Social Security Disability
Additional Performance Measures and Better Cost Estimates Could Help Improve SSA's Efforts to Eliminate Its Hearings Backlog Gao ID: GAO-09-398 September 9, 2009(SSA) has experienced processing delays and significant backlogs of disability claims at the hearings level. In May 2007, SSA began implementing a plan for eliminating the hearings backlog entitled Summary of Initiatives to Eliminate the SSA Hearings Backlog (the Plan). In response to a congressional request, GAO (1) examined the Plan's potential to eliminate the hearings-level backlog, (2) determined the extent to which the Plan included components of sound planning, and (3) identified potential unintended effects of the Plan on hearings-level operations and other aspects of the disability process. To address these objectives, GAO analyzed SSA data, conducted a risk analysis, assessed the Plan and its update--the May 2009 Draft Appomattox Plan--using planning criteria identified in previous GAO work, interviewed SSA officials, and conducted site visits in three SSA regions.
SSA's Plan should help the agency reduce its hearings-level backlog, but the likelihood that SSA will eliminate the backlog within its projected time-frame depends on the extent to which SSA's assumptions for improved administrative law judge (ALJ) hiring, availability, and productivity are achieved in practice. Both SSA and GAO believe that the agency has about a 78 percent chance of eliminating the backlog, that is, reducing the number of hearings-level pending claims below 466,000 claims, by the end of fiscal year 2013--SSA's target date--if those assumptions are fully realized. However, SSA's assumptions project higher levels of performance achieved than recent experience--from fiscal year 2008 to April 2009. ALJ productivity improvements are especially important to SSA's reaching its goal. The likelihood that SSA will eliminate the backlog by its target date changes under different scenarios for achieving its ALJ hiring, availability, and productivity goals. If SSA achieves its average ALJ productivity, but not its ALJ hiring and availability goals, GAO estimated that SSA's chances are reduced from about 78 percent to about 53 percent. Conversely, if SSA achieves its goals for ALJ hiring and availability, but not for average productivity, its chances are about 34 percent. If SSA is unable to achieve any of its ALJ workforce and performance goals, the likelihood of the agency eliminating the hearings-level backlog by its target date drops to about 14 percent. SSA's Plan includes important elements of the six components of sound planning GAO identified in previous work, but does not provide some key management information that could facilitate effective plan management. SSA did not fully address elements of two components. Specifically, the Plan does not include performance goals and measures for about half of the initiatives and cost estimates for many, which would allow SSA to evaluate the initiatives' effect on the hearings-level backlog and determine resource allocations and return on investment. Although the Plan does not identify implementation risks or strategies to address them, SSA officials said they are developing a system that will aid in creating formal performance goals and measures and risk analysis, several of which SSA plans to release in the fall of 2009. The Plan could have unintended effects on SSA offices involved in the disability process. For example, the Plan's initiatives to increase the number of hearings-level decisions could affect decisional quality and accuracy, and increase workloads in offices that are responsible for reviewing appeals of hearing office decisions, processing payments for claims, and conducting continuing disability reviews to determine whether beneficiaries remain eligible for benefits. Although SSA has developed plans to address increased workloads related to appeals of hearing decisions and monitors other disability workloads, it does not have a systematic approach to identify and address unintended effects caused by Plan initiatives over the course of the Plan.
RecommendationsOur recommendations from this work are listed below with a Contact for more information. Status will change from "In process" to "Open," "Closed - implemented," or "Closed - not implemented" based on our follow up work.
Director: Team: Phone:GAO-09-398, Social Security Disability: Additional Performance Measures and Better Cost Estimates Could Help Improve SSA's Efforts to Eliminate Its Hearings Backlog
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Report to Congressional Committees:
United States Government Accountability Office:
GAO:
September 2009:
Social Security Disability:
Additional Performance Measures and Better Cost Estimates Could Help
Improve SSA's Efforts to Eliminate Its Hearings Backlog:
GAO-09-398:
GAO Highlights:
Highlights of GAO-09-398, a report to congressional committees.
Why GAO Did This Study:
The Social Security Administration (SSA) has experienced processing
delays and significant backlogs of disability claims at the hearings
level. In May 2007, SSA began implementing a plan for eliminating the
hearings backlog entitled Summary of Initiatives to Eliminate the SSA
Hearings Backlog (the Plan). In response to a congressional request,
GAO (1) examined the Plan‘s potential to eliminate the hearings-level
backlog, (2) determined the extent to which the Plan included
components of sound planning, and (3) identified potential unintended
effects of the Plan on hearings-level operations and other aspects of
the disability process.
To address these objectives, GAO analyzed SSA data, conducted a risk
analysis, assessed the Plan and its update”the May 2009 Draft
Appomattox Plan”using planning criteria identified in previous GAO
work, interviewed SSA officials, and conducted site visits in three SSA
regions.
What GAO Found:
SSA‘s Plan should help the agency reduce its hearings-level backlog,
but the likelihood that SSA will eliminate the backlog within its
projected time-frame depends on the extent to which SSA‘s assumptions
for improved administrative law judge (ALJ) hiring, availability, and
productivity are achieved in practice. Both SSA and GAO believe that
the agency has about a 78 percent chance of eliminating the backlog,
that is, reducing the number of hearings-level pending claims below
466,000 claims, by the end of fiscal year 2013”SSA‘s target date”if
those assumptions are fully realized. However, SSA‘s assumptions
project higher levels of performance achieved than recent experience”
from fiscal year 2008 to April 2009. ALJ productivity improvements are
especially important to SSA‘s reaching its goal. The likelihood that
SSA will eliminate the backlog by its target date changes under
different scenarios for achieving its ALJ hiring, availability, and
productivity goals. If SSA achieves its average ALJ productivity, but
not its ALJ hiring and availability goals, GAO estimated that SSA‘s
chances are reduced from about 78 percent to about 53 percent.
Conversely, if SSA achieves its goals for ALJ hiring and availability,
but not for average productivity, its chances are about 34 percent. If
SSA is unable to achieve any of its ALJ workforce and performance
goals, the likelihood of the agency eliminating the hearings-level
backlog by its target date drops to about 14 percent.
SSA‘s Plan includes important elements of the six components of sound
planning GAO identified in previous work, but does not provide some key
management information that could facilitate effective plan management.
SSA did not fully address elements of two components. Specifically, the
Plan does not include performance goals and measures for about half of
the initiatives and cost estimates for many, which would allow SSA to
evaluate the initiatives‘ effect on the hearings-level backlog and
determine resource allocations and return on investment. Although the
Plan does not identify implementation risks or strategies to address
them, SSA officials said they are developing a system that will aid in
creating formal performance goals and measures and risk analysis,
several of which SSA plans to release in the fall of 2009.
The Plan could have unintended effects on SSA offices involved in the
disability process. For example, the Plan‘s initiatives to increase the
number of hearings-level decisions could affect decisional quality and
accuracy, and increase workloads in offices that are responsible for
reviewing appeals of hearing office decisions, processing payments for
claims, and conducting continuing disability reviews to determine
whether beneficiaries remain eligible for benefits. Although SSA has
developed plans to address increased workloads related to appeals of
hearing decisions and monitors other disability workloads, it does not
have a systematic approach to identify and address unintended effects
caused by Plan initiatives over the course of the Plan.
What GAO Recommends:
GAO recommends that SSA develop additional performance measures and
cost estimates for its critical initiatives, as well as conduct an
analysis of risks associated with Plan implementation and identify
steps to address them. SSA said that it has taken or has planned
actions to develop performance measures as appropriate. SSA disagreed
that it should develop further cost estimates, but agreed it should
conduct risk analyses and outlined steps it is taking to do so.
View [hyperlink, http://www.gao.gov/products/GAO-09-398] or key
components. For more information, contact Daniel Bertoni, (202) 512-
7215, bertonid@gao.gov.
[End of section]
Contents:
Letter:
Background:
SSA's Plan Should Help Reduce the Hearings-Level Backlog, but whether
SSA Does So within Its Projected Timeframe Depends on SSA's Ability to
Achieve Its Key Goals:
SSA's Plan Partially Addresses Five of Six Components of Sound
Planning, but Does Not Provide Some Key Management Information:
The Plan Could Have Unintended Effects on SSA Operations, but SSA Lacks
a Systematic Approach to Identify and Address Them:
Conclusions:
Recommendations for Executive Action:
Agency Comments and Our Evaluation:
Appendix I: Objectives, Scope, and Methodology:
Appendix II: Modeling Methodology and Results:
Appendix III: Status of Plan Initiatives:
Appendix IV: Comments from the Social Security Administration:
Appendix V: GAO Contact and Staff Acknowledgments:
Related GAO Products:
Tables:
Table 1: Key SSA Offices Involved in the Disability Process:
Table 2: The Plan's Approaches and Examples of Initiatives:
Table 3: Extent to Which SSA's Plan Addresses Components of Sound
Planning:
Table 4: Components of Sound Planning and Examples of Their Elements:
Table 5: Fiscal Year 2007 Regional Backlog Performance Factors:
Table 6: Fiscal Year 2007 Hearing Office Statistics:
Figures:
Figure 1: SSA's Disability Process:
Figure 2: DDS Initial Disability Claims Receipts, Fiscal Years 2003
through 2008:
Figure 3: Hearings-Level Receipts, Fiscal Years 2003 through 2008:
Figure 4: Hearings-Level Dispositions, Fiscal Years 2003 through 2008:
Figure 5: Hearings-Level Pending Claims, Fiscal Years 2003 through
2008:
Figure 6: Hearings-Level Backlogged Claims, Fiscal Years 2003 through
2008:
Figure 7: Number of CDRs Completed at DDS Offices, Fiscal Years 2003
through 2008:
Abbreviations:
AALJ: Association of Administrative Law Judges:
ALJ: administrative law judge:
CDR: continuing disability review:
CCS: Case Control System:
CPMS: Case Processing and Management System:
DARES: Disability Adjudication Reporting and Evaluation System:
DCO: Deputy Commissioner of Operations:
DDS: Disability Determination Services:
DIODS: Disability Operations Data Store:
DSI: Disability Service Improvement:
FIT: Findings Integrated Template:
HOTS: Hearing Office Tracking System:
HPI: Hearings Process Improvement:
NADE: National Association of Disability Examiners:
NOSSCR: National Organization of Social Security Claimants'
Representatives:
ODAR: Office of Disability Adjudication and Review:
SSA: Social Security Administration:
SSAB: Social Security Advisory Board:
[End of section]
United States Government Accountability Office:
Washington, DC 20548:
September 9, 2009:
The Honorable Tom Harkin:
Chairman:
The Honorable Thad Cochran:
Ranking Member:
Subcommittee on Labor, Health and Human Services, Education, and
Related Agencies: Committee on Appropriations:
United States Senate:
The Honorable David R. Obey:
Chairman:
The Honorable Todd Tiahrt:
Ranking Member:
Subcommittee on Labor, Health and Human Services, Education, and
Related Agencies: Committee on Appropriations:
United States 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 and Supplemental Security
Income. From fiscal years 1997 through 2006, the total number of
backlogged claims in these programs more than doubled, with the
greatest accumulation of claims occurring among those that were
awaiting a decision at the hearings level, where claimants who are
dissatisfied with the state determination of their claim can request a
hearing before an administrative law judge (ALJ). Backlogged claims at
the hearings level--those exceeding the level SSA considers optimal for
work to continually move through the hearings-level process--rose from
12,000 in 1999 to nearly 295,000 by the close of fiscal year 2008. In
addition, claimants had to wait, on average, almost a year and a half
after they requested a hearing to learn the outcome of their claims
during fiscal year 2008. In light of disability backlogs and other
program challenges at SSA and other agencies, we first designated
federal disability programs a high-risk area in 2003 and continue to
consider them a high-risk area in 2009.[Footnote 1]
The current recession is contributing to a significant increase in
disability claims receipts. This occurrence has the potential to
further exacerbate SSA's challenges in eliminating its disability
claims backlog. To help address increased claims receipts and its
claims backlog, Congress provided SSA additional funding through the
American Recovery and Reinvestment Act of 2009 (Recovery Act) and its
fiscal year 2009 appropriation.[Footnote 2]
In May 2007, SSA presented to Congress and began implementing a plan
for eliminating the hearings-level backlog and preventing its
recurrence entitled Summary of Initiatives to Eliminate the SSA
Hearings Backlog (the Plan). In response to a request by the House and
Senate Appropriations Committees, we (1) examined the Plan's potential
to eliminate the hearings-level backlog, (2) determined the extent to
which the Plan included components of sound planning, and (3)
identified potential unintended effects of the Plan on hearings-level
operations and other aspects of the disability process.
To address the Plan's potential to eliminate the hearings-level backlog
by fiscal year 2013, we documented assumptions that SSA used to project
this target date. We examined the reasonableness of these assumptions
using recent (fiscal year 2008 through April 2009) workload and
performance data and interviews with SSA officials. We also used a
commercially available forecasting and risk analysis software program
to determine the likelihood of SSA eliminating the hearings-level
backlog by 2013. See appendix II for additional information on our
projection modeling methodology and assumptions used in this analysis.
To determine the extent to which SSA's Plan included components of
sound planning, we assessed the Plan against criteria from previous GAO
reports that identified desirable characteristics of an effective,
results-oriented plan.[Footnote 3] We also evaluated additional
planning documentation provided by SSA, including its Draft Appomattox
Plan, and interviewed SSA officials to determine how the agency
developed the Plan and is monitoring its implementation[Footnote 4]. To
identify potentially unintended effects of the Plan on hearings-level
operations and other aspects of the disability process, we conducted
site visits to three regions, including seven hearing offices, two
state Disability Determination Services (DDS) offices, one program
service center, one SSA field office, and one teleservice center.
[Footnote 5] We selected one region that performed above average and
two that performed below average based on regional performance factors,
such as the number of backlogged claims per ALJ. In our site selection,
we also took into consideration regions that would potentially be most
affected by the Plan because they had the largest backlogs. We selected
the seven hearing offices within the three regions based on differences
in terms of receipts, backlogged claims, and average number of
dispositions per ALJ, as well as their reasonable proximity to each
other within each selected region and their involvement in implementing
select Plan initiatives.[Footnote 6] In addition, we conducted phone
interviews with staff from several additional offices in our three
selected regions, including one DDS office, one program service center,
three field offices, and one Regional Office of Quality Assurance. In
addition, we interviewed SSA central office officials and
representatives of relevant associations. We conducted our work between
May 2008 and September 2009 in accordance with generally accepted
government auditing standards. Those standards require that we plan and
perform the audit to obtain sufficient, appropriate evidence to provide
a reasonable basis for our findings and conclusions based on our audit
objectives. We believe that the evidence obtained provides a reasonable
basis for our findings and conclusions based on our audit objectives.
See appendix I for more information on our scope and methodology.
