget Request: 6,092;
Final Appropriation: 6,407.
Fiscal year: 1998;
Commissioner's Request: 6,654;
President's Budget Request: 6,522;
Final Appropriation: 6,409.
Fiscal year: 1999;
Commissioner's Request: 6,640;
President's Budget Request: 6,541;
Final Appropriation: 6,426.
Fiscal year: 2000;
Commissioner's Request: 6,908;
President's Budget Request: 6,706;
Final Appropriation: 6,572.
Fiscal year: 2001;
Commissioner's Request: 7,356;
President's Budget Request: 7,134;
Final Appropriation: 7,124.
Fiscal year: 2002;
Commissioner's Request: 7,982;
President's Budget Request: 7,574;
Final Appropriation: 7,562.
Fiscal year: 2003;
Commissioner's Request: 7,974;
President's Budget Request: 7,937;
Final Appropriation: 7,885.
Fiscal year: 2004;
Commissioner's Request: 8,895;
President's Budget Request: 8,530;
Final Appropriation: 8,313.
Fiscal year: 2005;
Commissioner's Request: 9,310;
President's Budget Request: 8,878;
Final Appropriation: 8,733.
Fiscal year: 2006;
Commissioner's Request: 10,106;
President's Budget Request: 9,403;
Final Appropriation: 9,109.
Source: CRS Report for Congress, Social Security Administration:
Administrative Budget Issues; Updated October 26, 2007.
[End of table]
Management Weaknesses Also Contributed to Disability Case Backlogs:
Management of the disability claims system and particularly of
strategies initiated to remedy the backlogs may have also contributed
to their growth in some circumstances. In the last decade, a number of
initiatives undertaken by SSA to improve the disability process and
remedy backlogs have faltered for a variety of reasons, including poor
execution. Implementation of these initiatives, therefore, has often
slowed case processing. Prior GAO work found that many of the
initiatives the agency has undertaken since the late 1990s were poorly
planned and implemented and yielded more losses than gains. In some
cases, the plans were too large and too complex and fell far short of
expectations. In addition, in 2001, the Social Security Advisory Board
raised concerns about SSA's many proposed process changes and about the
amount of time and resources the agency had invested in changes that
resulted in minimal gains.
Some initiatives had the effect of slowing processing times by reducing
staff capacity, increasing the number of appeals, or complicating the
decision process. Some improved the process, but were too costly and
subsequently abandoned. This was the case for several facets of a major
1997 initiative, known as the "Disability Process Redesign," which
sought to streamline and expedite disability decisions for both initial
claims and appeals.[Footnote 28] Various initiatives within this effort
became problematic. In addition, implementation of an electronic system
enhanced some aspects of the disability claims process, but also caused
some delays.
Process Unification. This initiative, which was designed to standardize
decisions made both at the initial claims and the hearings level by
streamlining existing regulations required disability examiners to more
fully develop and document their decisions. Although this would require
more time early in the process, this initiative was expected to reduce
backlogs by decreasing the number of appeals. This initiative was only
partially implemented and portions of it, such as the development of a
unified policy guide for adjudicators, were later abandoned by SSA
because of high costs and an overly-ambitious scope.
The Prototype. This initiative was designed to ensure that all
legitimate claims were awarded as early in the initial claims process
as possible by eliminating the second independent review or
reconsideration step in the disability adjudication process. Although
designed to streamline initial processing of claims by screening for
claims with clear eligibility, this process resulted in an increase in
the number of appeals for a hearing by an administrative law judge.
After introducing the process in ten states, SSA, in 2002, discontinued
its expansion based on its high administrative costs and the increased
number of appeals.[Footnote 29] SSA also concluded that this initiative
would cause claimants to wait significantly longer for a final decision
on a hearings claim.
The Disability Claims Manager. SSA implemented this initiative in 1999
to make the claims process more user-friendly and efficient by
assigning a disability claims manager as the primary point of contact
until initial decisions are made. The disability claims manager altered
the process by which numerous employees handled discrete parts of the
initial claim. Both SSA and DDS employees served as disability claims
managers during the test, performing both claims representative and
disability examiner functions. While the test showed greater customer
satisfaction and faster processing, SSA, in June 2002, ended the
initiative because of significant start-up and maintenance costs,
including employee training and insufficient infrastructure to support
the new claims process.
The Adjudication Officer. This initiative was designed to expedite
decision-making at the hearings level by assigning single points of
contact to (l) provide claimants with information about the hearing and
their rights to representation, (2) develop the record for a hearing,
(3) issue fully favorable on-the-record decisions when supported by
evidence, and (4) narrow issues and fully develop cases that are
forwarded to the administrative law judge for a decision. Since this
initiative did not meet most of its milestones for testing or
implementation because of an overly ambitious plan that required the
agency to move forward on many fronts simultaneously, SSA discontinued
implementation in 1999.
With the Disability Process Redesign Plan of 1997 largely discontinued,
in 2000, SSA undertook new efforts to improve processing, but most of
these changes have been troubled by protracted implementation and
slowed claims processing.
Electronic Disability Process. In 2000, SSA revived a prior plan to
transform its paper-based processing system to a national, fully
integrated electronic processing system. The initiative has several
goals, including (1) reducing delays caused by losing paper folders
during transfers to other offices, (2) providing more complete
disability information on claimants, and (3) reducing keying errors as
well as storage and mailing costs. However, SSA's decision in 2002 to
accelerate its rollout of the electronic claims process before
conducting end-to-end testing of the systems resulted in systemic
instability and shutdowns at the DDS and hearings offices.[Footnote 30]
For example, DDS managers in one SSA region we visited said as a result
they were faced with computer shutdowns as long as a half hour each
day, making it difficult to process cases. However, SSA regional
officials told us that these problems are now improving.
Also, the electronic folder system, a component of the electronic
disability process, was implemented at the hearings offices without "e-
pulling," a feature that was part of SSA's original vision of a mature
electronic disability process that would automatically eliminate
duplicate documents and organize the remaining documents. While a pilot
of the functionality for e-pulling is scheduled for implementation in
April 2008, technicians must still perform this activity manually.
Staff in one region we visited said that because of system problems and
the time required to eliminate duplicate electronic documents, and
master the new system, it has been taking up to three times as long to
prepare a case. Moreover, administrative law judges we spoke with in
two SSA regions said that as a result they had experienced some delays
because the support staff could not prepare enough claims files for
hearings.
Currently, new claims are generally processed in the electronic folder
system at all stages of the process with the exception of the Appeals
Council, where an electronic folder system is expected to be installed
January 2008. In addition, since June 24, 2007 hearing offices have
been able to "reactivate" the most recent closed electronic file, thus
allowing cases remanded by the Appeals Council to remain electronic.
Prior to June 24, 2007, any disability claim that was sent back to a
previous level of the process for adjudication, such as claims that
were remanded from the Appeals Council back to a hearings office, had
to be converted and processed in paper, which caused some claims
processing delays.
Hearings Process Improvement. This initiative, implemented in 2000 to
reduce the number of appeals by improving their review at the hearings
level, reorganized staff into small groups in the hearing offices to
screen and analyze claims before they were scheduled for a hearing with
an ALJ. Among other things, this resulted in the promotion--without
replacement--of some staffers who had formerly been key to assembling
claims documents for hearings. Also, the automated systems that were
necessary to support the full implementation of this initiative were
never put in place. Many of the senior SSA officials we spoke with
expressed the opinion that this initiative was responsible for dramatic
increases in delays and processing times at the hearings level. Also,
during a May 2002 congressional hearing, the Commissioner of SSA
acknowledged that this initiative had created additional bottlenecks at
the hearings level.
Appeals Council Process Improvement. This initiative was implemented in
2000 to improve customer service by reducing processing times and
pending disability workloads at the Appeals Council level among other
strategies, through increased adjudicatory capacity. It was credited
with reducing both disability case processing times and the backlog of
pending claims at the Appeals Council level. However, the initiative
was hampered by automation problems and policy changes. For example, an
inefficient and error-prone case tracking system caused process delays.
Additionally, policy changes required that subsequent applications for
benefits filed by claimants be kept separate from original ones. This
resulted in two cases pending at different levels of the process, which
complicated adjudication, requiring more time for resolution.
In 2002, SSA introduced several short-term initiatives to reduce
processing times and delays at the hearings level. These short-term
initiatives included several approaches such as, bench decisions
whereby an ALJ could issue a favorable decision based on the evidence
when holding a hearing; use of information technology such as video
hearings; early screening analysis to identify claims with a high
likelihood of being granted; and use of outside contractor assistance
for file assembly. Although many of these strategies are still
employed, SSA discontinued the use of contractors for file assembly--in
part because of problems with lost folders.
SSA Has Introduced a New Set of Comprehensive Reforms, but Suspended
Their Rollout to Concentrate on the Hearings Backlog and on Electronic
Processing:
In 2006, SSA introduced the Disability Service Improvement initiative
(DSI), a comprehensive set of reforms to the disability process, which
was initially rolled out in the Boston region with the intention of
extending it nationally.[Footnote 31] However, DSI was hampered by
rushed implementation, poor communication within the agency, and
inadequate financial planning. Thus far, results of the initiative have
been mixed. SSA recently published proposed regulations to suspend
certain portions of the initiative operating in the Boston region that
have cost more than anticipated. SSA has said that it will continue to
evaluate these portions of the initiative to determine whether they
should be reinstated. However, it is not clear whether accuracy of
decisions will be a key consideration in addition to cost and
timeliness when conducting these evaluations. In the meantime, SSA will
re-focus its efforts on clearing out the hearings backlog, which has
reached over 400,000 claims, and on increasing the functionality of the
electronic folder system.
Rushed Implementation of SSA's "Disability Service Improvement"
Initiative as well as Poor Communication and Inadequate Financial
Planning Has Produced Mixed Results:
In March of 2006, SSA instituted a comprehensive plan to improve all
phases of the disability claims process with fundamental changes,
expecting to make it operational in the Boston region by August of 2006
and in a second region, at the earliest, a year later.[Footnote 32]
This plan, called the Disability Service Improvement initiative (DSI)
was designed to produce correct decisions on disability claims as early
in the application process as possible, with the expectation that DSI
would reduce both appeals of denied claims and future backlogs. (See
app. III for key aspects of DSI).
By regulation, DSI began in the Boston region in August of 2006--just 4
months after publication of the final rule describing the program.
According to regional officials, this left insufficient time to get
these programs up and running. Also, according to agency and regional
officials we spoke with, problems caused by a tight schedule were
compounded by limited communication between SSA headquarters and the
Boston region prior to the DSI rollout. Officials from the Boston
region said that regional staff were not party to DSI planning, which
took place in SSA's Baltimore office, and that until the final
regulation was published in March, the only information the officials
received about DSI was the information that was released publicly.