Background:
Under the Social Security Act, SSA administers both the Disability
Insurance and Supplemental Security Income programs.[Footnote 7]
Disability Insurance replaces a portion of income related to prior
earnings levels for those with a Social Security work record, while the
Supplemental Security Income program provides cash benefits to the
elderly and individuals with disabilities who have limited or no work
history as well as limited income and resources.[Footnote 8] To be
considered disabled for purposes of eligibility under either program,
individuals must be unable to engage in any substantial gainful
activity by reason of a medically determinable impairment that can be
expected to result in death or has lasted or can be expected to last
for a continuous period of not less than 12 months.[Footnote 9]
SSA Disability Process:
The process to obtain SSA disability benefits is complex and can
involve several state and federal offices. The disability adjudication
process, which is the same for Disability Insurance and Supplemental
Security Income claimants, can involve an initial determination and an
opportunity for reconsideration at the state level with two subsequent
levels of appeals in SSA hearing offices and the Appeals Council, which
is SSA's final administrative appeals level. Claimants must file any
further action in federal court. Claims at all levels for which the
claimant is determined to be eligible for Supplemental Security Income
payments or entitled to Disability Insurance benefits, also called
favorable claims, are forwarded to other SSA offices for payment. (See
figure 1.)
Figure 1: SSA's Disability Process:
[Refer to PDF for image: illustration]
Claimant contacts SSA field office:
* SSA field office staff determine if claimant meets non-medical
eligibility requirements;
* If requirements are met, application forwarded to state DDS initial
claims level.
Non-medical eligibility met:
Initial determination:
* State DDS staff gather, develop,and review medical and vocational
evidence;
* State DDS examiners and doctors make a disability determination based
on medical and vocational evidence;
If eligible:
Eligible claim is processed and paid:
* SSA field office staff process Supplemental Security Income eligible
claims, as well as claims eligible for both Supplemental Security
Income and Disability Insurance, and forward them to program service
centers for payment;
* Program service center staff process Disability Insurance eligible
claims and make payments for all claims.
If denied:
* Claimant has 60 days to request a reconsideration.
Reconsideration[A]:
* Different group of state DDS staff reexamine prior and new evidence;
* Different state DDS examiners and doctors perform the review;
If eligible:
Eligible claim is processed and paid:
* SSA field office staff process Supplemental Security Income eligible
claims, as well as claims eligible for both Supplemental Security
Income and Disability Insurance, and forward them to program service
centers for payment;
* Program service center staff process Disability Insurance eligible
claims and make payments for all claims.
If denied:
* Claimant has 60 days to request a hearing before an ALJ.
Hearings level:
* Hearing office staff collect any additional evidence and prepare, or
pull, the claim for ALJ review;
* ALJs review the claim and may conduct a hearing by videoconference or
in person;
* ALJs render a new decision, which is written by ALJs or decision
writers, such as attorneys and paralegals;
If eligible:
Eligible claim is processed and paid:
* SSA field office staff process Supplemental Security Income eligible
claims, as well as claims eligible for both Supplemental Security
Income and Disability Insurance, and forward them to program service
centers for payment;
* Program service center staff process Disability Insurance eligible
claims and make payments for all claims.
If denied:
* Claimant has 60 days to request an Appeals Council review.
Appeals Council:
* Administrative appeals judges decide whether to review the claim and
new evidence;
* If claim is reviewed, administrative appeals judges decide whether to
issue a decision or return claim to ALJ to issue a new decision;
If eligible:
Eligible claim is processed and paid:
* SSA field office staff process Supplemental Security Income eligible
claims, as well as claims eligible for both Supplemental Security
Income and Disability Insurance, and forward them to program service
centers for payment;
* Program service center staff process Disability Insurance eligible
claims and make payments for all claims.
Sources: GAO analysis of SSA data; images, Art Explosion.
[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 wished to appeal their initial DDS determination must
appeal for review before an ALJ.
[End of figure]
Key SSA offices involved in the disability process include the Office
of Disability Determinations, which oversees state DDS offices that
make medical determinations regarding claimants' alleged disabilities,
and the Offices of the Regional Commissioner, which oversees the
offices that are involved with making payments to claimants who are
eligible for benefits. In addition, the Office Disability Adjudication
and Review (ODAR) oversees hearing offices and the Appeals Council.
(See table 1.)
Table 1: Key SSA Offices Involved in the Disability Process:
Office of Deputy Commissioner: Operations;
Office: Office of Disability Determinations;
Function: Oversees state DDS offices, which determine claimants'
eligibility for disability benefits.
Office of Deputy Commissioner: Operations;
Office: Offices of the Regional Commissioner;
Function: Oversees SSA field offices, which provide a contact for
claimants and are involved in processing favorable claims for payment,
and oversees program service centers, which are involved in processing
and making payments for favorable claims.
Office of Deputy Commissioner: Disability Adjudication and Review;
Office: Office of Appellate Operations (Appeals Council);
Function: Serves as the final level of administrative review under the
Administrative Procedure Act for disability claims.
Office of Deputy Commissioner: Disability Adjudication and Review;
Office: Office of the Chief Administrative Law Judge;
Function: Serves as the principal consultant and advisor to the Deputy
Commissioner on all matters concerning the ALJ hearing function.
Office of Deputy Commissioner: Disability Adjudication and Review;
Office: Office of Management;
Function: Provides administrative support for all management and office
automation activities related to ODAR.
Office of Deputy Commissioner: Retirement and Disability Policy;
Office: Office of Disability Programs;
Function: Plans, develops, evaluates, and issues substantive
regulations, policies, standards, and instructions for the state and
federal adjudicators who implement SSA-administered disability
programs.
Office of Deputy Commissioner: Quality Performance;
Office: Office of Quality Review;
Function: Reviews, evaluates, and assesses the integrity and quality of
the administration of Social Security programs.
Office of Deputy Commissioner: Budget, Finance, and Management;
Office: Office of Budget;
Function: Plans, develops, and executes the SSA budget, including for
the disability process.
Source: GAO analysis of the organizational structure of the Social
Security Administration.
[End of table]
Individuals receiving disability benefits periodically undergo
continuing disability reviews (CDR) to determine if they remain
eligible for benefits. SSA generally determines when beneficiaries will
undergo CDRs--called medical CDRs--based on their potential for medical
improvement. However, in the case of any individual determined to be
disabled, the law generally requires that CDRs be performed for the
purposes of continuing eligibility at least once every 3 years.
[Footnote 10] In addition, SSA field offices and program service
centers conduct other CDRs---called work CDRs--which are reviews of
beneficiaries' earnings and work activities to determine whether they
remain financially eligible to receive benefits. SSA is also generally
required to conduct CDRs at least once every 3 years for children
receiving Supplemental Security Income benefits and has established
criteria for others receiving these benefits.
SSA Disability Workloads:
Over the past several fiscal years, receipts of initial disability
claims at state DDS offices fluctuated but also increased in each of
the last 2 fiscal years. In fiscal year 2008, DDS offices received more
than 2,600,000 claims, an increase of almost 4 percent over fiscal year
2006. (See figure 2.)
Figure 2: DDS Initial Disability Claims Receipts, Fiscal Years 2003
through 2008:
[Refer to PDF for image: vertical bar graph]
Year: 2003;
Number of claims: 2,517,438.
Year: 2004;
Number of claims: 2,614,684.
Year: 2005;
Number of claims: 2,551,728.
Year: 2006;
Number of claims: 2,507,958.
Year: 2007;
Number of claims: 2,524,211.
Year: 2008;
Number of claims: 2,605,362.
Source: SSA.
[End of figure]
Similarly, receipts of claims at the subsequent hearings level also
fluctuated over time but increased in each of the last 2 fiscal
years.[Footnote 11] Hearing offices received nearly 590,000 claims in
fiscal year 2008, an increase of almost 6 percent over fiscal year
2006. (See figure 3.)
Figure 3: Hearings-Level Receipts, Fiscal Years 2003 through 2008:
[Refer to PDF for image: vertical bar graph]
Fiscal Year: 2003;
Number of claims: 580,889.
Fiscal Year: 2004;
Number of claims: 576,611.
Fiscal Year: 2005;
Number of claims: 592,343.
Fiscal Year: 2006;
Number of claims: 557,970.
Fiscal Year: 2007;
Number of claims: 579,127.
Fiscal Year: 2008;
Number of claims: 589,499.
Source: SSA.
Note: While we were able to assess the reliability of these data for
fiscal years 2005 through 2008, we were unable to assess their
reliability for fiscal years 2003 and 2004 because they are archived in
systems that SSA no longer uses to input and house hearings-level
receipt data. SSA officials told us that there is no basic difference
in the way they calculated these data in fiscal years 2003 through 2004
and 2005 through 2008, but we were unable to validate them. See
appendix I for more information about our data reliability efforts.
[End of figure]
The total number of dispositions made on claims at the hearings level,
which includes both decisions and dismissals, generally increased in
the last 6 fiscal years, resulting in an overall increase of more than
16 percent--from more than 490,000 in fiscal year 2003 to more than
575,000 in fiscal year 2008. (See figure 4.)
Figure 4: Hearings-Level Dispositions, Fiscal Years 2003 through 2008:
[Refer to PDF for image: vertical bar graph]
Fiscal Year: 2003;
Number of claims: 493,923.
Fiscal Year: 2004;
Number of claims: 497,379.
Fiscal Year: 2005;
Number of claims: 519,359.
Fiscal Year: 2006;
Number of claims: 558,978.
Fiscal Year: 2007;
Number of claims: 547,951.
Fiscal Year: 2008;
Number of claims: 575,380.
Source: SSA.
Note: While we were able to assess the reliability of these data for
fiscal years 2005 through 2008, we were unable to assess their
reliability for fiscal years 2003 and 2004 because they are archived in
systems that SSA no longer uses to input and house hearings-level
disposition data. SSA officials told us that there is no basic
difference in the way they calculated these data in fiscal years 2003
through 2004 and 2005 through 2008, but we were unable to validate
them. See appendix I for more information about our data reliability
efforts.
[End of figure]
SSA measures its hearings-level performance in terms of the average
time it takes to issue a decision (or average processing time) and the
number of claims awaiting decisions (total hearings-level pending).
Average processing time has increased in recent years from almost 350
days in fiscal year 2003 to over 510 days in fiscal year 2008.[Footnote
12] In addition, total hearings-level claims pending increased from
over 550,000 in fiscal year 2003 to over 760,000 in fiscal year 2008.
(See figure 5.)
Figure 5: Hearings-Level Pending Claims, Fiscal Years 2003 through
2008:
[Refer to PDF for image: line graph]
End of Fiscal Year: 2003;
Number of claims: 556,369.
End of Fiscal Year: 2004;
Number of claims: 635,601.
End of Fiscal Year: 2005;
Number of claims: 708,164.
End of Fiscal Year: 2006;
Number of claims: 715,568.
End of Fiscal Year: 2007;
Number of claims: 746,744.
End of Fiscal Year: 2008;
Number of claims: 760,813.
Source: SSA.
Note: While we were able to assess the reliability of these data for
fiscal years 2005 through 2008, we were unable to assess their
reliability for fiscal years 2003 and 2004 because they are archived in
systems that SSA no longer uses to input and house hearings-level
pending data. SSA officials told us that there is no basic difference
in the way they calculated these data in fiscal years 2003 through 2004
and 2005 through 2008, but we were unable to validate them. See
appendix I for more information about our data reliability efforts.
[End of figure]
Despite increases in total hearings-level claims pending, SSA data
indicate that the hearings-level backlog for fiscal year 2006 through
fiscal year 2008 decreased. In order to calculate its hearings-level
backlog, SSA defines an optimal pending number--the number of claims
SSA considers optimal for work to continually move through the hearings-
level process--and subtracts that number from total hearings-level
pending. SSA has revised its optimal pending number twice since fiscal
year 2006, in turn reducing the number of claims SSA considered
backlogged each time. (See figure 6.)
Figure 6: Hearings-Level Backlogged Claims, Fiscal Years 2003 through
2008:
[Refer to PDF for image: line graph]
End of Fiscal Year: 2003;
Number of claims: 256,369
End of Fiscal Year: 2004;
Number of claims: 335,601.
End of Fiscal Year: 2005;
Number of claims: 408,164.
End of Fiscal Year: 2006;
Number of claims: 415,568.
May 2007;
Number of claims: 437,910.
Begin May 2007;
Number of claims: 337,910.
End of Fiscal Year: 2007;
Number of claims: 346,744.
September 2008;
Number of claims: 367,595.
Begin September 2008;
Number of claims: 301,595.
End of Fiscal Year: 2008;
Number of claims: 294,813.
Source: GAO analysis of SSA data.
Note: While we were able to assess the reliability of these data for
fiscal years 2005 through 2008, we were unable to assess their
reliability for fiscal years 2003 and 2004 because they are archived in
systems that SSA no longer uses to input and house hearings-level
pending data. SSA officials told us that there is no basic difference
in the way they calculated these data in fiscal years 2003 through 2004
and 2005 through 2008, but we were unable to validate them. See
appendix I for more information about our data reliability efforts.
[End of figure]
From fiscal years 1999 to 2006, SSA defined its optimal pending number
as 300,000 claims, and only those undecided claims that exceeded
300,000 were considered to be backlogged. At the end of fiscal year
2006, SSA had more than 715,000 total pending claims at the hearings
level. Thus, we reported in 2007 that SSA had a backlog of over 415,000
claims. However, in May 2007 SSA reported a new definition for its
optimal pending number--400,000--which it identified as the ideal
number of outstanding claims based on the number of ALJs on board. As a
result, the backlog was, in essence, adjusted downward to just over
345,000 claims, while total pending claims increased to more than
745,000 claims. In fiscal year 2008, SSA again redefined its optimal
pending number to factor in the assumption of an optimal average
processing time of 270 days.[Footnote 13] On the basis of the revised
criteria, SSA defined its new optimal pending number as 466,000 claims.
Thus, fewer than 300,000 hearing claims were reported as backlogged at
the end of fiscal year 2008, while total pending claims increased to
more than 760,000 claims.[Footnote 14] See appendix I for our
assessment of SSA's definition of optimal pending.
SSA's Efforts to Reduce Disability Backlogs:
In the last decade, SSA undertook a number of initiatives to improve
the disability process and reduce or eliminate its backlogs. One
significant initiative enabled SSA to convert its paper-based
disability claims process to one that is electronic. SSA also
introduced two other significant efforts designed to address the
backlogs, including the Hearings Process Improvement (HPI) initiative
in 2000 and the Disability Service Improvement (DSI) initiative in
2006. HPI was aimed at reducing the number of Appeals Council receipts
by improving claims review at the hearings level, and DSI was a
comprehensive plan to improve all phases of the disability claims
process. There were some positive outcomes from these efforts, such as
a DSI initiative that utilized a computer model to identify claims on
which SSA could render a decision within 20 days. However, both of
these efforts faltered for a variety of reasons, including poor
execution, which slowed claims processing and resulted in several
aspects being suspended within a few years.
We have issued several reports on SSA's disability program challenges.
For example, in July 1996 we noted that increases in hearings-level
backlogs and processing times were the result of both a surge in
hearings-level receipts and SSA's inattention to several long-standing
problems, including multiple levels of claims development and decision
making, fragmented program accountability, and decisional disparities
between state agencies and hearings-level adjudicators.[Footnote 15]
Similarly, in December 2007 we identified several factors that
contributed to disability backlogs, including a more than 20 percent
increase in disability applications in the past decade, substantial
turnover and losses in personnel throughout the disability process, and
SSA management weaknesses, as evidenced by poor planning and
implementation of prior initiatives intended to remedy disability
backlogs. We recommended that SSA fully monitor backlogs and better
execute and evaluate initiatives to address them. SSA partially agreed
with our recommendations and believed that it was taking steps to
better manage disability backlogs.[Footnote 16] We also reported on the
need to modernize the disability system, citing concerns that SSA's
disability programs use outmoded criteria for determining program
eligibility that do not fully reflect advances in medicine and
technology or changes in the labor market.[Footnote 17] We suggested
that Congress may wish to consider authorizing an entity consisting of
appropriate federal leaders to integrate services and support to
persons with disabilities. We also recommended that SSA use its annual
performance reports to help ensure that it places greater priority on
updating its disability criteria and that the agency study how advances
in medicine and technology and changes in the labor market could affect
program eligibly criteria and benefit packages. SSA agreed with our
recommendations and stated it is taking steps or already has taken
steps to address these issues.
In May 2007, SSA began to implement its current Plan, which includes 38
initiatives organized under four approaches aimed at eliminating the
hearings-level backlog by 2013 and preventing its recurrence. (See
table 2.) A full list of Plan initiatives and a more detailed
description of their status can be found in appendix III. In response
to the changing economic environment, the agency also developed a draft
plan update in May 2009 to document revisions to various initiatives
and how it plans to implement them going forward, including utilizing
additional Recovery Act and budgetary resources.
Table 2: The Plan's Approaches and Examples of Initiatives:
Plan approach: 1. Compassionate allowances;
Examples of initiatives:
* Use processes, such as Quick Disability Determinations, to screen
claims for approval at the initial claims level;
* Update medical listings and definition of disability categories for
the initial claims level.
Plan approach: 2. Improve hearing office procedures;
Examples of initiatives:
* Reduce aged claims at the hearings level by working on claims that
have been in the hearings process the longest;
* Allow attorney advisors to issue fully favorable decisions at the
hearings level without requiring direct ALJ involvement (Attorney
Advisor Program);
* Hire additional ALJs and support staff for the hearings level.
Plan approach: 3. Increase adjudicatory capacity;
Examples of initiatives:
* Improve ALJ productivity to 500 to 700 dispositions per year;
* Screen potentially favorable claims at the hearings level and return
them to the DDS for another review and possible favorable
determination;
* Open a centralized National Hearings Center to handle electronic
files at the hearings level and conduct only video hearings.
Plan approach: 4. Increase efficiency with automation and improved
business processes;
Examples of initiatives:
* Provide additional videoconferencing equipment to conduct hearings;
* Implement electronic file assembly (ePulling) for the hearings level
to help identify duplicates, classify documents by type of evidence,
and sequentially number pages;
* Use electronic tools to expand reviews of reconsideration denials.
Source: GAO analysis of SSA's Plan.
[End of table]
SSA's Plan Should Help Reduce the Hearings-Level Backlog, but whether
SSA Does So within Its Projected Time Frame Depends on SSA's Ability to
Achieve Its Key Goals:
Some Plan initiatives have produced positive results that should help
SSA reduce its hearings-level backlog, but SSA's ability to eliminate
the backlog by 2013 depends heavily on achieving the greater average
ALJ productivity it assumes. Other factors, such as ALJ hiring and
availability, will also be important, as well as other aspects, such as
the number of new requests for hearings.
Some Plan Initiatives Have Produced Results That Should Help Reduce the
Hearings-Level Backlog:
SSA has implemented some Plan initiatives that have reduced hearings-
level receipts and increased hearings-level dispositions and,
therefore, should help eliminate the backlog. For example, the Appeals
Council initiative, which was implemented in July 2007, has reduced the
number of hearing office receipts. Under this initiative, Appeals
Council staff correct technical deficiencies in written hearings-level
decisions, where possible, instead of returning claims to hearing
offices for corrections. Partly as a result of this initiative, the
Appeals Council returned about 4,500 fewer claims to ALJs in fiscal
year 2008 than in fiscal year 2007.
The Informal Remand initiative, which was implemented in fiscal year
2007, has also increased hearings-level dispositions. Under this
initiative, claims that were previously denied by DDS offices are
screened for characteristics that make them good candidates for a
favorable determination. Typically, these are claims in which the
claimants' symptoms have worsened, or the claimants have provided
additional medical evidence since the claims were originally denied.
These claims are returned to state DDS offices where staff take a
second look at them and decide if a fully favorable determination can
be made. Since implementation of this initiative, DDS staff have
reversed over 25,000 previous DDS denials, allowing hearing office
staff to dismiss the related requests for hearings and remove them from
hearings-level pending. Because of this success, SSA officials told us
that they plan to continue this initiative through fiscal year 2013.
However, the officials mentioned that if DDS workloads prevent their
continued participation in this initiative, they plan to increase the
scale of another similar initiative that they expect will produce
similar results.
SSA also implemented two other initiatives in fiscal year 2007 that
increased or may help increase hearings-level dispositions. In November
2007, SSA reestablished the Attorney Advisor Program, which helped
increase hearings-level dispositions in fiscal year 2008.[Footnote 18]
This initiative, which produced 24,575 decisions in fiscal year 2008,
provides authority for certain attorney advisors in hearing offices to
issue fully favorable decisions on certain claims without a hearing
before an ALJ.[Footnote 19] Because of its success, SSA plans to
continue this initiative through fiscal year 2013. SSA also implemented
the Deputy Commissioner of Operations (DCO) Overtime initiative in June
2007, which likely helped increase hearings-level dispositions in
fiscal years 2007 and 2008. For this initiative, some DCO employees
worked overtime to provide critical support to hearing office staff in
preparing claims for ALJ hearings, such as by photocopying, preparing
CDs for claimant representatives, processing paper mail, and filing.
In addition to the initiatives that have already increased or will
likely increase hearings-level dispositions, SSA's initiative to hire
additional ALJs should increase hearing office capacity to make future
claim dispositions. In fiscal year 2008, SSA hired 190 new ALJs for its
ALJ corps, which had declined to about 1,060 on-duty ALJs at the end of
fiscal year 2007.[Footnote 20] The additional 190 ALJs, hired during
the last 6 months of fiscal year 2008, did not significantly contribute
to increased dispositions in that year, primarily because they required
training and experience. However, once trained, they will contribute to
increased hearings-level productivity in future years. For example, if
the ALJs hired in fiscal year 2008 ultimately produce dispositions at
the same average rate as experienced ALJs, they will likely produce
more than 50,000 additional dispositions each fiscal year going
forward. In addition, SSA officials plan to hire enough ALJs to
maintain a cadre of about 1,450 ALJs by fiscal year 2011 using SSA's
fiscal year 2009 and 2010 appropriations and some of the funding it
recently received under the Recovery Act.
SSA's Success in Eliminating the Hearings-Level Backlog by 2013 Depends
on Its Ability to Achieve Its Key Workforce and Performance Goals:
The likelihood that SSA will eliminate the hearings-level backlog by
its target date depends on the extent to which SSA's actual workforce
and performance levels reflect the assumptions it made for ALJ hiring,
availability, and productivity. Using a model, SSA officials estimate
that it has about a 78 percent chance of eliminating the backlog, that
is, reducing the number of hearings-level pending claims below its
established optimal pending number of 466,000 claims by fiscal year
2013.[Footnote 21] Using a similar model and SSA's workforce and
performance assumptions, we also estimated a similar likelihood, that
is, a 77 percent chance that SSA will eliminate its backlog by its
target date. (See appendix II for more information on our modeling
methodology and assumptions.) For these estimations, both we and SSA
included activities funded by additional Recovery Act and fiscal year
2009 appropriations, and SSA's increased projections for hearing
receipts. SSA plans to use the additional funding, along with the
additional $997 million it requested in its fiscal year 2010
administrative budget request, to hire more than 360 ALJs and 1,500
additional management and support staff in fiscal years 2009 and 2010.
SSA's estimate for the likelihood of eliminating its backlog by the end
of fiscal year 2013 assumes it will meet its workforce and performance
goals. However, if ALJs issue, on average, fewer decisions than SSA
projected and SSA is unable to hire and train the number of ALJs
planned and have them available in the expected amount of time, SSA
will have a lower chance of eliminating the backlog by its target date.
Because SSA's projection was based on its assumptions, we ran a number
of simulations to determine the likelihood that SSA would meet its
target date if some or all of SSA's assumptions, which reflected what
SSA believed it could achieve given its new initiatives and resources,
were not realized. In some cases where SSA's recent experience was
different than its assumptions, we varied the assumptions in our
simulations. Elsewhere, we used SSA's assumptions.[Footnote 22] We
varied the following assumptions in our simulations:
Average ALJ productivity. SSA assumes that average ALJ productivity
will be at about 570 dispositions per average available ALJ in fiscal
years 2009 through 2013.[Footnote 23] Our analysis of recent
performance data shows that ALJs have not produced at 570 dispositions
per average available ALJ in the past 5 years. Most recent experience
shows that each average available ALJ produced at an annualized rate of
about 546 dispositions in fiscal year 2009 through April. However,
since SSA plans to hire additional staff with funding provided through
the Recovery Act, its fiscal year 2009 appropriation, and its fiscal
year 2010 budget request, we estimated that this number could be
adjusted upward to 560 dispositions per average available ALJ to
reflect the potential effect of the increased support staff on ALJ
performance.
Average number of on-duty ALJs. SSA's goal is to hire enough ALJs to
reach a cadre of about 1,450 in fiscal year 2011, but SSA officials
told us that the average number of on-duty ALJs could be slightly less
because of annual ALJ attrition and timing constraints in the hiring
process. Thus, SSA assumes that it will be able to hire ALJs to reach
an average of 1,442 on-duty ALJs in fiscal year 2011 and maintain that
level through 2013. Our assessment of SSA's staffing data shows that in
fiscal year 2008 the average number of on-duty ALJs was 1 percent lower
than SSA expected, and in fiscal year 2009 through April, SSA's average
number of on-duty ALJs has been 2 percent below SSA's expectation for
the year. Thus, we used values for this assumption that ranged from 98
percent of SSA's annual expectation to 100 percent of SSA's
expectation.
Average ALJ availability. Generally, SSA assumes that experienced ALJs
are available about 93 percent of the time, but for years when SSA
hires many new ALJs, it assumes that average ALJ availability will be
lower because the new ALJs need to be trained and gain experience
before they start to produce at the level of an experienced ALJ. In
fact, because SSA plans to hire ALJs in fiscal years 2009 through 2013
to reach and maintain a cadre of about 1,450 ALJs, SSA assumes lower
average ALJ availability percentages in each year through fiscal year
2013--about 90 percent of the time in fiscal years 2009 and 2010 and
between 91 and 92 percent in each fiscal year from 2011 to 2013. Our
analysis of SSA staffing data shows that average ALJ availability, as
reported by hearing offices, was 88 percent in fiscal year 2008, when
SSA hired 190 additional ALJs, and 91 percent in fiscal year 2009
through April. Because SSA plans to hire over 360 additional ALJs in
fiscal years 2009 and 2010, we used values for this assumption that
ranged from 88 percent to 91 percent (actual reported values). However,
consistent with SSA's expectations, we used average ALJ availability
values for fiscal years 2011 through 2013 ranging from 91 to 92
percent.
For the following assumptions we used values similar to those SSA used
in its model:
Hearing receipts. We based our assumptions for hearings-level receipts
entirely on SSA's assumptions, including SSA's subcategories and
related ranges to vary this assumption to obtain our results.
Informal remands reversed. We used SSA's assumptions, since this
initiative was new in fiscal year 2007 and little recent data existed.
SSA used point estimates of 8,500 informal remands reversed for each
year and did not attribute any ranges to this assumption.
Attorney Advisor Program dispositions. Since this initiative was
reestablished in fiscal year 2008 and thus few recent data were
available, we used SSA's assumptions of a most likely value of 32,300,
and a range of plus or minus 1 percent--as SSA does--for this
disposition type.
To make our estimates, we developed a model we used in concert with a
commercially available risk analysis software, called Crystal Ball, and
used the assumptions we described above. Based on this model, we
estimated that the likelihood of SSA eliminating its hearing-level
backlog by its target date ranges from about 77 percent to about 14
percent, depending on the extent to which it achieves its workforce and
performance goals.
We found that:
* If SSA achieves the ALJ hiring, availability, and productivity levels
it assumes, we estimate there is about a 77 percent likelihood of
eliminating the hearings-level backlog by 2013.
* If SSA achieves the ALJ productivity levels it assumes but its
average ALJ hiring and availability remain more consistent with SSA's
recent experience, we estimate there is about a 53 percent chance of
eliminating the hearings-level backlog by 2013.
* If SSA achieves the ALJ hiring and availability levels it assumes,
but its rate of average ALJ productivity remains more consistent with
recent experience--though increased because of additional support
staff--we estimate that SSA has about a 34 percent chance of
eliminating the hearings-level backlog by 2013.
* If SSA does not achieve any of the levels of ALJ hiring,
availability, or productivity that it assumes, and if its performance
is more consistent with SSA's recent experience but with productivity
increased because of additional support staff--we estimate that SSA has
about a 14 percent chance of eliminating the hearings-level backlog by
2013.
SSA's Plan Partially Addresses Five of Six Components of Sound
Planning, but Does Not Provide Some Key Management Information:
SSA's Plan includes important elements of the components of sound
planning we identified in our previous work, but it does not fully
address them, and may not provide some key information to facilitate
effective plan management. Although there is no established set of
requirements for all plans, components of sound planning are important
because they define what organizations seek to accomplish, identify
specific activities to obtain desired results, and provide tools to
help ensure accountability and mitigate risks. According to SSA
officials, they developed the Plan to promptly address the increasing
hearings-level backlog and, as a result, implemented it before fully
addressing many of the planning components. Although SSA's Plan
addresses some important elements of sound planning, such as clearly
stating the Plan's purpose of eliminating the hearings backlog and
outlining initiatives to help SSA achieve this, it only partially
addresses five of six components and does not address one. (See table
3.)
Table 3: Extent to Which SSA's Plan Addresses Components of Sound
Planning:
Component: Purpose, scope, and methodology;
Brief description: Addresses why the Plan was produced, the scope of
its coverage, and the process by which it was developed;
SSA's Plan: Partially addresses;
Summary of analysis: The Plan does not detail the process by which it
was produced.