Despite multiple requests for meetings, regional officials said they
did not meet with SSA headquarters personnel to discuss implementation
until May 2006, less than 3 months before the program's scheduled
rollout and they had few details on how the DSI process was intended to
work logistically. Further, DSI implementation was complicated by the
fact that staff were still becoming familiar with the electronic
processing system, which had been recently implemented.
Additionally, SSA did not provide training to offices outside the
Boston region on how to handle claims that are filed originally in the
Boston region under the DSI system.[Footnote 33] While examiners in non-
DSI regions were instructed to use an electronic search system for
guidance on DSI cases, they generally found the system to be
inadequate. According to these officials, the search engine did not
allow a search by words or phrases and was not effective in providing
information to examiners on DSI or other topics.
DSI involved several envisioned changes to improve the disability
determination process, but several factors, including tight time frames
and poor communication, converged to undermine the initiative,
producing mixed results in the Boston region, which has resulted in SSA
expediting national rollout of some portions of the initiative and
proposing indefinite suspension of others.
Quick Disability Determination Process. For initial claims, the DSI
initiative added an automated screening function designed to identify
disability claims that have a high likelihood of being approved for
expedited processing. This process, known as the Quick Disability
Determination (QDD) program, has been successful in fully adjudicating
79 percent of targeted claims within 20 days or fewer with an average
decision time of 10 days.[Footnote 34] Moreover, SSA's Office of
Quality Performance found high accuracy rates when reviewing decisions
made under this screening strategy. Nevertheless, Boston regional
officials told us that the screening mechanism may not consistently
identify claims that appear to fit SSA's established profile for
adjudication under this process. For example, an SSA official in one
state noted a case in which applications for disability benefits were
submitted for two low birth-weight twins, only one of whom was
identified as eligible under the QDD screening process, although they
both had the same condition. According to SSA, this happened because
the application for the twin that was not selected for QDD did not have
a weight listed. While SSA headquarters officials have expressed
enthusiasm about QDD, and the agency has published regulations to roll
it out nationally, regional officials cautioned that achieving rapid
resolution of identified claims is highly dependent on hospitals or
other medical centers expediting the submission of patient records to
SSA. To date, examiners in the Boston region have been successful in
convincing doctors and hospitals to expedite evidence for QDD cases,
but the examiners still cautioned that providers of medical evidence
may grow less responsive to requests for expedited information as these
requests increase.
Office of the Federal Reviewing Official. While reconsideration
adjudications for a denied claim have traditionally been handled by
disability examiners at the DDS offices, the DSI initiative transferred
such reviews to a new federal office of attorneys. These officials,
known as Federal Reviewing Officials (FedRO), provide more extensive
documentation of the decision to the claimant for this first level of
appeal. Decisions by examiners from this specialized federal office
have, as of March 2007, had accuracy rates of 97 percent.[Footnote 35]
According to SSA, this is higher than accuracy rates for DDS
reconsideration adjudications.[Footnote 36] Data provided by SSA on
FedRO decisions to date also showed that these decisions had resulted
in fewer appeals compared to standard reconsideration reviews in
Boston.[Footnote 37] While the FedRO has only recently begun issuing
decisions, SSA officials have noted that they have so far been well
documented and legally consistent.
While case documentation and accuracy appear to have improved under
FedRO, which is staffed at half of planned capacity, pending claims
levels and processing times have begun to increase substantially as
more cases are decided under this process. Between November of 2006 and
March of 2007, the number of claims pending at the FedRO increased from
209 to over 4,000. Moreover, the average time it took to adjudicate a
claim increased from 41 to 80 days and continued to rise to 113 days at
the close of June 2007. Meanwhile, receipts coming into the FedRO
office are increasingly outpacing dispositions at a rate that could
create a new backlog. (See table 3.)
Table 3: Office of Federal Reviewing Official (FedRO) Claims End of
Month Status, October 2006 to March 2007:
Pending;
October: 55;
November: 209;
December: 811;
January: 1,584;
February: 2,775;
March: 4,876.
Receipts;
October: 50;
November: 158;
December: 616;
January: 827;
February: 1,269;
March: 2,328.
Dispositions;
October: 0;
November: 4;
December: 14;
January: 54;
February: 78;
March: 226.
Average age of pending;
October: 12;
November: 24;
December: 32;
January: 38;
February: 46;
March: 55.
Source: SSA data.
[End of table]
In August of 2007, SSA published a proposed rule to suspend the FedRO
review in the Boston region, citing high administrative costs and lack
of data to perform adequate evaluation on the effectiveness of FedRO
review as reasons for suspension. If the proposed regulation is
finalized, claims appealed after an initial decision will be reviewed
at the DDS under the existing reconsideration procedures. The proposed
rule states that SSA intends to continue to process claims already
received at the FedRO and will continue to evaluate the FedRO through
the processing of these claims. SSA says it will make a final
determination as to whether to reinstate the processing of claims at
the FedRO based on this evaluation.
Office of Medical and Vocational Expertise (OMVE). The DSI initiative
established a specialized office to supply medical expertise. The
Medical and Vocational Expert System commonly called the Office of
Medical and Vocational Expertise (OMVE), is staffed with nurse case
managers who support the FedROs. Nurse case managers at the OMVE obtain
and collect needed medical evidence, schedule consultative exams for
claimants with SSA-contracted physician specialists, and conduct a
general review of each claim. The OMVE was not formed until June 2006
and as of June 2007, this office was staffed at about half the capacity
required to support the Boston region. This has contributed to over
6,500 claims pending review at the OMVE with about 1,800 claims pending
over 75 days as of June of 2007. In addition, the office has failed to
establish sufficient numbers of contracts with specialty physicians, a
problem that was attributed to the lack of availability and the cost of
retaining such specialists. As a result, staff acknowledged that as of
June 2007, claims were pending 3 weeks for psychiatric review and 5
weeks for orthopedic review. Additionally, some agency officials told
us they often found the nurse case-manager review unnecessarily
duplicative of the work done by the FedRO and noted that the dual
review was also expensive since both the FedRO and OMVE involve high
level positions with substantial salaries. In August of 2007, SSA
proposed using the OMVE in a more limited role to develop and manage a
national registry of medical, psychological, and vocational experts.
Deadline for Submission of Evidence at the Hearings Level. At the
hearings level, the DSI initiative generally requires claimants to
submit evidence no later than five business days before a
hearing.[Footnote 38] In limited circumstances, the ALJ will accept
evidence submitted at the hearing or during the five business days
before the hearing, or after the hearing and before the hearing
decision is issued.[Footnote 39] Submission of additional evidence at
or immediately prior to a hearing can necessitate rescheduling the
hearing in order for ALJs to consider new evidence. Such delays could
postpone hearings for several months and require staff resources to
prepare for the hearing. The official record closes once the ALJ issues
a decision; regardless of whether it becomes the final
decision.[Footnote 40] Officials we spoke with in the Boston region
viewed these deadlines as positive improvements and the Commissioner of
SSA has recently endorsed these changes. However, since very few DSI
cases have made it to a hearing as of this date, it is difficult to say
how these regulations will work in practice.
New Templates for Documenting Decisions. Under DSI, initial disability
examiners are also required to provide more extensive documentation
describing why a claim is awarded or denied. In support of this
requirement, SSA planned to institute the electronic Case Analysis
Tool, (eCAT), a computer based system that guides examiners through the
decision making process and helps them fully document their cases.
However, SSA's Office of Systems did not have adequate time to fully
develop and test the tool and, as of August 2006, eCAT was not as
functional as SSA had expected. Despite, the fact eCAT was not fully
operational, beginning in August, SSA required DDS examiners to either
use it or another decision template, which was based on Microsoft Word,
to document their cases. Both templates caused considerable delays in
processing caseloads. Regional staff told us the templates were time
consuming: the eCAT template had technical problems which caused the
system to crash and lose information and because the Microsoft Word-
based template was designed to address every possible disability claim,
it required examiners to sort through an unrealistically long list of
choices to document each element of every claim. In March 2007, the
Commissioner of SSA discontinued the template requirement. He later
noted in a May testimony before Congress that electronic templates
developed for the DDSs under DSI had been discontinued because they
were "not ready for real world use".[Footnote 41]
Apart from the above operational problems, the Disability Service
Improvement (DSI) initiative has also cost more than the agency
anticipated. SSA officials told us that they had originally estimated
that DSI would draw resources from existing programs within SSA. The
expectation was that resources for staffing and new technology would
come from the budgets for disability hearings and the electronic folder
respectively and that implementation of DSI would not increase SSA's
overall budget. However, according to SSA budget officials, partial
rollout of the DSI initiative in the Boston region alone, had by June
of 2007, incurred $24 million in staffing expenses above normal
administrative costs for disability programs. Meanwhile, budget
officials told us they had not yet estimated the cost of national
implementation of DSI. However, they had recently estimated that fully
staffing the Boston region--one of the smallest of SSA's ten regions--
will require as much as $46 million. This estimate did not include the
cost of funding new technology associated with DSI, such as eCAT.
Recently, SSA acknowledged the costs of DSI, particularly those
associated with the FedRO and OMVE, were higher than expected.
SSA Has Suspended National Rollout of the DSI Initiative Pending
Further Evaluation:
SSA suspended further implementation of the DSI initiative beyond the
Boston region and in August 2007, issued a proposed rule that would
suspend the FedRO and OMVE portions of DSI. In discussing suspension of
the national rollout, several agency officials reported to us that the
agency would conduct an evaluation of DSI in Boston before any further
decisions were made. According to SSA's proposed regulation, the agency
will decide whether to reinstate the FedRO and OMVE based on an
analysis of their performance in the processing of claims already
received as well as alternative approaches. SSA stated that the
evaluation will include an assessment of program and administrative
costs and timeliness. However, one criterion not mentioned for
evaluation in the regulation is accuracy--which, according to officials
involved in the creation of DSI, was one of the primary goals of FedRO
and OMVE review.
To date, the agency has undertaken only limited assessments of other
components of DSI even though the strategic plan for the initiative
originally included a schedule for a detailed evaluation plan. This
evaluation plan was never carried out, and several components of DSI
have not yet been assessed. Those evaluations that have been conducted,
which we reviewed, were limited in scope and covered only short time
periods. For example, we found that SSA's evaluations of QDD cases
examined the accuracy of decisions, but not the criteria used for their
selection or the speed at which individuals whose claims were approved
under the program received their benefits. In addition, SSA's
preliminary evaluation to assess FedRO's effectiveness was inherently
limited by the number of cases involved, as the FedRO had processed
fewer than 350 cases during the initial period of the evaluation.
SSA Is Concentrating on Reducing the Hearings Backlog and Improving the
Electronic Processing System:
SSA recently outlined a new plan that concentrates on clearing out
backlogged cases that includes investing at a minimum, an additional
$25 million to improve the electronic processing system. Officials we
spoke with at SSA emphasized that the new plan is not meant to replace
the DSI initiative but to complement it until a final decision is made
regarding the future of DSI. They noted that a large factor in the
decision to suspend national rollout of DSI was the cost of the
program, especially since its implementation was diverting resources
from addressing the hearings backlog, which they said was at critical
levels.