Component: Problem definition, causes, and operating environment;
Brief description: Addresses or defines the problem the Plan is
directed toward, the causes of those problems, and the current
operating environment;
SSA's Plan: Partially addresses;
Summary of analysis: The Plan does not discuss the problems affecting
the hearings-level backlog in detail.
Component: Goals, objectives, activities, and performance measures;
Brief description: Addresses what the Plan is trying to achieve and how
it will achieve those results, as well as the priorities, milestones,
and performance measures to monitor and gauge results;
SSA's Plan: Partially addresses;
Summary of analysis: The Plan does not identify performance measures
and goals for about half of the initiatives.
Component: Resources, investments, and risks;
Brief description: Addresses what the Plan will cost, the sources and
types of resources and investments needed, and where resources and
investments should be targeted while assessing and managing risks;
SSA's Plan: Partially addresses;
Summary of analysis: The Plan does not include cost estimates or
identify implementation risks.
Component: Roles, responsibilities, and coordination;
Brief description: Addresses who will be implementing the Plan, what
their roles will be compared with those of others, and mechanisms for
them to coordinate their efforts;
SSA's Plan: Partially addresses;
Summary of analysis: The Plan mentions some offices involved in Plan
implementation, but does not discuss roles and responsibilities or
mechanisms for coordination.
Component: Integration among and with other entities;
Brief description: Addresses how the Plan relates to other agency
goals, objectives, and activities--and to subordinate levels of
government;
SSA's Plan: Does not address;
Summary of analysis: The Plan does not discuss how it relates to other
agency efforts or priorities.
Source: GAO analysis.
Note: The six components can be subdivided into 27 separate elements
for more detailed assessment. If the Plan addressed all of the elements
related to a component, we determined that it fully addressed this
component. If the Plan addressed at least 1 but not all of the elements
related to a component, we determined that it partially addressed this
component. If the Plan addressed none of the elements related to a
component, we determined that it did not address this component.
[End of table]
During our review, SSA largely clarified to us how its Plan addresses
four of the components of sound planning, even though they are not
specifically articulated in the Plan. For example, for the purpose,
scope, and methodology component, the Plan does not detail the process
by which it was produced, such as what analyses were used to develop
the initiatives and who was involved. SSA officials later told us that
they developed the Plan based on initiatives that had worked in the
past and in consultation with management from various SSA offices. For
the problem definition, causes, and operating environment component,
the Plan identifies several problems driving the hearings-level
backlog, including large numbers of hearings-level receipts,
insufficient resources and staff, and some hearings-level
inefficiencies, but does not discuss the problems in detail or clarify
how the initiatives will address these problems. However, SSA officials
subsequently discussed the problems affecting the hearings-level
backlog with us and explained how the Plan initiatives intend to
address them. We found that the problems discussed were consistent with
those cited in prior GAO work, by SSA stakeholders involved in the
disability process, and by staff in the seven hearing offices we
visited. These staff stated that one problem causing the hearing office
backlog was the lack of staff needed to prepare claims for ALJ review.
To address this issue, SSA officials explained that the Plan includes
initiatives to increase overtime to prepare claims and automate some
claim preparation functions. As noted earlier, SSA recently stated it
plans to significantly increase staff over fiscal year 2008 levels. For
the roles, responsibilities, and coordination component, the Plan does
not discuss roles and responsibilities for implementing the Plan and
mechanisms for coordination. However, SSA officials later clarified
that ODAR is the designated lead for overseeing overall Plan
implementation; and responsibilities for implementing the initiatives
are divided among it and several other SSA offices. Finally, regarding
the integration among and with other entities component, the Plan does
not include information on how it relates to other SSA offices and
agency priorities. However, SSA's strategic plan for 2008 through 2013
specifically notes that Plan implementation is one of the agency's top
priorities. In addition, SSA offices involved with the Plan also
participated in a multi-office effort, beginning in August 2007, to
examine ways to improve consistency in claims processing across the
disability process, such as at the initial and hearings levels.
SSA did not fully clarify how it addresses the two remaining components
of sound planning: (1) goals, objectives, activities, and performance
measures and (2) resources, investments, and risks. Within those
components, SSA's Plan specifically did not address three key elements:
performance goals and measures, resources and costs, and potential
implementation risks.
* Performance measures. Although SSA's Plan establishes its overall
goal of eliminating the hearings-level backlog by 2013, SSA did not
develop performance measures and goals for about half of the 38
initiatives. In addition to defining goals or desired outcomes,
performance measures are important because they tell organizations how
well they are achieving their goals and enable them to assess
accomplishments, make decisions, realign processes, and assign
accountability.[Footnote 24] While SSA tracks its progress in
implementing initiatives, it has not established the specific expected
outcomes that each initiative is expected to achieve with respect to
eliminating the hearings-level backlog. For example, the Plan includes
an initiative to provide additional videoconferencing equipment to
conduct hearings, but it does not specify how many additional hearings
are expected to be conducted as a result. While SSA's fiscal year 2008
Plan update report notes that the number of hearings conducted through
videoconferencing has increased and that SSA installed 145 new
videoconferencing units, the report does not describe the impact, if
any, the additional videoconferencing units have on the hearings-level
backlog. In addition, the Plan includes an initiative to establish a
standardized electronic business process to improve claim-processing
time, but does not specify performance goals, such as how much time
this effort is intended to save. SSA's fiscal year 2008 Plan update
report states that the agency is piloting this new process, but does
not indicate how SSA will measure the initiative's impact on processing
time. In discussing our concerns, SSA officials stated that they are
developing a system that will provide for developing formal performance
measures and goals for the initiatives. Moreover, SSA officials
provided examples of formal performance goals for four Plan initiatives
that it developed as part of this system and stated that they plan to
release performance information on a total of seven initiatives in the
fall of 2009.
* Resources and costs. SSA did not develop resource and cost estimates
for many of the 38 initiatives. Such estimates are necessary for
organizations to support decisions about whether to fund one program
over another, develop annual budget requests, and evaluate resource
requirements at key decision points.[Footnote 25] Moreover, a realistic
estimate of program costs makes for effective resource allocation,
which can ultimately increase a program's probability of success. SSA
developed cost estimates for its electronic and automation initiatives
through its annual process for approving specific systems projects.
However, SSA officials stated that they did not estimate costs for the
entire Plan or their other initiatives because they determine resource
needs at an office level--rather than specifically for the Plan--and
allocate resources to these offices according to appropriated funds and
agency priorities. In addition, SSA officials stated that cost
estimates for specific initiatives would not be accurate, because they
overlap with the normal costs of processing a claim, such as staffing
and operational costs. They also stated that cost estimates would not
include potential savings the initiatives would bring and that these
could not be determined by initiative because multiple initiatives may
have contributed to the savings. While we acknowledge these challenges,
we believe it is possible to estimate the costs of implementing the
initiatives. For example, the Plan did not include cost estimates for
an initiative to open and operate a National Hearing Center to hear
claims from backlogged hearing offices through videoconferencing or its
potential cost-effectiveness compared with that of a traditional
hearing office. At our request, SSA subsequently developed staffing and
operational cost estimates for this initiative, but SSA officials
stated that they do not have plans to develop cost estimates for other
initiatives, including those it considers critical to eliminating the
hearings-level backlog, which are potentially more costly. For example,
SSA did not estimate the costs of hiring additional ALJs. Although SSA
recently stated how much of its Recovery Act funds would be spent on
hiring some ALJs and support staff and video equipment, SSA has not
estimated other costs associated with this initiative, such as hearing
office space.
SSA stated that it had developed cost estimates associated with
implementing all major aspects of the Plan, but we found that it only
provided time savings estimates for a few initiatives and did not
provide cost estimate information for many initiatives. For example,
SSA stated that remanding cases to DDS offices to be decided by DDS
staff provides a savings of 15 minutes per case to ODAR, but SSA did
not provide the cost of DDS overtime needed to perform this task.
* Risks. SSA's Plan did not identify potential implementation risks,
such as factors that could hinder its success, or methods to assess and
manage these risks. Although risk management cannot eliminate all
risks, it provides tools for making informed choices about how to use
available resources effectively and for monitoring the effect of those
choices.[Footnote 26] It involves assessing vulnerabilities and
consequences and establishing a feedback loop that continually
incorporates new information as organizations move forward with
implementation. SSA officials stated that they discussed risk
management prior to Plan implementation, but neither the Plan nor SSA
has a formal method to proactively identify risks, monitor their
effects, and develop plans to mitigate them. For example, SSA officials
originally estimated that a Plan initiative to automate file assembly
to prepare claims for ALJ review--called ePulling--would save 90
minutes of support staff time per claim and reduce the need for some
support staff. However, SSA did not consider risks or alternate
implementation strategies, such as what SSA would do if ePulling did
not work as expected. SSA officials stated that the ePulling initiative
has had a negligible effect on time savings, and the Draft Appomattox
Plan noted that not achieving the anticipated results from electronic
initiatives like ePulling is one of several factors that has
significantly compromised agency efforts to provide disability-related
services. SSA officials stated they completed risk analyses for three
initiatives in early fiscal year 2008 and, as part of their effort to
develop a formal risk analysis process, they plan to use the system
they are creating to develop risk analysis information for a total of
eight initiatives for release in the fall of 2009. They stated that the
agency has generally performed risk analyses informally as it rolled
out initiatives and they had developed plans for mitigation strategies
if the risks identified materialized. However, SSA did not provide
documentation of this effort, except for the senior attorney
initiative, and therefore we were unable to assess the extent to which
these analyses were performed.
The Plan Could Have Unintended Effects on SSA Operations, but SSA Lacks
a Systematic Approach to Identify and Address Them:
SSA's implementation of the Plan could have unintended effects on
various aspects of hearings-level performance, but SSA does not have a
systematic approach to identify and address them. For example, staff in
all seven hearing offices we visited stated that SSA's push to increase
productivity by encouraging each ALJ to issue between 500 and 700
dispositions annually could reduce the quality of ALJ decisions, and
ALJs in two of these offices also stated that it could increase the
potential for ALJs and decision writers to make technical errors when
preparing decisions.[Footnote 27] Such an increase in errors could
ultimately cause the Appeals Council and federal courts to return more
claims to the hearings level for correction, although SSA has been
taking steps that could help address this concern. For example, SSA
developed a tool to help draft decisions that has reduced such errors.
In addition, SSA's Plan includes an initiative to develop a quality
assurance program to review selected prepared claims and decision
drafts to identify problems, such as technical errors. According to
SSA, it will begin this quality assurance program in early fiscal year
2010. SSA's Draft Appomattox Plan identifies another initiative
intended to identify errors in cases, whereby SSA's Appeals Council
will review cases favorable to the claimant. SSA plans to begin this
initiative in fiscal year 2010. Beyond technical errors, many ALJs and
staff members in hearing offices we visited told us that the current
push for greater productivity could increase the potential for
decisional errors. Also, officials representing the Association of
Administrative Law Judges we spoke with stated that asking judges to do
up to 700 cases per year is unrealistic and cannot be done in a high-
quality manner. In addition, we have reported concerns regarding ALJ
decisional accuracy for years. In 1996, we reported that pressure to
meet the goals set out in SSA's short-term plan to reduce the hearings-
level backlog could put the agency at risk of incorrectly allowing
claims, which could increase overall program costs for SSA and
taxpayers.[Footnote 28] Further, in 2003, we recommended that SSA take
action to improve ALJ quality assurance reviews.[Footnote 29] However,
SSA's Plan does not include a method for systematically reviewing the
accuracy of decisions. SSA officials stated that the agency currently
takes two actions to monitor ALJ decisions; however, neither of these
efforts is intended to systematically assess the accuracy and quality
of ALJ decisions. First, SSA reviews data on the number of hearing
dispositions that ALJs issue in order to identify ALJs making unusually
low or high numbers of dispositions and takes actions as necessary.
However, these reviews are not documented. Second, SSA monitors the
percentages of favorable and unfavorable decisions ALJs make in order
to determine if these percentages change as ALJs increase productivity.
SSA officials stated that in 2008 they reviewed the quality of the work
of several of the highest producing ALJs and found no problems with the
quality. They stated that they do not believe that asking for a minimum
of 500 dispositions per year per ALJ would lead to concerns about the
quality of dispositions.
Some of the Plan's initiatives could also significantly affect key
hearing office workloads. For example, SSA's efforts to increase ALJ
productivity and hire additional ALJs have increased the pressure on
hearing office staff to prepare more claims for ALJ review. Hearing
office staff in all seven hearing offices we visited stated that more
support staff are needed, particularly in light of normal attrition and
the increased number of ALJs on board as a result of the Plan. Staff in
four hearing offices we visited also told us that the increased
pressure to prepare more claims has reduced morale. While the Plan
notes that hiring more staff is essential to reducing the hearings-
level backlog, it did not specify how many more staff are actually
needed. Although SSA has not yet determined how many more staff are
needed, in March 2009, SSA's Commissioner said that the agency plans to
hire the staff necessary to increase the national average support staff-
to-ALJ ratio to 4.5.
SSA's focus on eliminating the hearings-level backlog has also affected
the workloads of other SSA offices. For example, SSA officials stated
that the increase in ALJ productivity resulted in some increased
workloads at the Appeals Council, which is SSA's final administrative
appeals level. In fact, SSA recognized in its fiscal year 2008 through
2013 strategic plan that a backlog could occur in the Appeals Council
as SSA increases hearings-level dispositions. In addition, the Appeals
Council initiative also increased the Appeals Council's workload. As
mentioned earlier, in fiscal year 2008 the Appeals Council returned
about 4,500 fewer claims to ALJs, partly because of this initiative.
However, Appeals Council staff stated that this causes an increase in
their workload because correcting claims takes longer than returning
them to ALJs. SSA has included in its Draft Appomattox Plan specific
information on plans for hiring Appeals Council staff and making
electronic improvements, such as system enhancements to improve
consistency, reduce errors, and speed case processing. The draft
specifies that SSA plans to hire 14 additional Administrative Appeals
Judges and 135 attorneys and professional staff in late fiscal year
2009, and a timeline for acquiring space for these staff.
A substantial increase in the number of hearing dispositions could also
affect the workloads of field offices and program service centers, both
of which are involved in processing payments for approved claims. In
April 2008, the Chairman of the Social Security Advisory Board
testified that the board was particularly concerned that SSA's focus on
eliminating the hearings-level backlog could result in backlogs in the
program service center operations. SSA officials responsible for
allocating resources and analyzing workloads stated that they do not
expect increases in hearings dispositions to contribute significantly
to backlogs in field offices and program service centers because
hearings dispositions make up only part of field office and program
service center workloads. However, SSA officials had not estimated the
potential impact on these workloads beyond the next fiscal year if ALJs
sustained the planned 20 percent increase in productivity starting in
2010. Staff in some of the field offices and program service centers we
contacted told us that a 20 percent increase would likely significantly
affect workloads and their ability to manage them. However, these staff
had no specific plans regarding how to manage such increases beyond
reallocating resources when needed, and the Plan does not outline ways
to address this potential workload surge. SSA central office officials
who have responsibility for the field offices said that they would deal
with a sustained increase in their workload by requesting that more
staff be assigned to their offices, and noted that they have made some
efforts to help address overall field office workloads, such as
increasing the number of Web-based disability applications instead of
in-person applications. However, these plans may not provide the
immediate help that could be needed if hearings-level dispositions
increase suddenly and dramatically. SSA officials told us that a group
of senior management officials from various SSA offices, called the
Disability Determination Services Management Forum, recently expanded
their work reviewing disability policies to look at broader issues
across the entire disability process, including how the Plan affects
this process.
In addition, SSA staff we spoke with stated that the agency's focus on
implementing its Plan could divert resources from other critical
workloads, such as CDRs. CDRs are key program integrity activities
designed to ensure that only those eligible continue to receive
benefits. CDRs have the potential to yield hundreds of millions of
dollars in savings by removing program participants who no longer meet
eligibility requirements. We recently reported that certain actions
taken after claims are awarded--including CDRs, among other things--are
typically delayed or deferred when an office is under stress.[Footnote
30] SSA reported that although it performed nearly 40,000 more CDRs in
fiscal year 2008 than the approximately 210,000 performed in fiscal
year 2007, the overall number of CDRs conducted annually has generally
decreased over time. (See figure 7.)
Figure 7: Number of CDRs Completed at DDS Offices, Fiscal Years 2003
through 2008:
[Refer to PDF for image: vertical bar graph]
Fiscal year: 2003;
Number of CDRs: 687,415.
Fiscal year: 2004;
Number of CDRs: 700,457.
Fiscal year: 2005;
Number of CDRs: 542,347.
Fiscal year: 2006;
Number of CDRs: 343,650.
Fiscal year: 2007;
Number of CDRs: 209,159.
Fiscal year: 2008;
Number of CDRs: 247,249.
Source: SSA.
Note: We compared CDR data given to us by SSA with data in a
complementary SSA database and generally found similar trends in annual
totals of CDRs completed at DDS offices between fiscal years 2003 and
2008. However, the annual totals varied slightly in each of the years,
and the trend between fiscal years 2007 and 2008 was off by over 8
percent.
[End of figure]
SSA reported that it had scaled back the number of CDRs it conducts
because of increases in other competing workloads, among other things.
SSA officials also reported that in fiscal year 2007, the CDR workload
was over 200,000 and was projected to increase by almost 300 percent by
fiscal year 2013. SSA officials stated that the agency's focus on the
Plan could not affect the number of CDRs that could be done because
funding for CDRs is earmarked for this purpose. In addition, they
pointed out that staff in DDS offices--not hearing office staff--
conduct CDRs. Finally, they stated that DDS offices did not have the
capacity to absorb more staff to do more CDRs than these offices have
been assigned, even if more resources were shifted to DDS offices for
this purpose. However, officials agreed that this assessment was based
on plans for the next budget cycle and that it did not take into
account longer-range impacts over the course of the Plan.
Conclusions:
SSA has faced long-standing challenges with disability backlogs,
especially at the hearings level. SSA's estimate that it likely will
eliminate the backlog by 2013 is dependent on achieving higher levels
of performance in key areas than recent experience has shown. If
performance is less than expected, and more comparable to recent
experience, SSA may be less likely to achieve its goal. As a result, it
will be important for SSA to monitor its progress toward meeting
initiatives that are designed to achieve higher levels of performance.
At the same time, SSA will need to monitor risks to ensure that other
operations are not adversely affected. SSA has recently taken a number
of positive actions such as developing its own modeling capability,
which will allow it to routinely check assumptions against actual
performance. SSA has developed some performance goals for initiatives,
estimated time savings, and plans to develop formal risk analyses. It
will be important for SSA to continue these efforts to ensure that it
is well positioned to make progress toward its goals, understand the
full costs, and mitigate any possible adverse effects on operations.
Recommendations for Executive Action:
To help SSA monitor progress and evaluate individual Plan initiatives'
effect on the hearings-level backlog, inform its decisions about
resource allocations for eliminating this backlog, and minimize adverse
effects of the Plan's implementation, we recommend that the
Commissioner of the Social Security Administration take the following
three actions:
* develop performance goals and measures for initiatives that currently
do not have them;
* develop cost estimates for the initiatives SSA considers critical to
eliminating the hearings-level backlog in addition to the time savings
estimates already developed; and:
* move forward with formalizing agency risk assessments associated with
the Plan's implementation, including assessing both risks that would
hinder the Plan's success and risks that could cause adverse effects or
trade-offs related to hearings-level performance and other SSA
operations, along with mitigating strategies.
Agency Comments and Our Evaluation:
We provided a draft of this report to the Commissioner of the Social
Security Administration for review and comment. SSA partially disagreed
with our first recommendation on developing performance goals and
measures. SSA stated that it has established performance goals and
measures for 19 of its 35 initiatives and that it is in the process of
developing goals and measures for 2 additional initiatives--the
standardized electronic business process and the in-line quality
assurance program, but noted that the 14 remaining initiatives are not
conducive to a performance goal or measure.[Footnote 31] Instead, SSA
tracks milestones to ensure these initiatives remain on schedule for
implementation. We commend SSA for its efforts to develop performance
goals and measures for 21 of its 35 initiatives. However, we believe
that it is possible to develop performance measures and goals for some
of the remaining 14 initiatives. While tracking milestones for these
initiatives provides important information on their status, we believe
that performance goals and measures are needed to gauge the success of
certain initiatives by comparing outcomes with expected results. For
example, while SSA stated that it has milestones for the initiative
related to the delivery of additional video hearing equipment,
performance goals and measures that specify how many units will be
added, and how many additional hearings will be conducted as a result,
can help SSA determine the impact additional video hearing equipment
has on the hearings-level backlog. In addition, SSA did not develop
performance goals and measures for its initiative to improve hearing
office management information, although identifying the ultimate
improvements desired and how these improvements would affect the
hearings-level backlog would allow SSA to better understand whether its
efforts met expected results.
SSA disagreed with our second recommendation, on developing costs for
initiatives it considers critical to eliminating the backlog, and noted
that it conducted a full evaluation of the costs and savings associated
with implementing all major aspects of the Plan, which it incorporated
into its fiscal year 2009 and 2010 budget estimates. SSA also stated
that it has refined cost and savings estimates over time, when
possible. However, we believe that it is also important to develop cost
estimates for individual Plan initiatives over the entire course of the
Plan--through fiscal year 2013--because it would allow SSA to determine
which initiatives provide the best return on investment as it moves
forward with Plan implementation. Such information is critical to
making informed decisions regarding the most effective use of funds to
eliminate the backlog.
SSA agreed with our third recommendation to move forward with
formalizing risk assessments associated with the Plan's implementation,
and said that it is currently developing a management tool, called the
Disability Adjudication Reporting and Evaluation System (DARES), that
will contain information about the overall "health" of initiatives
based upon metrics, scheduling timelines, and risk assessments. SSA
further stated that the first release of DARES is scheduled for August
2009, and future DARES releases will continue to address risks and
formulate further mitigation strategies. SSA noted that while it is
important to proactively identify risks, this activity must be balanced
with the urgency to take action to help those who have long waited for
a hearing decision.
In its comments SSA agreed that ALJ productivity is critical to the
success of its backlog reduction efforts. SSA reiterated that, even
with the variability it estimated for ALJ productivity, it believes it
has a 78 percent chance of eliminating the backlog by the end of fiscal
year 2013 and is on track to meet its ALJ productivity goals. However,
SSA agreed that in order to stay on course to reach its 2013 goal, it
would have to fully realize its assumptions--particularly its goals for
ALJ hiring and estimates about workload receipts--and receive timely,
adequate, and sustained funding.
In conclusion, SSA agreed that it needs to take a closer look at the
effect that a 20 percent increase in ALJ productivity could have on its
operations and stated that it is in the process of doing so. SSA
believes that the following steps have improved the processing of the
hearings-level disposition workload:
* Electronically identifying and tracking all hearings-level
disposition cases. This process, developed in January 2008 in one
program service center, is aimed at providing improved customer service
by allowing these cases to be worked based on the hearing request date.
* Better managing and tracking hearings-level disposition cases and
improving the proficiency and efficiency of staff through the
establishment of a centralized group of staff assigned to process these
cases. SSA established this group in one program service center in
August 2008.
* Monitoring hearings-level disposition receipts daily to increase the
focus on processing hearings-level disposition cases, including
dedicating overtime resources to this effort as needed.
* Hiring additional staff in the Program Service Centers in
anticipation of increasing hearings-level disposition cases.
SSA's written comments are reproduced in appendix IV. SSA also provided
technical comments, which were incorporated into the report as
appropriate.
We are sending copies of this report to the Commissioner of SSA and
others who are interested. The report is also available at no charge on
GAO's Web site at [hyperlink, http://www.gao.gov].
If you or your staff have any questions concerning this report, please
contact me at (202) 512-7215 or bertonid@gao.gov. Contact points for
our Office of Congressional Relations and Public Affairs may be found
on the last page of this report. Staff members making key contributions
to this report are listed in appendix V.
Signed by:
Daniel Bertoni:
Director Education, Workforce, and Income Security Issues:
[End of section]
Appendix I: Objectives, Scope, and Methodology:
We were asked to evaluate the Social Security Administration's (SSA)
plan for reducing the hearings-level backlog and preventing its
recurrence, entitled Summary of Initiatives to Eliminate the SSA
Hearings Backlog (the Plan). Specifically, we (1) examined the Plan's
potential to eliminate the hearings-level backlog, (2) determined the
extent to which the Plan included components of sound planning, and (3)
identified potential unintended effects of the Plan on hearings-level
operations and other aspects of the disability process. To address
these objectives, we analyzed SSA workload and performance data at
multiple disability process levels for fiscal year 2003 through April
2009, assessed the Plan and the Draft Appomattox Plan using sound
planning criteria from prior GAO reports, conducted interviews and site
visits with SSA central and field officials and disability-related
associations, and reviewed relevant documents from SSA and other
organizations. In addition, to address the Plan's potential to
eliminate the hearings-level backlog by fiscal year 2013, we documented
assumptions that SSA used to make this projection. We examined the
reasonableness of these assumptions based on our analysis of SSA's
workload and performance data and on interviews with SSA officials. We
also used a commercially available forecasting and risk analysis
software program to determine SSA's likelihood of eliminating the
hearings-level backlog by 2013. For additional information on our
projection modeling methodology and assumptions used in this analysis,
see appendix II. We conducted this performance audit from May 2008 to
September 2009 in accordance with generally accepted government
auditing standards. Those standards require that we plan and perform
the audit to obtain sufficient, appropriate evidence to provide a
reasonable basis for our findings and conclusions based on our audit
objectives. We believe that the evidence obtained provides a reasonable
basis for our findings and conclusions based on our audit objectives.
Analysis of SSA Workload and Performance Data:
We obtained and analyzed historical SSA workload and performance data
related to processing Disability Insurance and Supplemental Security
Income disability claims and continuing disability review (CDR)
decisions, primarily for the Disability Determination Services (DDS)
initial and hearings levels of the disability process, including the
following:[Footnote 32]
DDS initial level. We analyzed nationwide annual totals of DDS initial
claims receipts and CDR decisions for the time period from fiscal years
2003 to 2008. In addition, we analyzed nationwide annual totals of
informal remands processed and reversed by DDS offices during fiscal
years 2007, 2008, and 2009 through April.[Footnote 33]
Hearings level. We analyzed hearings-level staffing data in September
of each fiscal year, 2003 through 2008 and fiscal year 2009 through
April, for the nation. For fiscal years 2003 through 2008, we analyzed
annual totals of hearings-level receipts, dispositions, and pending
claims for the nation, and we also analyzed dispositions for fiscal
year 2009 through April. For fiscal years 2005 through 2008, we
analyzed nationwide annual totals of Appeals Council remands to hearing
offices and nationwide average hearings-level processing time. In
addition, we analyzed the fiscal year 2008 and fiscal year 2009 through
April totals of fully favorable decisions made by attorney advisors.
[Footnote 34]
To calculate the hearings-level backlog at the end of each of fiscal
years 2003 through 2008 and fiscal year 2009 through April, we compared
SSA's optimal number of pending claims with the actual number of
pending claims. If the actual number of pending claims exceeded the
optimal number of pending claims, the difference was the backlog. SSA
redefined its optimal number of pending claims two times during the
period covered by our review: in May 2007 and again in fiscal year
2008. We did not test the validity of SSA's new definitions of its
optimal number of pending claims, but SSA provided detailed rationales
for the changes.
The workload and performance data we analyzed came from several sources
within SSA. SSA said that data for the DDS initial level came from
SSA's Disability Operations Data Store (DIODS), which contains data
submitted by state DDS agencies. Data for the hearings level came from
SSA's Case Control System (CCS), Case Processing and Management System
(CPMS), and Biweekly Staffing Reports. To assess the reliability of the
hearings-level workload and performance data that SSA provided, we
conducted limited tests for which we obtained comparable data sources
identified by SSA. For example, we obtained SSA-831 and SSA-833 data as
substitutes for DIODS and CPMS Management Information data as
substitutes for CPMS data. We applied the methodology that SSA
officials told us they use to calculate workload and performance data
to the comparable data sources provided to us for our reliability
testing, and compared the results from our analyses with the results
reported by SSA. We also interviewed SSA officials and reviewed
documents regarding the reliability of these data. In general, we
determined that the data were sufficiently reliable for the purposes of
our review, although we did find one limitation with DIODS data on CDR
decisions at the DDS initial level in fiscal year 2008 that we
acknowledge in the report when discussing those data.
While we were able to assess the reliability of hearings-level
receipts, dispositions, and pending claims; Appeals Council and court
remands to hearing offices; and average hearings-level processing time
data for fiscal years 2005 through 2008, we were unable to assess the
reliability of these data for fiscal years 2003 and 2004. SSA provided
two sources for these data: Hearing Office Tracking System (HOTS),
which was replaced by CPMS in fiscal year 2005, and CCS. However, we
found that we could not assess the reliability of the data using either
source. First, HOTS did not contain raw data that we could manipulate.
Second, SSA no longer uses CCS to generate hearings-level workload and
performance data, had concerns about the reliability of these data, and
no longer had staff with technical expertise and knowledge of these
data to help us in our validation efforts.
Components of Sound Planning:
To determine the extent to which SSA's Plan included components of
sound planning, we assessed the Plan based on criteria from previous
GAO reports.[Footnote 35] In these reports we defined a number of
desirable characteristics of an effective, results-oriented plan, or
components of sound planning. Although there is no established set of
requirements for all plans, we determined that these components of
sound planning help implementing parties and decision makers
effectively shape policies, programs, priorities, and resource
allocations so that they can achieve desired results while ensuring
accountability. While the components may be organized in a variety of
ways and/or use different terms, we present them in six categories,
from plan conception to implementation. Table 4 describes the
components of sound planning and examples of their elements.