The hearings backlog reduction plan, described in an 18-page document,
focuses on reducing the existing hearings backlog through a series of
steps that employ some prior innovations and also new initiatives. The
plan focuses on updating SSA's medical eligibility criteria, expediting
cases for which eligibility is more clear-cut, improving the electronic
processing system, and focusing heavily on clearing out the backlog at
the hearings level through a number of targeted actions.[Footnote 42]
We highlight several of the proposed activities below:
Update of SSA's Medical Condition Listings. As part of the effort to
expedite cases, the Commissioner said SSA's existing medical listings
would be updated so that disability categories are better defined.
Quick Disability Determination (QDD). Citing that the QDD process was
both efficient and compassionate, the Commissioner said the DSI quick
decision process for claimants with clear-cut cases would be continued
and implemented nationally.
Improvements in Hearings Office Capacity and Performance. The
Commissioner announced that the agency will increase the numbers of
ALJs as well as support staff and will focus on clearing out cases that
are more than 1,000 days old. The Commissioner has also proposed
reviving the Senior Attorney Advisor program that was in place from
1995 to 2000 and gave Senior Attorney Adjudicators the ability to
approve cases for claimants with clear disabilities that did not
require a hearing. To increase the number of ALJs, the Commissioner
plans to hire new judges, appoint ALJs from other agencies, and also re-
hire some retirees. The backlog reduction plan also calls for remanding
more cases back to the DDS, when appropriate, for fully favorable
determinations. Finally, the plan calls for tightening performance
measures for ALJs to ensure that cases are processed in a timely
manner.
Use of a Findings Template for Hearings Decisions. The plan mandates
the use of a template to be used by decision writers and ALJs, when
documenting hearings decisions. The purpose of the Findings Integrated
Template (FIT) is to ensure that all pertinent legal requirements are
addressed in the ALJ's decision, with the hope that this will reduce
the number of cases that are remanded from the Appeals Council back to
the hearings level. However, the template was not designed to analyze
or marshal evidence and according to decision writers in one region we
visited, FIT does not help them associate evidence with relevant
regulations, which often is a primary source of decision writing
errors. While officials noted that decisions written using this
template had a lower rate of remands, overall, FIT has received mixed
reviews from officials and staff at SSA we talked with who have used it
for processing cases. They also noted that portions of the template
were not always relevant to all decisions, which made it difficult to
use. The decision writers said that an open format rather than a
template provided more room for associating evidence for a specific
case with a pertinent regulation.
Temporary Service Area Realignments. The plan proposes to temporarily
realign service areas by assigning additional service areas to hearing
offices without backlogs and with low receipts. This is expected to
correct caseload imbalances caused by dramatic fluctuations in receipts
among the 141 hearing offices across SSA's geographic regions. Requests
for hearings are to be routed by the servicing field office to the new
hearing office rather than the original office. According to agency
officials, this will significantly reduce mailing and computer inputs
required under SSA's previous process, freeing valuable staff time for
essential case preparation activities. However, agency officials told
us that claims that are adjudicated in a region other than where they
are filed require substantial investment for judicial travel or video
equipment in the case of remote hearings. In addition to video
equipment, remote hearings require the use of two rooms for the
hearing, although SSA already faces constraints on physical space for
hearings. Further, SSA would need to create additional permanent sites
where the agency could leave video equipment rather than relying on
rental of temporary sites, such as conference centers and hotel rooms,
which the agency currently uses to conduct hearings in remote areas.
The Commissioner is also proposing to continue with interregional case
transfers, which are short-term reassignments of cases to other regions
on an as needed basis if temporary service area realignments are not
possible.
Improve and Complete Implementation of the Electronic Processing
System. The Commissioner has announced that SSA will dedicate $25
million in resources from its technology reserve fund to update
elements of the electronic folder that were not fully functional when
the system was rolled out. The agency also plans the initial rollout of
the electronic folder to the Appeals Council in January 2008. It also
calls for enhancing the electronic folder by automating file assembly
at the hearings level, allowing for electronic signatures on approved
cases, facilitating shared access to the folder for SSA staff, and
expanding internet support and functionality for claimants or their
representatives. An official responsible for the information technology
(IT) budget at SSA recounted that in the previous year the agency had
budgeted all technology resources to the DSI initiative rather than the
electronic folder. Referring to the electronic folder, now, as the
"backbone" of the disability processing system, the official said the
updates will be needed to make it fully functional and that SSA is now
refocusing its priority on the electronic folder system. While
electronic improvements are designed to shorten processing times, the
National Association of Disability Examiners and staff we spoke with
who have used the electronic system--disability examiners, decision
writers and judges--described a mixed picture. They noted that
transmitting and tracking cases is faster, but file reviews may
actually take longer given that they necessitate scrolling through
hundreds of pages of medical evidence on a computer screen.[Footnote
43]
Conclusions:
SSA has long been confronted with the difficult challenge of weighing
the nature and severity of individual disabilities for people who apply
for benefits from two very complex programs. Adding to this challenge
has been the substantial increase in disability applications over the
past decade, just as the agency was experiencing increased losses in
examiners, support staff, and administrative law judges. An overall
loss of experienced staff combined with increasing workloads and
resource constraints can reduce the success of any initiative aimed at
reducing backlogs. Unfortunately, SSA also has a history of
implementing initiatives to improve claims processing that have been
poorly executed and therefore compounded its problems.
While there is recognition of the severity of the disability claims
backlog at the hearings level, it is unclear whether a similar
situation exists at the first level of appeal--reconsiderations that
occur at DDS offices. Without this recognition, SSA may fail to focus,
when necessary, on any backlogs that occur at this stage and also
understate the total backlog, which in fiscal year 2006, exceeded a
half million claims.
SSA's decision to "pause" the national rollout of the Disability
Service Improvement initiative of 2006 may be appropriate given the
fact that the hearings backlog has reached critical levels and that
further rollout would prevent the agency from focusing on relieving the
backlog and fully implementing a modern system of electronic
processing. However, some features of the suspended Disability Service
Improvement initiative could improve the disability process. SSA has
noted that FedRO and OMVE are costly and may have to be discontinued.
While the agency has stated it will consider cost and timeliness in its
evaluations of these components, it is unclear whether the agency will
assess accuracy, one of the primary goals of DSI, or attempt to
identify aspects of the FedRO and OMVE that worked well and could be
incorporated into the disability claims process should they not be
reinstated. Any failure to weigh their potential through careful
evaluation could risk additional waste in resources. Finally, the
latest measures announced by the Commissioner to focus specifically on
the hearings backlog also appear promising. Experience has shown,
however, that without careful planning, execution, and evaluation even
the best strategies can become expensive undertakings that impose
unnecessary hardship on both claimants and agency staff.
Recommendations for Executive Action:
To ensure that current and future modifications to the disability
determination process achieve the desired and optimal outcome, we
recommend that the Commissioner of the Social Security Administration
take the following three steps:
* establish a "target pending" for cases in the reconsideration stage
as the agency does for the other stages, to allow identification and
monitoring of backlogs,
* conduct a thorough evaluation of the Disability Service Improvement
(DSI) initiative before deciding which elements should be implemented
nationwide and which should be discontinued, and:
* take needed steps to increase the likelihood that new initiatives
will succeed through comprehensive planning to anticipate the
challenges of implementation, by including the appropriate staff in the
design and implementation stages, by establishing feedback mechanisms
to track progress and problems, and by performing periodic evaluations.
Agency Comments and Our Evaluation:
We provided a draft of this report to the Commissioner of the Social
Security Administration (SSA) for review and comment. In comments on a
draft of this report, SSA agreed either in part, or with the intent of
our recommendations, but did not fully agree with a number of our
conclusions. Also, SSA proposed that GAO recommend that the agency
explore ways to improve ALJ performance. Moreover, SSA expressed
concern that the draft report did not sufficiently emphasize SSA's need
for additional funding. In addition, SSA had specific comments
regarding our characterization of DDS target pending levels, the
financial impact of DSI, and the agency's efforts to address the
backlog at the hearings level.
Regarding our recommendation that SSA establish a "target pending" for
the reconsideration stage of the disability process, SSA agreed that
tracking claims pending at this stage should be part of the agency's
routine and comprehensive monitoring of all DDS workloads. However, SSA
did not believe that it should establish an agency target or goal for
reconsideration claims. Rather, SSA believed the number of
reconsideration cases over a certain age could be used as an
alternative indicator of performance, a measure that is consistent with
the agency's current direction of focusing on aged claims.
While aged claims might be a useful alternative indicator of
performance, we continue to believe that SSA should establish a target
pending or goal for the reconsideration stage as it does for the other
three stages--initial, hearings, and Appeals Council--of the disability
process. Establishing and monitoring a target pending at the
reconsideration stage would help SSA to determine when the number of
reconsideration claims pending exceeds the optimal level that should be
in the pipeline, indicating a backlog exists. Knowing when pending
claims have exceeded optimal levels at any stage in the disability
claims process will help SSA better determine where the agency needs to
focus its attention.
SSA partially agreed with our recommendation that the agency should
conduct a thorough review of DSI before deciding which elements should
be implemented nationwide and which should be discontinued. SSA noted
that it will continue to collect data and monitor outcomes to evaluate
DSI and is implementing parts of DSI, such as QDD, that have been shown
to enhance the agency's ability to make timely and accurate decisions.
SSA stated that it will continue to evaluate the effect of FedRO and
OMVE on its administrative functions. SSA added that the agency does
not have sufficient resources to reduce the hearings backlog and fully
staff FedRO and OMVE and that therefore, SSA's evaluation of these two
components will have limited reliability.
The intent of our recommendation is to help ensure that SSA
incorporates a strong evaluation component in the DSI initiative. To
date, SSA has conducted only limited assessments of DSI, even though
the agency had previously developed a detailed evaluation plan and
indicated this plan would be used to thoroughly evaluate the
initiative. However, the assessments that have been completed were
limited in scope and covered short time periods. In conducting a
thorough evaluation of DSI, SSA would have more reliable data on which
to base its decision on which aspects should be continued,
discontinued, or modified. Any failure to weigh the potential of DSI to
improve the disability claims process through careful evaluation could
risk additional waste in resources.
SSA agreed with the intent of our recommendation to take necessary
steps to improve the likelihood of the success of future initiatives
and stated it has already taken steps toward this end.
We are pleased that SSA agrees with the intent of our recommendation
and is "moving forward with clear accountable leadership, a solid plan,
a very inclusive executive steering committee, regular management
information data as feedback, ongoing monitoring, and coordinated
monthly evaluation mechanisms." We hope that the agency's success in
implementing this recommendation is evidenced in its future
initiatives.
SSA proposed that we recommend that the Commissioner of SSA explore
ways that the agency can manage the performance of unproductive ALJs.
Our report acknowledges that variations in ALJ productivity has been a
long-standing challenge to addressing the backlog problem. In prior
reports, we have also recommended ways to address ALJ performance
issues. For example, in December 1989, GAO recommended that the
Commissioner of SSA direct the Office of Hearings and Appeals (OHA)
(now ODAR) to conduct a study to determine the appropriate number of
cases that ALJs should be expected to decide.[Footnote 44] In July
1996, we noted that SSA's disability Redesign Plan did not specifically
address how SSA would consistently define and communicate its
management authority over ALJs.[Footnote 45] Thus, we believe that SSA
can pursue ways to manage the performance of unproductive ALJs on its
own initiative without another GAO recommendation.
Regarding budget implications, SSA believed that the report should
elaborate on the full impact of reduced funding on the disability
claims process and highlight this point throughout the report. The
agency stated that since 2001, the Congress has appropriated on average
$150 million less each year than the President's budget requested and
that the agency employed 19,000 fewer people in fiscal year 2005, than
it did 30 years ago. In addition, SSA points out that a minimum
increase of over $300 million each year is required to support its
large infrastructure. Further, the agency pointed out that despite
budget shortfalls, since 2001, with innovations, automation, and
dedicated staff, the agency has improved productivity by on average 2.5
percent annually. However, according to SSA, to compensate for
insufficient funding would require an additional 10 percent increase in
productivity annually, a feat that the agency believes is not possible.
We have added additional information to our report on SSA's budget
requests and the amounts appropriated over the last several years.
However, we do not know how the differences in funding requested and
appropriations received affected backlogs and processing times since we
did not conduct this analysis. To conduct such an analysis would
require a separate study that would assess such factors as staffing,
workloads, and, as SSA points out, the effects of innovations and
automation on case processing, steps that can improve productivity.
Regarding DDS target pending and staffing, SSA expressed concern that
the report draft's discussion of the DDS backlog and target pending
does not clearly explain that the target pending cited is the optimal
pipeline and does not reflect the DDS's annual targets as outlined in
SSA's Annual Performance Plan, which are based on available funding and
staffing. Further, the agency pointed out that program integrity
requirements also limit DDSs' flexibility in determining workload
priorities.
We have added additional information to the report to clarify our use
of the term, "target pending". Since we did not conduct an analysis of
SSA's budget or how the agency used its funding, we do not believe we
can comment on how these factors specifically impact DDSs' capacity to
process pending claims.
Regarding DSI, SSA provided actuarial cost estimates for the DSI
regulation regarding the effect DSI would have on total allowances and
benefit costs. SSA said that the draft report did not acknowledge that
the statutory requirement that 50 percent of all DDS allowances under
DI programs must be reviewed prior to taking any action to effectuate
the determination, represents a major workload and added approximately
2 weeks to average processing times.
Our discussion of DSI costs in this report is confined to
administrative costs incurred beyond what SSA had anticipated. While we
do not dispute SSA's assertion regarding the effect of pre-effectuation
reviews, this factor did not surface as a major contributor to claims
backlogs and processing delays during the course of our work.
Regarding the agency's efforts to address the hearings backlog, SSA
believed that given the emphasis the report places on the exploration
of past initiatives, the report should provide a more thorough
exploration of the agency's current initiatives for handling the
hearings backlog, and provided additional information on the status of
its current initiatives. SSA also pointed out that the success of the
agency's initiatives depends on timely and adequate agency funding.
We believe that we have given appropriate attention to both SSA's past
and current initiatives to address the backlog and that it would be
more appropriate to more thoroughly explore the current initiatives
once they are fully implemented.
SSA's comments appear in appendix IV. SSA also provided technical
comments, which we have incorporated as appropriate.
As agreed with your offices, unless you publicly announce the contents
of this report earlier, we plan no further distribution until 30 days
from the report date. At that time, we will send copies of this report
to relevant congressional committees, the Commissioner of the Social
Security Administration, and other interested parties. We will make
copies of this report available to others upon request. In addition,
the report will be available at no charge on the GAO Web site at
[hyperlink, http://www.gao.gov].
If you or your staff have questions concerning this report, please
contact me at (202) 512-7215. Contact points for our Offices of
Congressional Relations and Public Affairs may be found on the last
page of this report. See appendix V for a listing of key contributors
to this report.
Signed by:
Daniel Bertoni:
Director, Education, Workforce, and Income Security Issues:
[End of section]
Appendix I: Objectives, Scope, and Methodology:
We were asked to examine the backlog in disability claims at the Social
Security Administration (SSA). Specifically, we (1) examined the trends
in the disability claims backlog and the time SSA required to decide a
claim, (2) identified key factors that have contributed to the
disability claims backlogs and processing times, and (3) described the
steps SSA is currently taking to reduce the backlog and claims
processing times. To address these objectives, we analyzed
administrative data related to SSA's claims processing between fiscal
years 1997 and 2006. We conducted interviews with SSA central office
officials, including officials from the Offices of Disability and
Income Security Programs, Disability Adjudication and Review,
Disability Determinations, Budget, Systems, and Appellate Operations
and the Chief Actuary; with a variety of regional SSA and state
Disability Determination Services officials, during site visits and
over the telephone; and with officials from the National Association of
Disability Examiners (NADE). We also reviewed relevant documents from
SSA and other organizations. We conducted our work from November 2006
through October 2007 in accordance with generally accepted government
auditing standards.
Analysis of Administrative Data:
To identify trends in SSA disability claims, we analyzed SSA
administrative data for Disability Insurance (DI) and Supplemental
Security Income (SSI) disability claims for the four levels of the
disability determination process. We analyzed data for the time period
of fiscal years 1997 to 2006.[Footnote 46] The data we analyzed
included:
New receipts: The number of new claims receipts during the fiscal year
at each level of adjudication. These data include Disability
Determination Services (DDS) initial claims (excluding receipts that
resulted in non-medical denials and eliminated the need for a DDS
determination), DDS reconsideration claims, appeals for a hearing
before an administrative law judge (ALJ), and appeals for review by the
Appeals Council.[Footnote 47]
Dispositions: The number of cases in which some adjudicative action was
taken regarding the claim for disability benefits--including an
allowance, a denial, or a dismissal--during the fiscal year, at each
level of adjudication.
Pending claims: The number of claims pending a review by SSA at the end
of the fiscal year, at each level of adjudication.
Average processing time: The average time it took for SSA to adjudicate
a claim and reach a decision for all cases that were decided during the
fiscal year, at each level of adjudication.[Footnote 48]
Target pending: SSA's estimate of the number of cases that should
optimally be pending at year-end. SSA provided estimates of the
targeted number of pending cases for fiscal years 1999 to 2006 for each
level of adjudication except for the DDS reconsideration
level.[Footnote 49] For DDS initial claims, SSA estimated the targeted
number of pending claims was 400,000. For the hearings level, the
targeted number of pending cases was 300,000; and for the Appeals
Council level, the targeted number of pending cases was 40,000. SSA
used these same estimates for each fiscal year from 1999 to 2006.
To calculate the number of backlogged claims at the end of each fiscal
year for each level of adjudication, we compared the targeted number of
pending cases at that level of adjudication to the actual number of
pending cases. If the actual number of pending cases exceeds the
targeted number of pending cases, then the difference is the backlog.
The total backlogged cases we present in this report equals the sum of
backlogged cases at the DDS initial, the hearings, and the Appeals
Council level, as no estimate of target pending cases was available for
the reconsideration level. Also, to calculate backlogs for fiscal years
1997 and 1998, we used the same estimates of targeted pending cases
that were provided for fiscal years 1999 to 2006. We judged this
approach to be reasonable because these estimates did not change
between 1999 and 2006.
The data we analyzed came from several sources within SSA. Data on
receipts, dispositions, and pending claims at the initial and
reconsideration levels came from SSA's Disability Operations Data Store
and the system that preceded it and data on case processing times at
the initial and reconsideration levels came from SSA's SUMS Title II
and SUMS SSI Processing Time applications and the systems that preceded
them. All of these databases contain data submitted by the state DDS
agencies. Data on receipts, dispositions, pending claims, and
processing times at the hearings level came from the Hearing Office
Tracking System (HOTS) and from the Case Processing and Management
System (which replaced HOTS in fiscal year 2005). Data on receipts,
dispositions, pending claims, and processing times at the Appeals
Council level came from the Appeals Council Automated Processing
System. To assess the reliability of the SSA data we interviewed SSA
officials and reviewed documents regarding the reliability of these
data. We determined that the data were sufficiently reliable for the
purposes of our review, although we did find some potential limitations
with HOTS data on case processing times at the hearings level, that we
acknowledge in the report when discussing that data.
Site Visits and Phone Interviews with Field Staff:
We conducted site visits to 3 of 10 SSA regions--Massachusetts (region
1), Texas (region 6), and California (region 9)--to obtain information
on claims processing trends, factors that have contributed to the
backlogs, and strategies SSA uses to address backlogs. During these
site visits, we interviewed a variety of staff from several offices:
the regional office Center for Disability, the regional Office of
Disability Adjudication and Review (ODAR) office, a hearing office, and
a state DDS office. For example, at the hearings offices, we met with
the Hearing Office Director, administrative law judges, support staff,
and decision writers. At the DDS offices, we met with the DDS director,
managers, disability examiners, line staff, and medical consultants
responsible for initial disability adjudications.
We used several criteria to select the regions for our site visits. We
selected region 1 because it was the only region that had implemented
the Disability Service Improvement (DSI) initiative. We selected the
other two regions because one has had below average processing times
for initial claims in recent years, while the other has had above
average processing times, even though the two have had similar numbers
of initial claims receipts. For example, in fiscal year 2006, the
national average processing time for initial DI claims was 88.9 days.
The processing time for initial DI claims in region 6 was 76.6 days,
and the processing time for initial DI claims in region 9 was 104.5
days. Also in fiscal year 2006, region 6 received about 342,000 initial
claims and region 9 received about 297,000 initial claims. (See table 4
for national and regional data on initial claims processing times and
initial claims receipts.) Within each region, we selected a hearing
office and a DDS office that were reasonably close to the regional
offices, so we could visit all four offices within our time frames.
Table 4: Fiscal Year 2006 Regional Data on Average Processing Times and
Receipts:
Nation;
Initial DI claims average processing time (days): 88.9;
Initial DI and SSI claims receipts: 2,507,958.
Region 1 (Boston);
Initial DI claims average processing time (days): 91.9;
Initial DI and SSI claims receipts: 108,072.
Region 2 (New York);
Initial DI claims average processing time (days): 98.4;
Initial DI and SSI claims receipts: 213,780.
Region 3 (Philadelphia);
Initial DI claims average processing time (days): 87.9;
Initial DI and SSI claims receipts: 250,602.
Region 4 (Atlanta);
Initial DI claims average processing time (days): 91.5;
Initial DI and SSI claims receipts: 588,960.
Region 5 (Chicago);
Initial DI claims average processing time (days): 84.9;
Initial DI and SSI claims receipts: 449,104.