Table 4: Components of Sound Planning and Examples of Their Elements:
Component: 1. Purpose, scope, and methodology;
Examples of elements:
* Discusses the plan's purpose;
* Defines or discusses key terms, major functions, mission areas, or
activities the plan covers;
* Discusses the process that produced the plan.
Component: 2. Problem definition, causes, and operating environment;
Examples of elements:
* Includes a detailed discussion or definition of the problems the plan
intends to address;
* Includes a detailed discussion of the causes of the problems;
* Includes a detailed discussion of the operating environment.
Component: 3. Goals, objectives, activities, and performance measures;
Examples of elements:
* Addresses plan goals and subordinate objectives;
* Identifies specific activities to achieve results;
* Addresses priorities, milestones, and outcome-related performance
measures;
* Identifies process to monitor and report on progress.
Component: 4. Resources, investments, and risks;
Examples of elements:
* Identifies what the plan will cost;
* Identifies the sources and types of resources or investments needed;
* Addresses where resources or investments should be targeted to
balance risks and costs;
* Identifies risk management principles and how they will aid
implementing parties in prioritizing and allocating resources.
Component: 5. Roles, responsibilities, and coordination;
Examples of elements:
* Addresses who will be implementing the plan;
* Addresses lead, support, and partner roles and responsibilities of
specific federal agencies, departments, or offices;
* Addresses mechanisms and processes for parties to coordinate efforts
both within the agency and with other agencies.
Component: 6. Integration among and with other entities;
Examples of elements:
* Addresses how the plan relates to other federal/state offices or
agencies (horizontal);
* Addresses integration with relevant documents from federal, state,
and subordinate levels (vertical).
Source: GAO.
[End of table]
Site Visits and Phone Interviews with SSA Central Office and Field
Staff:
We conducted site visits to the National Hearing Center and to 3 of 10
SSA regions--Atlanta (region 4), Chicago (region 5), and Seattle
(region 10)--to obtain information about the challenges of implementing
Plan initiatives and the Plan's potential effects on hearing offices
and other SSA operations. During these site visits, we interviewed a
variety of staff from seven hearing offices, including Hearing Office
Directors, administrative law judges (ALJ), decision writers, and
support staff. We also interviewed officials at three regional Office
of Disability Adjudication and Review (ODAR) offices, two state DDS
offices, one program service center, and one teleservice center located
in our three selected regions.[Footnote 36] In addition we conducted
phone interviews with staff from several additional offices in our
three selected regions, including one DDS office, one program service
center, three field offices, and one Regional Office of Quality
Assurance.
We used several criteria to select the regions for our site visits. We
selected one region that performed above average (region 10) and two
that performed below average (regions 4 and 5) based on fiscal year
2007 regional backlog performance factors that we calculated, including
the size of the backlog at the end of fiscal year 2007, the number of
backlogged claims per ALJ at the end of fiscal year 2007, and the
number of backlogged claims in relation to both the number of receipts
and the number of dispositions in fiscal year 2007. We also took into
consideration that regions 4 and 5 would potentially be most affected
by the Plan because together they represented over 60 percent of total
backlogged hearings-level claims at the end of fiscal year 2007, each
comprising over 30 percent of the backlog on that date.[Footnote 37] In
addition, Chicago and Seattle were the two regions that GAO previously
identified as having a large percentage of aged claims within them.
[Footnote 38] (See table 5.)
Table 5: Fiscal Year 2007 Regional Backlog Performance Factors:
Nation;
Backlog at the end of the fiscal year: 362,253;
Number of backlogged claims per full-time, on-duty ALJ: 339;
Backlog as a percentage of total receipts: 63;
Backlog as a percentage of total dispositions: 66.
Region 1 (Boston);
Backlog at the end of the fiscal year: 0;
Number of backlogged claims per full-time, on-duty ALJ: 0;
Backlog as a percentage of total receipts: 0;
Backlog as a percentage of total dispositions: 0.
Region 2 (New York);
Backlog at the end of the fiscal year: 33,873;
Number of backlogged claims per full-time, on-duty ALJ: 346;
Backlog as a percentage of total receipts: 65;
Backlog as a percentage of total dispositions: 64.
Region 3 (Philadelphia);
Backlog at the end of the fiscal year: 20,211;
Number of backlogged claims per full-time, on-duty ALJ: 166;
Backlog as a percentage of total receipts: 29;
Backlog as a percentage of total dispositions: 31.
Region 4 (Atlanta);
Backlog at the end of the fiscal year: 118,241;
Number of backlogged claims per full-time, on-duty ALJ: 448;
Backlog as a percentage of total receipts: 77;
Backlog as a percentage of total dispositions: 83.
Region 5 (Chicago);
Backlog at the end of the fiscal year: 111,009;
Number of backlogged claims per full-time, on-duty ALJ: 681;
Backlog as a percentage of total receipts: 109;
Backlog as a percentage of total dispositions: 136.
Region 6 (Dallas);
Backlog at the end of the fiscal year: 29,977;
Number of backlogged claims per full-time, on-duty ALJ: 217;
Backlog as a percentage of total receipts: 42;
Backlog as a percentage of total dispositions: 41.
Region 7 (Kansas City);
Backlog at the end of the fiscal year: 29,129;
Number of backlogged claims per full-time, on-duty ALJ: 594;
Backlog as a percentage of total receipts: 92;
Backlog as a percentage of total dispositions: 113.
Region 8 (Denver);
Backlog at the end of the fiscal year: 7,649;
Number of backlogged claims per full-time, on-duty ALJ: 255;
Backlog as a percentage of total receipts: 50;
Backlog as a percentage of total dispositions: 49.
Region 9 (San Francisco);
Backlog at the end of the fiscal year: 4,560;
Number of backlogged claims per full-time, on-duty ALJ: 37;
Backlog as a percentage of total receipts: 9;
Backlog as a percentage of total dispositions: 9.
Region 10 (Seattle);
Backlog at the end of the fiscal year: 11,324;
Number of backlogged claims per full-time, on-duty ALJ: 315;
Backlog as a percentage of total receipts: 66;
Backlog as a percentage of total dispositions: 66.
Source: GAO analysis of SSA data.
[End of table]
Within these 3 regions, we selected seven hearing offices showing
differences in terms of receipts, backlogged claims, and average number
of dispositions per ALJ in fiscal year 2007. We selected these hearing
offices, in part because they were within reasonable proximity to each
other within each selected region and were involved with implementing
selected Plan initiatives in fiscal year 2008. All of the offices had
implemented the Attorney Advisor Program, and one office was piloting
the ePulling initiative, both of which SSA believes are key to reducing
the backlog. (See table 6.)
Table 6: Fiscal Year 2007 Hearing Office Statistics:
Region 4;
Hearing office: Atlanta;
Receipts: 4,969;
Backlog (end of fiscal year): 6,662;
Average number of dispositions per ALJ: 394.
Region 4;
Hearing office: Atlanta North;
Receipts: 5,902;
Backlog (end of fiscal year): 9,042;
Average number of dispositions per ALJ: 559.
Region 4;
Hearing office: Tupelo;
Receipts: 3,774;
Backlog (end of fiscal year): 1,281;
Average number of dispositions per ALJ: 446.
Region 5;
Hearing office: Chicago;
Receipts: 4,207;
Backlog (end of fiscal year): 2,193;
Average number of dispositions per ALJ: 396.
Region 5;
Hearing office: Evanston;
Receipts: 3,770;
Backlog (end of fiscal year): 0;
Average number of dispositions per ALJ: 431.
Region 5;
Hearing office: Oak Brook;
Receipts: 4,543;
Backlog (end of fiscal year): 1,675;
Average number of dispositions per ALJ: 442.
Region 10;
Hearing office: Seattle;
Receipts: 6,080;
Backlog (end of fiscal year): 4,052;
Average number of dispositions per ALJ: 467.
Source: GAO analysis of SSA data.
[End of table]
In addition, we interviewed SSA central office officials, including
officials from ODAR, the offices of the Deputy Commissioners for
Operations and Quality Performance, and the offices of the Chief
Administrative Law Judge, Disability Determinations, Budget, Systems,
and the Chief Actuary. We also interviewed officials from various
associations, including the National Association of Disability
Examiners (NADE), the Association of Administrative Law Judges (AALJ),
the National Council of Disability Determination Directors, the
National Council of Social Security Management Associations, the Social
Security Advisory Board (SSAB), and the National Organization of Social
Security Claimants' Representatives (NOSSCR).
To analyze information from the interviews and site visits, we
conducted a content analysis using NVivo software and identified
factors that contributed to the hearings backlog and the Plan's
potential effects on hearing offices and other SSA operations. Of 20
potential effects identified, we selected 8 to highlight in this report
based on a number of factors, including how often the effect was cited,
the potential severity of the effect, and whether SSA had addressed the
effect.
Document Review:
We reviewed SSA's Plan and Draft Appomattox Plan, end-of-year annual
and semiannual Plan status reports from September 2007 through
September 2008, and other documents SSA provided to supplement
information in the Plan. We also reviewed prior reports and testimonies
from GAO, SSA, and SSA's Office of the Inspector General on the
hearings backlog. We also reviewed position papers and testimonies from
a number of national disability-related organizations, including NADE,
AALJ, NOSSCR, and SSAB. We reviewed these documents to gather
information on how SSA developed the Plan and monitored its progress
and to gather evaluations of and concerns about the Plan.
[End of section]
Appendix II: Modeling Methodology and Results:
This appendix describes the methodology and results of the analysis we
used to estimate the likelihood that the Social Security Administration
(SSA) will eliminate the hearings-level backlog by the end of fiscal
year 2013. Specifically, this appendix contains a discussion of the
following:
* the simulation technique and modeling framework we used to estimate
the likelihood that SSA will reach its backlog elimination target,
* SSA's modeling framework and results,
* SSA's assumptions and recent experience, and:
* a comparison of results from various alternate scenarios.
Modeling Methodology:
To conduct our analysis, we developed a modeling framework based on a
spreadsheet that SSA used to support its fiscal year 2010 budget
request in which it made assumptions about workload, performance, and
staffing levels through fiscal year 2013. SSA's Office of Budget
originally developed this spreadsheet to evaluate the reasonableness of
the SSA Commissioner's goal of eliminating the backlog by the end of
fiscal year 2013. SSA's spreadsheet begins with total hearings-level
pending at the end of fiscal year 2008 and extends through fiscal year
2013, and includes SSA's updated actuarial projections of disability
receipts, expectations about the effect of funding from the American
Recovery and Reinvestment Act of 2009 (Recovery Act), and plans for
increased fiscal year 2010 budget funding.[Footnote 39] We used SSA's
spreadsheet as the basis for our modeling framework that we input into
a commercially available forecasting and risk analysis software program
called Crystal Ball to project the likelihood that SSA would eliminate
the backlog by its target date, given various scenarios. Specifically,
the Crystal Ball program produced results for each of the scenarios by
running thousands of simulation trials in which the program randomly
selected values for workload, performance, and staffing inputs from
ranges that we prespecified.
SSA's Modeling Framework and Results:
SSA developed a similar modeling framework that it used in concert with
a Crystal Ball software program to estimate that it has a 78 percent
chance of eliminating the hearings-level backlog by the end of fiscal
year 2013. SSA officials told us that their framework should not
produce results substantially different than those from our framework,
given the same assumptions, because it uses the same basic calculation--
starting with total hearings-level cases pending at the end of fiscal
year 2008 and extending through fiscal year 2013. SSA officials stated
that their framework uses slightly different assumptions for
productivity and more detailed assumptions for hearings-level receipts.
For example, in our framework, there is one high-level summary total
for hearings-level receipts, but in SSA's framework, the hearings-level
receipts total is broken out into four subcategories, each of which has
its own minimum, maximum, and most likely values. We reviewed SSA's
framework to better understand SSA's estimate of its likelihood for
eliminating the hearings backlog by its projected date, but given our
time constraints, we were unable to validate the appropriateness of
SSA's new framework.
SSA's Assumptions and Recent Workforce and Performance Experience:
In both its fiscal year 2010 budget request spreadsheet and modeling
framework, SSA includes assumptions about future levels of hearings-
level receipts and dispositions--both of which affect the likelihood
that SSA will eliminate its backlog. While hearings-level receipts are
driven in part by factors outside of SSA's control, including the
health of the economy, size of the population, and appeals file rates,
given adequate funding, hearings-level dispositions are primarily
driven by factors within SSA's control, including its ability to
achieve workforce and performance goals. Because hearings-level
dispositions can be controlled by SSA, we evaluated SSA's recent actual
workforce and performance experience to determine the impact on its
likelihood for eliminating the backlog by fiscal year 2013, if SSA does
not meet its goals. To estimate these results, we used performance and
staffing data from SSA's Office of the Deputy Commissioner for
Disability Adjudication and Review and Office of Disability
Determinations for fiscal year 2008 through April 2009. For the
workforce and performance assumptions that we varied differently than
SSA, we primarily used these recent experience data to formulate our
minimum, maximum, and most likely values, but also included SSA's
expected values, to allow that SSA could at least achieve its goals.
See below.
Hearings-level receipts. We used SSA's hearings-level receipts
assumptions to vary this assumption for our results in all of our
scenarios, including SSA's subcategories and related maximum, minimum,
and most likely values.
Average number of on-duty ALJs. SSA's goal is to hire enough ALJs to
reach a cadre of about 1,450 in fiscal year 2011, but SSA officials
told us that the average number of on-duty ALJs could be slightly less
because of annual ALJ attrition and timing constraints in the hiring
process. Thus, SSA assumes that it will be able to hire ALJs to reach
an average of 1,442 ALJs on duty in fiscal year 2011 and maintain that
level through 2013. Our assessment of SSA's staffing data shows that in
fiscal year 2008, SSA's average number of on-duty ALJs was 1 percent
lower than SSA expected, and in fiscal year 2009 through April, SSA's
average number of on-duty ALJs was 2 percent below SSA's expectation
for the year. Thus, to estimate the impact of SSA's not meeting this
goal, we used values for this assumption that ranged from 98 percent of
SSA's annual expectation to 100 percent of SSA's expectation, with a
most likely value of 99 percent of SSA's expectation--the difference
actually experienced by SSA in fiscal year 2008.