Region 6 (Dallas);
Initial DI claims average processing time (days): 76.6;
Initial DI and SSI claims receipts: 341,670.
Region 7 (Kansas City);
Initial DI claims average processing time (days): 73.6;
Initial DI and SSI claims receipts: 114,269.
Region 8 (Denver);
Initial DI claims average processing time (days): 106.0;
Initial DI and SSI claims receipts: 54,710.
Region 9 (San Francisco);
Initial DI claims average processing time (days): 104.5;
Initial DI and SSI claims receipts: 297,144.
Region 10 (Seattle);
Initial DI claims average processing time (days): 78.3;
Initial DI and SSI claims receipts: 89,647.
Source: SSA data.
[End of table]
In the regions where we did not conduct site visits, we conducted
semistructured telephone interviews with officials at the regional
office Center for Disability and the regional ODAR office. We asked all
of the regional managers and executives we interviewed the same
questions.
Document Review:
We reviewed prior reports and testimonies from GAO, SSA, and SSA's
Inspector General on the backlog in disability claims. We also reviewed
position papers and testimonies from a number of national disability-
related organizations, including NADE, the Association of
Administrative Law Judges, the National Organization of Social Security
Claimants' Representatives, the National Council of Social Security
Management Associations, Inc., and the Social Security Advisory Board.
We reviewed these documents to gather information on the trends in
claims backlogs, the factors that contribute to the backlog, and the
effectiveness of prior strategies used by SSA to reduce the backlogs.
[End of section]
Appendix II: Continuing Disability Reviews, Fiscal Years 2004 to July
2007:
Table:
[See PDF for image]
Source: Data provided by SSA.
[A] A final decision on whether the claimant will continue to receive
Disability Insurance (DI) and Supplemental Security Income (SSI)
disability benefits.
[End of table]
[End of section]
Appendix III: Key Aspects of DSI as of August 2006:
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 DDS examiners 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 determinations;
* 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;
* 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]
[End of section]
Appendix IV: Comments from the Social Security Administration:
Social Security;
The Commissioner:
Baltimore, MD:
October 31, 2007:
Dan Bertoni:
Director, Education, Workforce, and Income Security Issues:
U.S. Government Accountability Office:
441 G Street, NW:
Washington, D.C. 20548:
Dear Mr. Bertoni:
Thank you for the opportunity to review and comment on the Government
Accountability Office (GAO) draft report, "Social Security Disability:
Claims Processing Initiatives Require Better Planning, Management, and
Evaluation" (GAO-08-40). The attached comments provide specific
responses to the recommendations and identify technical corrections
that should be made to enhance the accuracy of the report.
If you have any questions, please contact Ms. Candace Skurnik,
Director, Audit Management and Liaison Staff, at (410) 965-4636.
Sincerely,
Signed by:
Enclosure:
Comments On The Government Accountability Office (GAO) Draft Report,
"Social Security Disability – Claims Processing Initiatives Reouire
Better Planning, Management, And Evaluation" (GAO-08-40):
Thank you for the opportunity to review and comment on the draft
report. We appreciate the report's acknowledgement that the growth in
the hearings workloads coupled with declines in funding, staffing, and
resources were contributors to the disability claims processing delays.
We have put a great deal of effort in establishing specific initiatives
designed to eliminate the backlogs, and are committed to achieving
them. One of the primary lessons learned from all of our ambitious
plans over the past ten years is that adequate resources are critical
to the success of any new initiative. No major new initiative, no
matter how well its implementation is managed, can achieve expected
results without the accompanying resources.
Regarding the report's contents, we have a number of concerns as they
relate to the discussion on: 1) budget implications, 2) the State
Disability Determination Services, 3) the Disability Service
Improvement initiative, and 4) Hearing Office capacity and performance.
They are included in the "General Comments" section of this response.
For the recommendations, we appreciate your efforts to identify areas
needing attention as we work to manage this workload, however we do not
fully agree with a number of the conclusions or proposed remedies. Our
response to the specific recommendations provides additional
information as to the reasons for the findings and describes
alternative actions/measures that we have already taken or plan to take
to effectively manage the disability claims process.
General Comments:
Budget Implications:
In recognizing the difficulty caused by funding shortfalls, the report
states "As a result, the agency has not had sufficient resources and
has encountered challenges balancing its many workloads." We believe
the report should elaborate on the full impact of the reduced funding,
and this resource issue should be acknowledged and highlighted
throughout the report. We believe the report should acknowledge –up
front” the impact the Federal budget process and SSA's level of funding
and resources have had on the disability backlogs. The lack of
resources has played a significant role in the reasons for the pending
workloads.
Specifically, since 2001, Congress has appropriated on average about
$150 million less each year than the President requested. As a result,
fewer employees are available to process SSA's growing workloads. In
fiscal year (FY) 2005, SSA had 66,000 employees”down from more than
85,000 employees about 30 years ago”and in a few months we will drop
below 60,000. Yet, our workloads have become more complex and the
volume of work continues to grow every year with the aging of the baby
boom generation. In addition, Congress has mandated new workloads
outside of our core responsibilities, such as activities related to the
Medicare Prescription Drug Program and verification of employee work
eligibility for immigration purposes.
The following chart illustrates that if SSA had received the full
President's budget for FY 2002 through FY 2007, it would have had
available more than the cost of processing SSA's hearings backlog.
Figure: SSA Has Not Received the Resources Needed to Address the
Growing Hearings Backlog:
[See PDF for image]
[End of figure]
We have an effective, comprehensive plan to reduce the hearings backlog
by 2013, but it will require that Congress provide adequate funding in
FY 2008 and the future. Under any funding scenario currently being
contemplated by Congress, FY 2008 will be a very difficult budget year
for SSA and this follows FY 2007, a year in which we narrowly avoided
employee furloughs. In FY 2008, despite the increases provided in both
the House and the Senate bills, we expect to have less discretionary
money to spend than in FY 2007. We will remain under a hiring freeze
throughout FY 2008 unless we receive additional funding to drive down
the hearings backlog. Funding below the House mark will likely delay
the implementation of the hearings backlog reduction plan.
We have a large infrastructure, including over 1,400 field and hearing
offices in cities and towns across America and increases to mandatory
costs, such as rent and employee pay and benefits, require a minimum
administrative budget increase every year of over $300 million. With
these mandatory cost increases and the requirement in the current House
and Senate appropriations bills to spend $477 million on program
integrity work in FY 2008 ($264 million in the base and $213 million
additional funding in the program integrity cap), the amount of money
available to the Agency to deliver service to the public and invest in
workload processing is very limited. We believe the report should note
that we must spend $477 million on continuing disability reviews (CDRs)
and supplemental security income (SSI) redetermination in FY 2008 in
order to receive the full program integrity funding. If, for example,
we only spend $457 million 51.000 (or $20 million less) on program
integrity work, our budget will be reduced by $20 million.
Additionally, program integrity funding cannot be used to do other
important work, such as reducing the disability hearings backlogs.
We see no indication of improvement in our budget outlook for the
immediate future. We are currently operating under a continuing
resolution which keeps us at the FY 2007 funding level. If we have to
operate at the FY 2007 level of funding for all of FY 2008, we will
again be looking at potential furloughs and other unattractive options.
We believe the report should highlight the fact that despite the budget
shortfall, since 2001, our efforts to innovate and automate, coupled
with the dedication of our staff, have improved productivity on average
by 2.5 percent per year for a cumulative improvement of 13.1 percent
through FY 2006. Given sufficient funding, we can commit to Agency-wide
productivity improvements and achieve them. We believe that, given the
array of services that we provide and the major workload processing
initiatives implemented each year, incremental productivity
improvements are sustainable with full funding.
Despite our efforts, the productivity improvement has not been able to
compensate for insufficient funding increases approved by Congress. As
a result, we face significant resource challenges. If we tried to
address the challenge of processing all our incoming work with
productivity improvements alone, we would need to achieve approximately
10 percent productivity improvement in addition to the 2 percent
already planned in FY 2008, which is not possible. Additional resources
are needed to overcome this productivity gap.
The following charts show the disability hearings backlog if we
maintained the status quo and information about the Federal Reviewing
Official (FedRO).
Figure: If We Maintain The Status Quo, The Disability Hearings Backlog:
[See PDF for image]
* This projection assumes FY 2008 President's Budget resource levels
and hearings productivity in all years.
* Resources needed for the Federal Reviewing Official organization
would reduce the number of workyears available to process pending
hearings.
* The projection also assumes that hearings receipt rates would decline
under DS] consistent with estimates prepared by SSA's Office of the
Chief Actuary.
* The hearings receipt levels are based on the 2007 workload
projections.
[End of figure]
Figure: SSA Has Proposed To Place The FedRO On Hold While The Hearings
Backlogs Are Addressed:
[See PDF for image]
* SSA anticipates receiving new requests for FedRO review through
January 2008. With current resource constraints, SSA projects that the
final FedRO reviews should be processed by the end of December 2009.
* Once this work is completed, SSA will be able to redirect FedRO
resources to help reduce the hearings backlog.
* Public comment for the FedRO rule has just ended. If the rule is
finalized as proposed, this is the anticipated impact.
[End of figure]
Disability Determination Services (DDS):
We are very concerned that all conclusions relating to the DDS backlog
are predicated on the assumption that 400,000 is the target pending
level for initial claims. The 400,000 number was generated as part of a
Service Delivery Budget in an effort to estimate an optimum pipeline
based on available funding, staffing/workload levels, and business
processes at a particular point in time (1997). It was never intended
to be a targeted pending.
The report should also emphasize that we have never communicated an
expectation or held the DDSs accountable for reaching a targeted
pending of 400,000. Our Annual Performance Plan, which is based on
budgeted funding and staffing shows 2006 and 2007 pending targets of
577,000 initial disability claims for the DDSs. If 400,000 is the
baseline number that will be used to determine backlogs, the report
needs to make a better distinction between that and the "targeted
pending."
In recent years, DDSs have been funded to maintain a pending level of
577,000 and have met that target. In addition, almost all of these
pending claims have been assigned to an examiner and have had some
development done on them. Initial claims are not backlogged in the
sense that no work has been done on them. The DDSs do an outstanding
job of serving the public. In FY 2006, 77 percent of the initial claims
processed were completed within 120 days and 94 percent were processed
within 180 days. The DDSs also have done an outstanding job over the
years of balancing workloads and processing disability claims timely
despite the Federal budget process.
On page 14, the report states that--over a 10-year period--the DDSs saw
an increase almost every year in initial claims, which constituted an
overall increase of 21 percent by FY 2006. It further states that the
DDSs have not been able to keep pace with these rising receipts despite
increases in dispositions and some additional staffing. Note the
footnote at the bottom of the page”"the DDSs received an overall
increase of about 4 percent in staff workyears over the 10-year
period." We have two points to make regarding these statements. First,
the fact that DDS staffing only increased by 4 percent should be
highlighted on this page, not merely footnoted.[Footnote 51] The DDSs
have not been sufficiently funded over this 10-year period to process
the increase in receipts or to hire staff over their funding levels.
Second, our appropriations over most of this 10-year period had
discrete funding allocated to processing Continuing Disability Reviews
(CDR). Because of this mandated work we had limited flexibility in
determining workload priorities.
Disability Service Improvement (DSI):
To provide additional background information regarding the DSI
initiative, we are providing three memoranda regarding actuarial cost
estimates for the DSI regulations. The first two memoranda, dated July
21 and July 13, 2005 (enclosures 1 and 2) provide the initial estimates
for DSI on the basis of a 5-year implementation. The memorandum dated
January 10, 2007 (enclosure 3) provides updated estimates assuming that
DSI would be implemented over a 10-year period, with one new region
being implemented each year. The slower implementation is the basis for
estimates included in the current Trustees Report and the current
budget estimates.
The estimates in both 2005 and 2007 show that the expectation was that
DSI would accelerate allowances for disability somewhat without having
a significant impact on the total number of allowances from those who
apply for benefits each month. The acceleration of allowances resulted
in estimated cash-flow increases in program cost during the first 10
years for the initially assumed 5-year implementation, and somewhat
longer for the later prescribed 10-year implementation. In each case,
the annual net effect on program cash-flow cost was estimated to reach
essentially zero after 10 to 15 years from initial implementation.
There is another significant disability claims workload that the report
does not address. There is a statutory requirement that 50 percent of
all DDS allowances under the SSDI programs must be reviewed prior to
taking any action to effectuate the determination (section 221(c) (2)
of the Social Security Act). This review is a major Agency workload. In
FY 2006, we conducted pre-effectuation reviews on almost 350,000 DDS
allowances. These reviews added approximately 2 weeks to average
processing times.
Improvements in Hearings Office Capacity and Performance:
We have already taken a number of important steps to better manage our
workloads and place resources where they can best meet the desired
outcomes. We have formulated a plan to eliminate the backlog of cases
at the hearing level and prevent reoccurrence. On May 23, 2007, we
detailed this plan in testimony to the Senate Finance Committee.
Although we recognize that the report only "highlights" the provisions
of the backlog plan, we believe that given the emphasis the report
places on the exploration of past initiatives a more thorough
exploration of the current management plans for handling backlog issues
at the hearing level is called for. The success of these initiatives
depends on a timely and adequate Agency funding. Properly funded, these
initiatives will reduce the amount of time members of the public wait
for a hearing decision and will lead to a reduction in the number of
cases pending in our hearing offices. We offer the following
information regarding the status of those initiatives, all of which are
designed to improve hearing procedures, increase adjudicatory capacity,
and increase efficiency through automation and improved business
processes.
We began by attacking the problem of aged cases, starting with a plan
to provide decisions to claimants who had been waiting the longest. We
made a commitment to work down the inventory of 63,770 cases which
would be 1,000 days old or more by the end of FY 2007. Through
extensive oversight and improved management, only 108 of these cases
remained on September 28, 2007. During FY 2008, we will be focusing on
disposing of those cases which will be over 900 days old by the end of
the fiscal year. This initiative should provide decisions to those
claimants waiting the longest.
To free our Administrative Law Judge (ALT) resources for the most
difficult and complex cases, we established a plan to shift a portion
of our fully favorable on-the-record workload to Attorney Advisors. The
interim final rule for the Attorney Advisors was published in the
Federal Register on August 9, 2007. Amended position descriptions have
been written, and systems functionality to support this initiative will
be ready November 1, 2007. These additional adjudication resources
should be helpful in disposing of additional cases without the need for
a hearing in FY 08 and FY 09.
Hiring additional ALJs is an essential element in a successful plan for
reducing the backlog. We have worked with the Office of Personnel
Management to expedite the selection of 150 ALJs in FY 2008. Pending
receipt of the Office of Personnel Management register expected in
November 2007, and budget permitting, we plan to hire 150 ALJs in the
Spring of 2008. In FY 2007, four ALJs were hired from other Agencies.
All had prior SSA experience which mitigates the learning curve. Twelve
intermittent (part time) Senior ALJs and four rehired annuitant (full
time) ALJs were hired at the end of FY 2007. Seven current ALJs will
likely be placed in the National Hearing Center (NHC).
We have already begun to focus on the productivity of both decision
writers and ALJs. The Chief ALJ has communicated expectations for ALJs
to produce 500-700 decisions a year. In FY 2007, 498 ALJs produced 500
or more decisions during the year. In 2006 that number was 488 and in
2005 that number was 387. We are developing productivity information
indicators that will assist in measuring improvement. Currently the
Office of Adjudication and Review (ODAR) is utilizing the Decision
Writer Statistical Index Report to compute and assess decision writer
productivity. Increased monitoring of performance and productivity
should result in additional efficiency and the adjudication of a higher
number of cases.
In FY 2007, we took a proactive stance in dealing with AU misconduct.
Two reprimands and two suspension actions occurred in FY 2007.
Currently, three termination actions and one suspension action are
ready to be filed with the Merit System Protection Board (MSPB). Two
additional reprimands are in the process of being drafted. At the MSPB
level, one termination and four suspension actions are pending.
During FY 2007, ODAR implemented a major change in its business process
which involved transition from processing hearings using paper folders
to processing hearings using electronic folders. Transition to the
electronic folder not only involved training for hearing office
employees, representatives, vocational and medical experts and hearing
reporters, but also a learning curve associated with mastering a new
process. It involved working in a dual environment with paper and
electronic folders and a labor intensive certification process which
impacted all positions in the hearing office. During FY 2008, ODAR will
continue to focus on eliminating the backlog of paper files as well as
continuing to streamline processes within the electronic folder
environment.
Over $9,000,000 was spent in FY 2007 on installations and upgrades of
servers, video teleconferencing equipment and telecommunications
equipment in the hearing offices and for the set up of the NHC in Falls
Church, Virginia. These updates support electronic folder processing by
increasing the capacity of the infrastructure underlying the electronic
folder and other electronic services and will continue throughout FY
2008.
We established the NHC in October 2007 in Falls Church, Virginia, part
of the Agency's strategy to address the backlog by increasing
adjudicatory capacity and efficiency with a focus on an electronic
hearings process. With electronic folder receipts becoming the largest
part of our pending, we now have the flexibility to transfer workload
to the NHC easily, where a centralized cadre of ALJs using video
hearing technology will hear electronic cases from the most backlogged
offices in the country. Support staff reported for duty on October 15,
2007 and a solicitation for ALJs was released October 5th to all
Federal ALJs.
Video technology is an important part of our method for conducting
hearings. Additional video hearing units will decrease AU travel,
allowing for increased ALJ productivity. Currently there are 394
hearing rooms with video hearing equipment. Video hearings expanded
from 41,457 held in FY 2006 to 45,449 held in FY 2007. An award to
purchase an additional 158 video units was released on September 21,
2007 and shipping of new units will begin in the November/December
timeframe. The addition of these units will increase the ability to
more effectively balance workloads on a national level by using ALJ
resources from one geographic area to assist with hearings in another
geographic area without incurring travel time.
As part of the plan to increase adjudicatory capacity and reduce the
paper case backlog, we developed the Informal Remand initiative. SSA's
Office of Quality Performance (OQP) developed profiles to identify
cases for which a favorable decision appears likely. Those cases are
remanded back to the DDS for review. In FY 2007 about 20,000 cases were
remanded to the State DDSs, resulting in 8,714 fully favorable
decisions for claimants without a hearing. In FY 2008, we will be front
loading cases from New York, Georgia, North Carolina, Indiana, Florida,
Michigan, Kansas and Ohio to the DDSs since these six States have the
highest number of unworked profiled paper cases. Plans are to send
51,000 cases to the DDSs in FY 2008.
Another method of increasing adjudicatory capacity has come through the
Appeals Council (AC). Some cases that come before the AC contain
relatively minor technical deficiencies which could compromise the
support of the decision in court, but which do not ultimately affect
the correctness of the ultimate conclusion on entitlement to benefits.
If the case does not require a hearing or additional development, the
AC will consider granting the request for review to issue a new
decision with the technical issue corrected. Doing so, where
appropriate, should reduce overall processing time for the claimant and
reduce the number of cases remanded to the hearing level.
We have initiated a number of automation initiatives that will increase
efficiency, although many will not be ready for full implementation
until later in FY 2008. One of the most important provides for the
completion of the electronic process through the AC. The new Appeals
Review Processing System (ARPS) will allow the AC to process electronic
folder cases, with first release scheduled for January 2008.
Many of the automation improvements will enhance efficiency in the
processes that prepare cases for hearing by the ALJ. These are critical
given that the support staff ratios are lower than they should be. We
have had to provide for interim measures to prepare paper cases for
hearing, such as using volunteers from Field Offices and Teleservice
Centers across the nation to work on folders during overtime hours and
adopting a streamlined folder assembly process for pending paper cases
that gets the cases to the judges more quickly. When these cases are
finally adjudicated, they will be replaced by the electronic files
which will require less time and effort to prepare.
Some of the automation initiatives pending that will improve the
hearing process are:
* ePulling ” This functionality involves development of customized
software which has the potential to identify, classify, and sort page
level data, re-organize the images after classification, and identify
duplicates. A contract was awarded to eCompex in September 2007 to
develop this software. This automation initiative will enable hearing
offices to prepare cases for hearing in about half the time it takes
now. Implementation is scheduled to begin in the first quarter of FY
2009.
* eScheduling ” The eScheduling initiative envisions an automated
calendaring function that will incorporate scheduling of experts,
hearing sites and hearing rooms, equipment, and ALJ availability. ODAR
is working with the Office of Systems to develop this software which
should decrease the time it currently takes to schedule a hearing. This
initiative is still in the planning and analysis phase.
* Electronic Records Express (ERE) - This initiative will expand access
to the ERE website to allow outside end-users (representative and
expert witness community) the ability to view the electronic folder
online and to receive notices electronically. The target date to begin
a pilot to test functionality to allow select outside user
representatives to view the electronic folder via the website is June
2008. We are currently working on additional functionality to allow
hearing offices to send notices to representatives via the website.
Currently hearing offices currently spend much time burning CDs for
expert witnesses, claimants and representatives at various stages of
our process. The time spent doing this will be available for other
tasks.
* Electronic signature - The electronic signature will give ALJs the
ability to sign decisions electronically and provide the HOCALJ the
ability to sign on behalf of another ALJ in the hearing office. This
functionality will rollout out in January 2008 and will allow ALJ
decisions to be sent into the electronic folder and to be centrally
printed and mailed with no hearing office support staff involvement.
* Centralized Printing and Mailing ” This initiative will provide for
centralized, high speed, high volume printing and mailing of notices. A
pilot in four hearing offices will begin in January 2008.
* Shared Access to the Electronic Folder ” this provides the ability to
temporarily transfer cases for workload assistance while affording full
electronic functionality to both the receiving and owning offices.