Average ALJ availability. Generally, SSA assumes that experienced ALJs
are available about 93 percent of the time, but in years when SSA hires
many new ALJs, it assumes that average ALJ availability will be lower
because the new ALJs need to be trained and gain experience before they
start to produce at the level of an experienced ALJ. In fact, because
SSA plans to hire ALJs in fiscal years 2009 through 2013 to reach and
maintain a cadre of about 1,450 ALJs, SSA assumes lower average ALJ
availability percentages in each year through fiscal year 2013--about
90 percent of the time in fiscal years 2009 and 2010 and between 91 and
92 percent in each fiscal year from 2011 to 2013. Our analysis of SSA
staffing data shows that average ALJ availability, as reported by
hearing offices, was 88 percent in fiscal year 2008, when SSA hired 190
additional ALJs, and 91 percent in fiscal year 2009 through April.
Because SSA plans to hire over 360 additional ALJs in fiscal years 2009
and 2010, we used values for this assumption that ranged from 88
percent to 91 percent, actual reported values, with a most likely value
of SSA's expected average of 90 percent. However, consistent with SSA's
expectations, we used average ALJ availability values for fiscal years
2011 through 2013, ranging from 91 to 92 percent, with a most likely
average availability of 92 percent.
Average ALJ productivity. SSA assumes that average ALJ productivity
will be about 570 dispositions per average available ALJ in fiscal
years 2009 through 2013. Though SSA's way for measuring productivity in
its modeling framework differs slightly from the measure we used in our
modeling framework, SSA officials agreed that an average ALJ
productivity of 570 plus or minus 3 percent was a fair representation
of its productivity assumption. Our analysis of recent performance data
shows that ALJs have not produced 570 dispositions per average
available ALJ in the past 5 years. Most recent experience shows that
each average available ALJ produced at an annualized rate of about 546
dispositions in fiscal year 2009 through April. However, since SSA
plans to hire additional support staff with funding provided through
the Recovery Act, its fiscal year 2009 appropriation, and its fiscal
year 2010 budget request, we estimated that this number could be
adjusted upward to 560 dispositions per average available ALJ to
reflect the potential effect of the increased support staff on ALJ
performance. Consistent with SSA's treatment of a similar assumption
about productivity, we assumed a variation of plus or minus 3 percent
around this value to develop our minimum and maximum average ALJ
productivity range.
Informal remands reversed. Since this initiative was new in fiscal year
2007, and thus few recent data existed, we used SSA's assumptions in
our modeling framework. SSA used point estimates of 8,500 informal
remands reversed for each year and did not attribute maximum, minimum,
and most likely values to this disposition type.
Attorney Advisor Program dispositions. Since this initiative was
reestablished in fiscal year 2008, and thus few recent data existed, we
used SSA's assumptions in our modeling framework. SSA used a most
likely value of 32,300, and a range of plus or minus 1 percent of
32,300 for this disposition type.
Results from Various Alternate Scenarios:
To test the consistency between SSA's and our modeling frameworks, we
used an approximation of SSA's more detailed assumptions in our
framework, since SSA officials told us the assumptions were generally
still appropriate, and estimated that SSA has a 77 percent likelihood
of eliminating the backlog by fiscal year 2013.
In addition to replicating SSA's results, we ran several alternate
scenarios with varying assumptions to show how the likelihood of SSA's
eliminating the backlog by the end of fiscal year 2013 may change if
SSA is able to make progress toward its goals on workforce or
performance, but not achieve them completely. For all of our alternate
scenarios, we used varying combinations of SSA's assumptions and
assumptions from our assessment of recent SSA experience about average
numbers, availability, and productivity of ALJs. In these scenarios, we
found that:
* If SSA achieves the ALJ productivity levels it assumes, but its
average ALJ hiring and availability are consistent with SSA's recent
experience, we estimate it has about a 53 percent chance of eliminating
the hearings-level backlog by 2013.[Footnote 40]
* If SSA achieves the ALJ hiring and availability levels it assumes,
but its average ALJ productivity is consistent with SSA's recent
experience, but increased because of additional support staff, we
estimate that it has about a 34 percent chance eliminating the hearing-
level backlog by 2013.[Footnote 41]
* If SSA does not achieve any of the levels of ALJ hiring,
availability, or productivity that it assumes, and if its performance
is consistent with SSA's recent experience--but productivity is
increased because of additional support staff--we estimate that SSA has
about a 14 percent chance of eliminating the hearings-level backlog by
2013.[Footnote 42]
[End of section]
Appendix III: Status of Plan Initiatives:
Approach: compassionate allowances:
Plan initiatives[A]: 1; Use processes, such as Quick Disability
Determinations, to screen claims for approval at the initial claims
level;
SSA's intended effects on the hearings backlog[B]: Indirect effect--
allow claims to be decided quicker and improve accuracy at the initial
claims level, possibly reducing the number of claims entering the
hearings level;
Status as of fiscal year 2008 year end[C]: Was not included in SSA's
fiscal year 2008 Year End Annual Report on the Plan.
Plan initiatives[A]: 2; Update medical listings and definition of
disability categories for the initial claims level;
SSA's intended effects on the hearings backlog[B]: Indirect effect--
allow claims to be decided quicker and improve accuracy at the initial
claims level, possibly reducing the number of claims entering the
hearings level;
Status as of fiscal year 2008 year end[C]: Was not included in SSA's
fiscal year 2008 Year End Annual Report on the Plan.
Plan initiatives[A]: 3; Reorganize the Office of Disability and Income
Support Programs;
SSA's intended effects on the hearings backlog[B]: Does not relate--SSA
noted that initiative should be deleted from the Plan;
Status as of fiscal year 2008 year end[C]: Was not included in SSA's
fiscal year 2008 Year End Annual Report on the Plan.
Plan initiatives[A]: 4; Refine two primary Disability Determination
Services (DDS) electronic systems for the initial claims level;
SSA's intended effects on the hearings backlog[B]: Indirect effect--
improve electronic capabilities by supporting systems at the initial
claims level for other Plan initiatives, including Quick Disability
Determinations and processing informal remands from the hearings level;
Status as of fiscal year 2008 year end[C]: Was not included in SSA's
fiscal year 2008 Year End Annual Report on the Plan.
Approach: improve hearing office procedures:
Plan initiatives[A]: 5; Reduce aged claims at the hearings level by
working on those that have been in the hearings process the longest;
SSA's intended effects on the hearings backlog[B]: Improve processing
time as claims become more current by reducing the number of older
claims, which may take longer to process than newer ones;
Status as of fiscal year 2008 year end[C]: Eliminated all claims that
would be 1,000 days old in fiscal year 2007 and 900 days old in fiscal
year 2008, and work on 850-day old claims in fiscal year 2009.
Plan initiatives[A]: 6; Allow attorney advisors to issue fully
favorable decisions at the hearings level without direct ALJ
involvement (Attorney Advisor Program);
SSA's intended effects on the hearings backlog[B]: Increase
dispositions and improve processing time by expediting claims that are
screened to be fully favorable;
Status as of fiscal year 2008 year end[C]: Attorney advisors issued
24,575 fully favorable decisions in fiscal year 2008.
Plan initiatives[A]: 7; Hire additional ALJs and support staff for the
hearings level, appoint senior judges, and hire ALJs from other
agencies;
SSA's intended effects on the hearings backlog[B]: Increase
dispositions;
Status as of fiscal year 2008 year end[C]: A total of 190 new ALJs were
hired in fiscal year 2008. The number of support staff hired was not
included in SSA's fiscal year 2008 Year End Annual Report on the Plan.
Approach: increase adjudicatory capacity:
Plan initiatives[A]: 8; Increase overtime allocations for hearing
office and other SSA staff to prepare, or pull, claims for review in
order to fill hearing dockets to capacity;
SSA's intended effects on the hearings backlog[B]: Increase the number
of claims ready for ALJ review;
Status as of fiscal year 2008 year end[C]: Deputy Commissioner of
Operations employees used 62,800 hours of overtime in hearing offices
to complete 866,000 tasks, including preparing over 13,000 claims
through streamlined folder assembly in fiscal year 2008.
Plan initiatives[A]: 9; Provide options for ALJs to voluntarily review
streamlined folders, or folders that are either unprepared or partially
prepared by support staff, in order to fill hearing dockets to
capacity;
SSA's intended effects on the hearings backlog[B]: Increase the number
of claims ready for ALJ review;
Status as of fiscal year 2008 year end[C]: Over 51,000 claims were
prepared for hearings using streamlined folder assembly in fiscal year
2008.
Plan initiatives[A]: 10; Improve ALJ productivity to 500 to 700
dispositions per year;
SSA's intended effects on the hearings backlog[B]: Increase
dispositions;
Status as of fiscal year 2008 year end[C]: Issued a letter
communicating expectations to ALJs in October 2007. Also convened the
first National Judicial Education Conference for ALJs and
administrative appeals judges. ALJs conducted over 14,700 more hearings
in fiscal year 2008 than in fiscal year 2007.
Plan initiatives[A]: 11; Screen potentially favorable claims at the
hearings level and return, or remand, them to the DDS initial claims
level (Informal Remand initiative);
SSA's intended effects on the hearings backlog[B]: Reduce hearing
office workload--remanded claims that are found favorable are dismissed
at the hearings level, while those not decided as favorable are
returned to the hearings level;
Status as of fiscal year 2008 year end[C]: Of 50,000 claims remanded,
nearly 17,000 decisions were made by the DDS initial claims level in
fiscal year 2008.
Plan initiatives[A]: 12; Implement a screening process where medical
experts provide input to ALJs for likely on-the-record decisions, or
decisions that can be made without a hearing;
SSA's intended effects on the hearings backlog[B]: Improve processing
time by increasing the number of claims decided on the record;
Status as of fiscal year 2008 year end[C]: Implemented a medical expert
screening process in March 2008.
Plan initiatives[A]: 13; Open a centralized National Hearings Center to
handle electronic claims files at the hearings level and conduct only
video hearings;
SSA's intended effects on the hearings backlog[B]: Balance hearing
office workloads by transferring claims from hearing offices with
higher backlogs to the National Hearings Center;
Status as of fiscal year 2008 year end[C]: A National Hearings Center
opened in Virginia in October 2007 and issued over 2,000 dispositions
on over 4,500 claims transferred in fiscal year 2008. National Hearing
Centers in New Mexico and Illinois are planned for fiscal year 2009.
Approach: increase efficiency with automation and improved business
processes:
Plan initiatives[A]: 14; Develop a new electronic claim-processing and
management system for the Appeals Council;
SSA's intended effects on the hearings backlog[B]: Save time for
hearings-level support staff by eliminating some support staff
functions in converting Appeals Council remands from paper to
electronic files;
Status as of fiscal year 2008 year end[C]: Trained staff and
implemented system in June 2008.
Plan initiatives[A]: 15; Increase the amount of electronic data
propagated to the Hearing Office claim-processing system;
SSA's intended effects on the hearings backlog[B]: Save time for
hearings-level support staff by generating more data electronically;
Status as of fiscal year 2008 year end[C]: Enhancements made to July
2008 systems release.
Plan initiatives[A]: 16; Provide ALJs the ability to sign hearings-
level dispositions electronically (eSignature);
SSA's intended effects on the hearings backlog[B]: Save time for
hearings-level support staff by eliminating some support staff
functions necessary for obtaining an ALJ signature via paper;
Status as of fiscal year 2008 year end[C]: Implemented in July 2008.
Plan initiatives[A]: 17; Centralize hearing office printing and mailing
through a private contractor;
SSA's intended effects on the hearings backlog[B]: Save time for
hearings-level support staff by eliminating some support staff printing
and mailing functions, such as notices to claimants;
Status as of fiscal year 2008 year end[C]: Implemented in August 2008
with 11 notices. Additional notices to be added.
Plan initiatives[A]: 18; Plan initiatives[A]: Enhance electronic
hearing office management information;
SSA's intended effects on the hearings backlog[B]: Improve management
and accountability for hearing offices;
Status as of fiscal year 2008 year end[C]: Additional reports released
and more to be added.
Plan initiatives[A]: 19; Provide support to send additional documents
to the hearings-level electronic folder;
SSA's intended effects on the hearings backlog[B]: Save time for
hearings-level support staff by eliminating some support staff printing
and scanning functions;
Status as of fiscal year 2008 year end[C]: In development.
Plan initiatives[A]: 20; Provide shared access to the hearings-level
electronic folder for other components involved in the disability
process, such as the DDS initial claims level and Appeals Council;
SSA's intended effects on the hearings backlog[B]: Improve coordination
among SSA offices involved in the disability process;
Status as of fiscal year 2008 year end[C]: Enhancements made in
February 2008.
Plan initiatives[A]: 21; Enhance the Electronic Records Express, an
Internet support system for authorized claimant representatives at the
hearings level;
SSA's intended effects on the hearings backlog[B]: Save time for
hearings-level support staff by eliminating some support staff
functions in compiling and sending information to claimants'
representatives by allowing authorized representatives to access their
claimants' files electronically;
Status as of fiscal year 2008 year end[C]: Pilot began in July 2008.
Plan initiatives[A]: 22; Provide additional video hearing equipment to
conduct hearings, including video units in hearing rooms, on ALJ
desktop computers, and on desktops of authorized claimant
representatives;
SSA's intended effects on the hearings backlog[B]: Save time and costs
for ALJs by eliminating the need for ALJs to travel for hearings;
improve processing times because travel dockets do not have to wait to
be filled before ALJs hear the claims, and the number of available
hearing facilities is increased; balance hearing office workloads by
providing the ability to transfer claims between hearing offices in
different geographic locations;
Status as of fiscal year 2008 year end[C]: Added 145 new video units.
Pilot for desktop video units for hearing offices began March 2008.
Process of developing desktop video units for claimant representatives
is ongoing.
Plan initiatives[A]: 23; Update hearing office electronic systems
infrastructure;
SSA's intended effects on the hearings backlog[B]: Improve electronic
capabilities;
Status as of fiscal year 2008 year end[C]: Installed new servers,
workstations, printers, videoconferencing equipment, and
telecommunications equipment in hearing offices, including at the
National Hearings Center.
Plan initiatives[A]: 24; Implement electronic file assembly for the
hearings level to automate claim preparation, or pulling (ePulling);
SSA's intended effects on the hearings backlog[B]: Save time for
hearings-level support staff by eliminating some support staff claim
preparation activities prior to ALJ review, such as numbering pages and
removing duplicate documents;
Status as of fiscal year 2008 year end[C]: Pilot began in August 2008.
Plan initiatives[A]: 25; Implement electronic scheduling of hearings
(eScheduling);
SSA's intended effects on the hearings backlog[B]: Save time for
hearings-level support staff by eliminating some support staff
functions in scheduling hearings;
Status as of fiscal year 2008 year end[C]: In development.
Plan initiatives[A]: 26; Transition hearings-level paper claims to the
electronic folder system;
SSA's intended effects on the hearings backlog[B]: Improve electronic
capabilities;
Status as of fiscal year 2008 year end[C]: Eighty-six percent of
pending workload in fiscal year 2008 is electronic.