Enhancements for January 2008 will include the ability to provide
shared jurisdiction allowing temporary transfer of cases for pulling
and decision writing, thus providing the ability to move work to where
there are resources to perform these tasks.
* Findings Integrated Templates (FIT) for decision writing ” The
Findings Integrated Templates (FIT) system was designed as a roadmap of
our regulations to ensure that all pertinent legal requirements are
addressed in the ALJ's decision. FIT was intentionally never designed
to analyze or marshal evidence. Use of the FIT template by ALJs
(already familiar with the case) to draft fully favorable decisions
allows for use of decision writer resources for other more complex
decisions. For the month of September 2007, 95 percent of all written
decisions were written in FIT and use of FIT continues to rise. Use of
the FIT decision writing tool should provide decisions which are
legally sufficient and result in fewer remanded cases from the AC.
Part of our objective to manage workloads more effectively is a plan to
balance workloads among the regions across the nation. We are assisting
the most heavily impacted hearing offices and preventing cases from
aging by transferring cases electronically to sites where we have
greater capacity. We are also working to standardize our hearing
business process, by visiting offices to identify best practices and
problem areas. OQP and ODAR are working together to develop an improved
inline quality review procedure. Results of these quality assurance
reviews will provide information for training purposes and should
result in the production of a better quality product for our claimants.
Our responses to the specific recommendations are provided below.
Recommendation 1:
The Commissioner of Social Security should establish a "target pending"
for reconsideration stage as the agency does for the other stages, to
allow identification and monitoring of backlogs.
Comment:
We agree that tracking reconsideration pendings should be a part of the
Agency's routine and comprehensive monitoring of all DDS workloads.
However, we do not believe this should be an Agency target/goal. As an
alternative to a reconsideration pending goal, we could use a number or
percentage of reconsideration cases over a certain number of days old
as an indicator of performance. This would be consistent with the
Agency's current direction of focusing on aged claims.
Recommendation 2:
The Commissioner of Social Security should conduct a thorough
evaluation of the Disability Service Improvement (DSI) initiative
before deciding which elements should be implemented nationwide and
which should be discontinued.
Comment:
We partially agree. Although we do not concur with your specific
recommendation as written, we agree that we should continually evaluate
data to help guide us when implementing any nationwide initiative. We
will continue to collect data and monitor outcomes to evaluate DSI in
line with our commitment to outstanding service and continuous
improvement. We are implementing the parts of DSI that data have shown
to enhance our ability to make timely and accurate disability
determinations. For example, based on our careful evaluation, we issued
a final rule on September 5, 2007, extending the Quick Disability
Determination (QDD) process nationwide. Arizona, New Jersey and North
Dakota have started using QDD as part of a staged national roll out
that will be completed early next year. We are conducting special
reviews on QDD accuracy in each State as it rolls-out, and management
information (MI) data on case selection, timeliness, and allowance
rates will be tracked.
Regarding the FedRO/Office of Medical and Vocational Expertise (OMVE)
specifically, we continue to evaluate their effect on our program
administrative functions. Our experience over the last year in the
Boston region demonstrates that the administrative costs associated
with FedRO and its use of OMVE to develop medical and vocational
evidence is greater over the foreseeable future than we originally
anticipated.
Although we plan to suspend sending new claims to FedRO, we expect to
have over 17,000 claims pending when the regulation goes into effect.
This volume of pending claims will allow us to continue to collect and
evaluate data while targeting scarce resources to the hearings process
where hundreds of thousands of cases are now backlogged. We do not have
sufficient resources to continue to work down the hearings backlog and
to fully staff FedRO and OMVE. Therefore, our evaluation of these
components will have limited reliability.
Recommendation 3:
The Commissioner of Social Security should take needed steps to
increase the likelihood that new initiatives will succeed through
comprehensive planning to anticipate the challenges of implementation,
by including the appropriate staff in the design and implementation
stages, establishing feedback mechanisms to track progress and
problems, and by performing periodic evaluations.
Comment:
We agree with the intent of this recommendation and have already taken
steps towards comprehensive planning in the design and implementation
stages. Having learned from the past, we are moving forward with clear
accountable leadership, a solid plan, a very inclusive executive
steering committee, regular MI data as feedback, ongoing monitoring,
and coordinated monthly evaluation mechanisms.
For example, the NHC is a critical element of the Commissioner's plan
to eliminate the hearings backlogs. The NHC, established in October
2007 in Falls Church, Virginia, is designed to help address the backlog
by increasing adjudicatory capacity and efficiency with a focus on an
electronic hearings process. A centralized cadre of ALJs will use video
hearing technology to hear electronic cases from the most backlogged
offices in the country. As stated before, instead of going to full
implementation, the Commissioner is following the recommendation of
staff and using a staged roll-out for the NHC.
We are suggesting that the following recommendation be added to the
report:
Recommendation 4:
The Commissioner of Social Security should explore ways that the Agency
can manage the performance of ALJs who are unproductive.
Comment:
GAO noted on page 46 of the report that part of the Commissioner's plan
for improving hearing office capacity and performance includes
tightening performance measures for ALJs to ensure cases are processed
in a timely manner. We appreciate your comments in this regard.
Although most SSA ALJs are dedicated, hard-working employees, data show
that a significant number of ALJs fail to work at an acceptable level.
While not all cases are of the same level of complexity, ALJs hear and
decide the same mix of cases throughout the country. Yet, there is a
cohort of ALJs whose productivity year after year is below an
acceptable range achieved by their peers. For example, for FY 2007
twenty-six percent of ALJs had dispositions below 400 cases per year
while seventy-four percent of judges decided more than 400 cases. As
the number of new applications rises, and with budget and staffing
resources stretched to the limit, SSA must have the tools needed to
manage the performance of ALJs just as it does with any other group of
employees. It is unacceptable for ALJs to be free from management of
their performance when they do not hear and decide cases within an
acceptable range of performance.
Limitations on the Agency's ability to manage ALJ productivity are not
confined to issues of timeliness and quantity of dispositions. ALJs
hold hearings pursuant to a delegation from the Commissioner, yet some
ALJs refuse to follow properly promulgated Agency policy in deciding
cases, often leading to legally insufficient decisions requiring remand
by the Appeals Council or a district court. This results in further
delays for the claimant and a further increase in backlogs. Some ALJs
refuse to hold video hearings. Some do not schedule cases in sufficient
numbers, and some cancel scheduled hearings for insubstantial, personal
reasons. Yet these same ALJs assert that the qualified decisional
independence which is the right of claimants at the de novo hearing
somehow entitles the ALJ to exercise discretion in adhering to Agency
policy and procedures in these unrelated areas.
We also encounter difficulties in hiring and assigning ALJs, who are
appointed from a register of eligibles developed by OPM pursuant to the
Administrative Procedures Act and its own regulations. SSA employs the
largest number of ALJs in government, and yet its need for individuals
with experience in non-adversarial, high volume, highly automated,
videoconference and in-person adjudications is often frustrated by OPM
criteria better suited for employment of ALJs in regulatory agencies
whose proceedings are small in number, involve highly complex issues of
law and fact, and are adversarial in nature. Once hired, ALJs often do
not want to remain in the location for which they were originally
selected despite promises to do so. Yet current collective bargaining
language requires ALJs the opportunity to transfer before a new ALJ can
be assigned.
We need the flexibility to hire ALJs with Agency-specific experience,
to hire them quickly, to assign and transfer them to address workloads,
and to hire them on a term basis to address peaks in workloads.
Given the increased receipts at the hearing level, it is clear that a
cornerstone of any plan to reduce the backlog is to increase
adjudicatory capacity. Although hiring of additional ALJs must be part
of this plan, the Agency believes that it would be fiscally
irresponsible to allow some of its current ALJs to continue to perform
at unacceptable levels. Indeed, the Agency believes that its obligation
to serve the public in a timely manner requires that we approach the
issues of ALJ productivity, including the performance issues discussed
above, in the same way that we would approach similar problems with any
other employee. SSA will continue its efforts to manage AU productivity
with the limited tools available to do so, while at the same time
developing plans to strengthen performance measures. Some improvements
will likely involve legislative and regulatory changes. To this end, we
request that you move quickly on the request by Congress to examine
this matter in greater detail.
[End of section]
Appendix V: GAO Contact and Staff Acknowledgments:
GAO Contact:
Daniel Bertoni, Director, (202) 512-7215.
Staff Acknowledgments:
Shelia Drake, Assistant Director; Lucia DeMaio; Salvatore F. Sorbello;
and Linda Stokes made significant contributions to this report. In
addition, Daniel A. Schwimer provided legal assistance; Evan Gilman,
Lorin Obler, and Walter Vance assisted in the assessment of the
reliability of data; and Susan C. Bernstein and Rachael C. Valliere
assisted in report development.
[End of section]
Related GAO Products:
Disability Programs: SSA Has Taken Steps to Address Conflicting Court
Decisions, but Needs to Manage Data Better on the Increasing Number of
Court Remands. GAO-07-331. Washington, D.C.: April 5, 2007.
Social Security Administration: Agency Is Positioning Itself to
Implement Its New Disability Determination Process, but Key Facets Are
Still in Development. GAO-06-779T. Washington, D.C.: June 15, 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.
Social Security Administration: More Effort Needed to Assess
Consistency of Disability Decisions. GAO-04-656. Washington, D.C.: July
2, 2004.
Social Security Disability: Commissioner Proposes Strategy to Improve
the Claims Process, but Faces Implementation Challenges. GAO-04-552T.
Washington, D.C.: March 29, 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.
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.
SSA Disability Decision Making: Additional Steps Needed to Ensure
Accuracy and Fairness of Decisions at the Hearings Level. GAO-04-14.
Washington, D.C.: November 12, 2003.
Electronic Disability Claims Processing: Social Security
Administration's Accelerated Strategy Faces Significant Risks. GAO-03-
984T. Washington D.C.: July 24, 2003.
Social Security Disability: Efforts to Improve Claims Process Have
Fallen Short and Further Action is Needed. GAO-02-826T. Washington,
D.C.: June 11, 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.
SSA Disability Redesign: Actions Needed to Enhance Future Progress.
GAO/HEHS-99-25. Washington, D.C.: March 12, 1999.
SSA Disability Redesign: Focus Needed on Initiatives Most Critical to
Reducing Cost and Time. GAO/HEHS-97-20. Washington, D.C.: December 20,
1996.
SSA Disability Reengineering: Project Magnitude and Complexity Impede
Implementation. GAO/T-HEHS-96-211. Washington, D.C.: September 12,
1996.
Social Security Disability: Backlog Reduction Efforts Under Way;
Significant Challenges Remain. GAO/HEHS-96-8. Washington, D.C.: July
11, 1996.
[End of section]
Footnotes:
[1] We did not calculate backlogs for the reconsideration stage since
SSA could not provide data that would allow us to do so.
[2] For three of the four stages of the disability claims process, SSA
establishes targets for the number of claims that the agency considers
should optimally be pending a decision or in the pipeline at year-end.
The number of claims exceeding the target is considered a backlog.
[3] The regions we visited were Boston, San Francisco, and Dallas.
Several criteria were used to select the regions for our site visits.
We chose regions with comparable workloads in order to compare the
effects of different initiatives across similar regions. For this
comparison we considered recent data on DDS level processing times and
claims receipts. On each site visit, we contacted a DDS, SSA's regional
office for initial claims, its regional Office of Disability
Adjudication and Review (ODAR), as well as a hearings office.
[4] Throughout this report, when we refer to SSA disability claims we
are referring to claims filed under the SSI and DI disability programs.
[5] Eligibility for SSI is restricted to individuals who have countable
resources, determined monthly, that do not exceed $2,000 ($3,000 for a
couple).
[6] The District of Columbia and Puerto Rico also have state DDS
offices. Guam and the Virgin Islands have federal DDS offices that
perform this function.
[7] According to SSA, the 400,000 target pending was an estimate of an
optimal pipeline of claims. However, this target pending level was
never communicated to the DDSs nor were they held accountable for
reaching this optimum pending level. Also according to SSA, in recent
years DDSs have been funded to maintain a pending level of 577,000 and
have met this target.
[8] Initial claims processing times presented in our report are the
average processing times for Disability Insurance (DI) claims only, not
Supplemental Security Income (SSI) claims. SSA provided average
processing times separately for the two programs. We are reporting the
DI processing times because the number of DI cases is larger than the
number of SSI cases, but the differences in processing times between
the programs are minimal. See appendix I for more detail.
[9] Backlogged claims include claims that are backlogged at the initial
application level, the hearings level and at the Appeals Council level.
We could not compute the number of claims backlogged at the
reconsideration stage because SSA has not established an optimal level
of pending claims that would allow computation of the backlog. As a
results, references to the number of "target pending" and backlogged
claims throughout the report do not include reconsiderations.
[10] Agencywide numbers presented here represent the sum of all three
levels of adjudication at SSA for which we computed backlogs: (1)
Disability Determination Services' initial claim adjudications, (2)
hearings' offices adjudications before an administrative law judge, and
(3) Appeals Council reviews.
[11] SSA's overall optimal level of pending claims was about 740,000
claims per year in fiscal year 2006. See appendix I for further details
on how SSA estimates the optimal number of pending cases and how we
estimate the backlog.
[12] Processing times analyzed in this report for the DDS did not
account for any time before a claim reached a DDS office (such as time
spent at an SSA field office).
[13] From fiscal year 1997 to fiscal year 2006, processing times at the
initial claims level increased from 70 days to 89 days and processing
times at the reconsideration level increased from 51 to 72 days. During
the same time period, processing times at the hearings level increased
from 386 to 481 days.
[14] In fiscal year 1997, the average processing time at the Appeals
Council was 340 days; in fiscal year 2006, it decreased to 201 days.
[15] Total includes new claims, requests for Reconsideration, Hearing,
and Appeals Council review.
[16] The DDSs received an overall increase of about 4 percent in staff
work-years over the 10-year period.
[17] SSA's Office of Inspector General (OIG) found some problems with
the reliability of processing time data stored in the Hearing Office
Tracking System (HOTS), which is the source of processing time data we
report at the hearings level for fiscal years 1997 to 2004.
Specifically, the OIG found problems including incomplete data
(requests for hearings were not consistently entered in HOTS);
inaccurate data (especially in hearings request dates and hearings held
dates, which means data on claims processing are inaccurate); and a
lack of consistent management controls (e.g., no or infrequent reviews
of the data, lack of training for staff, unauthorized staff had access
to the system). For example, when the OIG compared a sample of hearing
request dates from HOTS to the dates in the original paper files, they
found that about 13 percent of the dates in HOTS were inaccurate.
However, in part because SSA has published HOTS data in reports
including its Annual Statistical Supplement, we judged the data to be
sufficiently reliable for our reporting objectives.
[18] The Chicago region includes Minnesota, Wisconsin, Illinois,
Indiana, Michigan, and Ohio. The Seattle region includes Washington,
Oregon, Idaho, and Alaska.
[19] SSA told us that insufficient numbers of ALJs and support staff,
increased receipts, and low productivity of some ALJs were problematic
in these regions and affected processing times.
[20] The number of Appeals Council claims received in fiscal 1997 was
120,540; in fiscal year 2006, it received 100,247 claims.
[21] This report was prepared by the DDS Recruitment and Retention
Workgroup, which was established in December 2006 to identify the DDSs'
staffing needs in the electronic environment for use in recruiting
nationally and maintaining a qualified DDS workforce.
[22] GAO, Social Security Administration: Strategic Workforce Planning
Needed to Address Human Capital Challenges Facing the Disability
Determination Services. GAO-04-121. (Washington, D.C.: Jan. 27, 2004).
[23] Hearings office support staff generally assist the ALJs with
adjudicating claims, developing the claims and getting the actual
claims ready for a hearing, and writing the decision once an ALJ
adjudicates the claim.
[24] The actual number of ALJs on board was slightly higher than the
number available to conduct hearings. For example, 1,153 were on board
in 1998 and 974 were on board in 2001.
[25] SSA's ability to hire sufficient administrative law judges has
been hindered in the past by a number of factors; including the length
of time it took the Office of Personnel Management to establish a
register of qualified ALJs that the agency could hire to fill vacant
positions, budgetary constraints, and stays due to class action
litigation.
[26] The recommended staffing ratio could change as SSA implements
planned automation initiatives that are expected to improve the hearing
process and increase efficiency.
[27] This program allowed senior attorneys to adjudicate claims that
were awaiting a hearing if the evidence indicated the claim should be
approved.
[28] In prior reports, GAO has noted that the productivity of
administrative law judges impacts processing times at the hearings
level. See GAO, Social Security Disability: Backlog Reduction Efforts
Under Way; Significant Challenges Remain, GAO/HEHS-96-87 (Washington,
D.C.: July 11, 1996) and GAO, Social Security: Many Administrative Law
Judges Oppose Productivity Initiative, GAO-HRD-90-15 (Washington, D.C.:
Dec. 7, 1989).
[29] Much of this major redesign project was undertaken to address
GAO's recommendations to redress problems experienced when the system
was revised in 1994, when the agency first attempted to reduce case
backlogs.
[30] The states where the prototype process was introduced include:
Alabama, Alaska, California (Los Angeles area), Colorado, Louisiana,
Michigan, Missouri, New Hampshire, New York, and Pennsylvania.
[31] In prior reviews of the electronic folder, we recommended that SSA
conduct end-to-end testing to evaluate the functionality and
performance of all electronic disability system components collectively
and that the agency not begin rollout without ensuring that all
critical problems identified in the pilot tests had been resolved. SSA
disagreed with both of these recommendations citing time constraints
which it believed made the recommendations unrealistic.
[32] The Boston region includes the states of Connecticut,
Massachusetts, Maine, New Hampshire, Rhode Island, and Vermont.
[33] This reform, the Disability Service Improvement (DSI) initiative,
was instituted by regulation in 2006. However, plans to create DSI had
been underway since at least 2003, when the Commissioner of the Social
Security Administration announced in a testimony before the House
Committee on Ways and Means that SSA would undertake fundamental reform
of the disability determination and appeals process.
[34] A claim is a DSI claim if a person is a permanent resident in the
Boston region at the time that he or she files a claim. This means that
examiners in non-DSI regions can encounter DSI claims in two ways: (1)
claimants may file in another region even if they are permanent
residents of one of the states in the Boston region or (2) claimants
file for disability while they are a permanent resident of Boston and
then move to another region and direct questions about claims to the
SSA field office in that region.
[35] These statistics are for all cases that had been initially
selected for QDD processing in the Boston region as of October 31,
2006; a total of 667 cases.
[36] Accuracy rates are based on SSA's Office of Quality Performance
review of FedRO decisions.
[37] According to internal evaluations which were provided to us by
SSA, as of March 31, 2007 SSA's Office of Quality Performance had
reviewed decisions on 259 FedRO decisions in the Boston region and
found a decisional accuracy rate of 97 percent. According to SSA, for
fiscal year 2007, the national accuracy rate for disability
reconsiderations performed by the state disability determination
offices was 91.9 percent overall, 97.5 percent for allowances, and 91
percent for denials.
[38] Appeals rates for the FedRO were calculated based on fewer than
3,000 cases, which were decided by the FedRO between implementation and
June of 2007, whereas the appeals rate for reconsideration was based on
all reconsiderations for fiscal year 2005 in the Boston region, which
consisted of over 26,000 cases. Limited data on FedRO appeals makes it
difficult to determine what the average FedRO appeal rate will be.
[39] 20 C.F.R. § 405.331(a)
[40] 20 C.F.R. § 405.331(b) and (c).
[41] 20 C.F.R. § 405.360. New evidence will be considered by the ALJ
after the issuance of the decision in limited circumstances set forth
in 20 C.F.R. § 405.373.
[42] According to SSA, the agency has been working on streamlining and
refining eCAT for the past 12 months and began piloting it in two DDSs
in September 2007.
[43] In announcing the new plan, the Commissioner stated that the most
aggressive timeline for eliminating the backlog is 2012 but that this
timeline depends largely on SSA's budget over the next several years.
[44] Disability examiners said hospitals tend to send all information
on a claimant to the DDS when the data is in electronic format,
regardless of whether it is relevant or has been requested.
[45] GAO, Social Security Administration: Many Administrative Law
Judges Oppose Productivity Initiatives, GAO/HRD-90-15 (Washington,
D.C.: Dec. 7, 1989).
[46] GAO, Social Security Disability: Backlog Reduction Efforts
Underway; Significant Challenges Remain, GAO/HEHS-96-87 (Washington,
D.C.: July 11, 1996).
[47] DDS initial and reconsideration claims data were available for the
nation, each region, and each state. Hearings data were available for
the nation and the regions but not for the states, because the areas of
jurisdiction for the hearing offices do not align with state borders.
Appeals Council data were only available for the nation, as the Appeals
Council process is managed in one central office.
[48] We also analyzed data on continuing disability reviews--including
new receipts as well as dispositions and pending cases--for fiscal
years 2004 to July 2007.
[49] The average processing times we analyzed do not include the time
it takes for SSA field offices to process claims, although SSA does
track these data as well. Also, at the DDS level, the average
processing times presented in this report are average processing times
for DI cases only, not for DI and SSI cases combined. SSA provided
average processing times separately for the two programs. We are
reporting the DI processing times because the number of DI cases is
larger than the number of SSI cases, but the differences in processing
times between the programs are minimal.
[50] SSA did not develop estimates of the targeted number of pending
claims for fiscal years prior to 1999. Also, SSA has not developed
estimates of the targeted number of pending claims at the DDS
reconsideration level.
[51] We note that you make the same point on page 28 of the draft, and
there you do include the 4-percent workyear increase in the text.
Therefore, this change would also make page 14 consistent with later
text in the document.
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