Plan initiatives[A]: 27; Mandate the Findings Integrated Template
(FIT), an electronic template for decision writing;
SSA's intended effects on the hearings backlog[B]: Reduce hearings-
level workloads by preventing Appeals Council remands due to improved
hearings-level decision writing;
Status as of fiscal year 2008 year end[C]: Template was used to draft
94 percent of written decisions in fiscal year 2008.
Plan initiatives[A]: 28; Provide the ability for the Appeals Council to
issue final decisions on claims that would have been remanded to the
hearings level (Appeals Council initiative);
SSA's intended effects on the hearings backlog[B]: Reduce hearings-
level workloads by decreasing the number of remands from the Appeals
Council;
Status as of fiscal year 2008 year end[C]: Appeals Council remands
consistently decreased in fiscal year 2008.
Plan initiatives[A]: 29; Provide improved training to the hearing
office management teams;
SSA's intended effects on the hearings backlog[B]: Improve management
and accountability for hearing offices;
Status as of fiscal year 2008 year end[C]: Training Web site launched
in January 2008 and hearing office management summit was held in June
2008.
Plan initiatives[A]: 30; Expand cooperation among hearing offices, SSA
field offices, and SSA area director offices;
SSA's intended effects on the hearings backlog[B]: Indirect effect--
improve customer service and coordination among SSA offices involved in
the disability process;
Status as of fiscal year 2008 year end[C]: National work group
developed recommendations.
Plan initiatives[A]: 31; Establish a standardized electronic business
process to provide procedural guidance on how claims should be
processed at the hearings level; conduct task time analyses to
determine processing times for each stage of the electronic business
process at the hearings level;
SSA's intended effects on the hearings backlog[B]: Improve management
and accountability for hearing offices. Save time for ALJs--ensures
that claims are appropriately prepared for ALJ review; balance hearing
office workloads by allowing claims to be more easily transferred
between hearing offices because they are prepared similarly;
Status as of fiscal year 2008 year end[C]: Process was developed based
on best practices and established policies to ensure consistent case
processing methods throughout the Office of Disability Adjudication and
Review.
Plan initiatives[A]: 32; Implement an in-line quality assurance program
for claim preparation and decision writing;
SSA's intended effects on the hearings backlog[B]: Improve management
and accountability for hearing offices, save time for ALJs by ensuring
that claims are appropriately prepared for ALJ review, balance hearing
office workloads by allowing claims to be more easily transferred
between hearing offices because they are prepared similarly, reduce
hearing office workloads by preventing Appeals Council remands due to
technical errors in hearings-level decision writing;
Status as of fiscal year 2008 year end[C]: In development.
Plan initiatives[A]: 33; Use electronic tools to expand reviews of
claims denied at the reconsideration level, which are made after the
initial claims level and before the hearings level;
SSA's intended effects on the hearings backlog[B]: Reduce hearings-
level workloads by improving the accuracy of reconsideration level
decisions that may enter the hearings level;
Status as of fiscal year 2008 year end[C]: Reviews began in September
2007.
Plan initiatives[A]: 34; Continue decision writer productivity
improvements;
SSA's intended effects on the hearings backlog[B]: Improve processing
time by increasing decision writer productivity;
Status as of fiscal year 2008 year end[C]: Management tools introduced
in fiscal year 2007 to assess the timeliness of decision writer
workloads.
Plan initiatives[A]: 35; Effectuate service area realignments and claim
transfers between hearing offices;
SSA's intended effects on the hearings backlog[B]: Balance hearing
office workloads by transferring claims from hearing offices with
higher backlogs to hearing offices with lower backlogs;
Status as of fiscal year 2008 year end[C]: Realignment and claim
transfer plan implemented and analysis of workload data continues.
Plan initiatives[A]: 36; Use weekly workload reporting and monitoring
at the hearings level;
SSA's intended effects on the hearings backlog[B]: Improve management
and accountability for hearing offices;
Status as of fiscal year 2008 year end[C]: Hearing office managers
encouraged to monitor hearing office workloads weekly and additional
workload reports are being developed.
Plan initiatives[A]: 37; Colocate remote hearing sites with SSA field
offices;
SSA's intended effects on the hearings backlog[B]: Indirect effect--
improve customer service and conserve SSA resources;
Status as of fiscal year 2008 year end[C]: Colocation plan developed
and will be implemented as leases expire.
Plan initiatives[A]: 38; Improve the public ALJ alleged misconduct
complaint process;
SSA's intended effects on the hearings backlog[B]: Indirect effect--
improve management, and accountability of ALJs;
Status as of fiscal year 2008 year end[C]: Electronic fact sheets,
posters, and letters to claimants updated. System to track complaints
is in development.
Source: GAO analysis of SSA data.
[A] Based on SSA data.
[B] Based on SSA data.
[C] Based on SSA's Plan to Eliminate the Hearing Backlog and Prevent
Its Recurrence Annual Report, Fiscal Year 2008.
[End of table]
[End of section]
Appendix IV: Comments from the Social Security Administration:
Social Security:
The Commissioner:
Social Security Administration:
Baltimore, MD 21235-0001:
July 20, 2009:
Daniel Bertoni, Director:
Education, Workforce, and Income Security Issues:
U.S. Government Accountability Office:
441 G St., 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:
Additional Performance Measures and Better Cost Estimates Could Help
Improve SSA's Efforts to Eliminate Its Hearings Backlog" (GAO-09-398).
Enclosed are our detailed comments to the draft report findings and
recommendations, along with suggested technical revisions.
If you have any questions, please contact me or have your staff contact
Candace Skurnik, Director, Audit Management and Liaison Staff, at (410)
965-4636.
Sincerely,
Signed by:
Michael J. Astrue:
Enclosure:
[End of letter]
Comments On The Government Accountability Office (GAO) Draft Report,
"Social Security Disability: Additional Performance Measures And Better
Cost Estimates Could Help Improve SSA'S Efforts To Eliminate Its
Hearings Backlog" (GAO-09-398)
Our responses to the specific recommendations are as follows:
Recommendation 1:
Develop performance goals and measures for initiatives that currently
do not have them.
Comment:
We partially disagree. We currently have established performance goals
and measures for 19 of our 35 initiatives.[Footnote 43] Fourteen of the
remaining initiatives are not conducive to a performance goal or
measure (such as, improving the administrative law judge (ALJ)
misconduct process and improving hearing office management training).
Rather than imposing a quantitative measure, we track milestones to
ensure these initiatives remain on schedule for implementation.
We are in the process of developing goals and measures for the
remaining two initiatives, standardized electronic business process and
in-line quality assurance program. We currently monitor our progress on
these initiatives using management information from our Case Processing
and Management System (CPMS).
We are also developing a management oversight tool called the
Disability Adjudication Reporting and Evaluation System (DARES) that
will contain information about the overall "health" of the initiatives
based upon metrics, scheduling timelines, and risk assessments. With
this reporting and decisional support dashboard tool, executives
overseeing the hearing backlog initiatives can more quickly identify
early warning signs and take necessary action to keep the initiatives
on track. While it is still a work in progress, this tool will address
risk analysis and mitigation strategies for each component of the plan.
Existing management information will show the data, or metrics, used to
assess how close we are to the target. The metric data in DARES is
based on CPMS management information, disability adjudication reporting
tools (DART), and spreadsheets that have been developed for specific
initiatives. Release I of DARES, supporting the first group of
initiatives (e.g., aged cases, senior attorney adjudication and DDS
informal remands). will he in production in August 2009. Subsequent
releases will accommodate additional initiatives.
Recommendation 2:
Develop cost estimates for the initiatives SSA considers critical to
eliminating the hearings-level backlog in addition to the time savings
estimates already developed.
Comment:
We disagree with the finding that we did not develop cost estimates for
the backlog reduction plan. An essential part of our development and
implementation planning process was a full evaluation of the costs and
savings associated with implementing all major aspects of the plan. Our
budget requests for fiscal years (FY) 2009 and 2010 incorporate the
full costs and savings related to implementation of the plan.
Specifically, as part of the budget formulation process, we are
required to identify associated costs and potential cost savings of any
initiatives we plan to pursue. Ln developing the plan, we identified
and included electronic initiatives that were in the early
developmental stages and, thus, we did not include specific costs
savings for each initiative. However, overall we have provided for the
anticipated impact on the backlog, and over time, we have refined cost
and savings estimates when possible.
Recommendation 3:
Move forward with formalizing agency risk assessments associated with
the Plan's implementation, including assessing both risks that would
hinder the Plan's success and risks that could cause adverse effects or
trade-offs related to hearings-level performance and other SSA
operations along with mitigating strategies.
Comment:
We agree that we need to move forward on formalizing risk assessment
and note that we are being proactive in identifying risks. While we
implemented the plan quickly to address a critical workload, we have
monitored all initiatives closely, and we continue to assess issues
that could prevent the success of an initiative and to plan mitigation
strategies, if possible. Although we may not have done "formal" risk
analysis for every initiative, since the plan's inception. we have
considered risks we may encounter and what effect the initiative may
have on all SSA components. We have put strategies in place to deal
with these risks using tools such as CPMS management information
reports, internal spreadsheets, and DART. As indicated above, we are
currently developing an additional tool for executive oversight, called
DARES, which will serve as the repository for both the evaluation of
risks associated with each initiative and the proposed, mitigation
strategies for use if the risk materializes. Release 1 of DARES is
scheduled to be in production in August 2009. We will be developing
future DARES releases that will continue to address potential risks and
formulate further mitigation strategies.
In addition, we are now using predictive modeling software that will
assist us in identifying potential risks throughout the process.
We agree that it is important to proactively identify risks and are
taking steps to do that, but this activity must be balanced with the
urgency to take action to help those who have waited so long for a
hearing decision. Delaying implementation of the backlog reduction plan
would have been the biggest risk of all, and was not an option,
considering the increasing receipts and the lengthy waiting time for a
hearing decision.
We offer the following general and technical comments regarding the
report for your consideration:
General Comments:
ALJ Productivity:
We agree that AU productivity is very important to the success of our
backlog reduction efforts. In fact, when we performed our risk analysis
using Crystal Ball, this was one of the factors to which we assigned
variability. Therefore, our determination that we have a 78 percent
chance of success includes scenarios in which productivity differs from
the budgeted assumption. For example, we allowed the hearings
productivity per workyear to vary from 103 hearings per workyear to 110
hearings per workyear in FY 2009 based on historic variability. Even
with that variability in productivity, our analysis still showed a 78
percent chance of reducing the hearings backlog to 466,000 by the end
of FY 2013.
The FY 2010 President's Budget assumes ALJ productivity of
approximately 2.28 cases per available ALJ per working day. We have a
number of approaches for projecting productivity, but in this case, we
estimated overall ALJ productivity based on FY 2008 actual performance
at the point in time we were formulating the budget. Our productivity
projection represents the annual rate we were achieving at that point,
and, as such, was a somewhat conservative estimate.
We are currently on track to hit at least 570 dispositions (2.28 per
day) per available AU in FY 2009. Ln addition, based on the historical
ALJ productivity over the last four years, it is clear that there is an
upward trend. Therefore, not only is it reasonable to assume a 2.28 ALI
productivity level, it is possible that AU productivity will actually
be greater than budgeted if the upward trend continues.
Moreover, increased management attention has also helped to improve ALJ
productivity and is expected to continue to do so. From the beginning
of FY 2005 until initial implementation of the hearings backlog
reduction plan in FY 2007, the daily ALJ production rate averaged 2.18.
Since that time, the average AIJ production rate has increased to 2.38.
Our focus on the hearings backlog reduction plan has clearly made an
impact and has helped us begin reducing the hearings backlog.
In connection with the Chief ALJ's guidance concerning 500-700
dispositions per ALJ per year, we request that the final report
reference the Office of the Inspector General report on ALJs' Caseload,
A-07-07-17072. The link for that report is: [hyperlink,
http://wvvw.socialsecurity.gov/oig/ADOBEPDF/audittxt/A-07-07-
17077.htm].
The Office of Personnel Management's (OPM) ALJ Register:
We agree that achieving our ALJ hiring goals is critical to the success
of the plan, and we need OPM's assistance and cooperation to meet these
goals.
With OPM's assistance and attention to this important matter, we are
confident that we will be able to hire a sufficient number of ALJs to
reduce the backlog. However, we too are concerned that any delays in
hiring ALJs pose a risk to our backlog plan.
The Economy:
In addition to the sensitivity to AU productivity and hiring, the
success of our plan is also dependent on our workload receipts. We are
currently reassessing our workload receipt estimates resulting from the
changing economic conditions and will publish them shortly. We expect
to see a significant increase in initial disability applications and
ultimately hearing requests.
The draft report notes that the current recession is contributing to a
significant increase in disability claims receipts and that this
increase has the potential to magnify the challenges we face in
eliminating the backlog. Experience has shown that when the number of
initial disability applications goes up, the number of hearing requests
also will increase. These increased hearing requests may jeopardize our
goal of eliminating the backlog by the end of FY 2013. Only if we fully
realize our assumptions and receive timely, adequate, and sustained
funding will we be able to maintain momentum and stay on course to
reach our 2013 goal.
The Effect on Operations:
We need to take a closer look at the effect that a 20 percent increase
in AU productivity starting in 2010 could have on Operations. We have
analyzed the effect on Operations staff and the actions we may need to
take.
We have been anticipating an increase in AU dispositions and have taken
several steps to ensure timely processing of the increased case
dispositions, including:
* In January 2008, we developed a plan for electronic identification
and tracking of all Program Service Center (PSC) 7 jurisdiction cases
cleared from the Office of Disability Adjudication and Review (ODAR).
The new process allows cases to be worked based on the hearing request
date, consistent with our efforts to improve customer service.
* In August 2008, we established a new component called the Centralized
AU Group (CAG) in PSC 7 to better control the AU disposition workload
in a centralized location. The sole function of the CAG is to
effectuate All cases. This "economy of scale" centralization process
improves technicians' proficiency and efficiency. It also provides
tighter management and tracking control of this sensitive workload.
* We are monitoring hearing disposition receipt patterns on a daily
basis and specific workload instructions on a daily and/or weekly basis
to increase the focus on processing cases as the need arises.
Additionally, overtime resources are dedicated for processing AU cases
as needed.
* We are hiring additional claims technical examiners and benefit
technical examiners in the PSCs in anticipation of increasing AU
disposition receipts.
We have seen significant improvement in the processing of the ALT
workload because of these actions. For the week ending July 10, 2009,
the number of AU cases pending in Operations was reduced to 11,737 from
the peak pending of 18,437 cases during the last week of November 2008.
[End of section]
Appendix V: GAO Contact and Staff Acknowledgments:
GAO Contact:
Daniel Bertoni, Director, (202) 512-7215 or bertonid@gao.gov:
Staff Acknowledgments:
Shelia Drake, Assistant Director; Julianne Hartman Cutts; Jessica Gray;
and Nhi Nguyen made significant contributions to this report. In
addition, Craig Winslow provided legal assistance, Walter Vance and
Mehrzad Nadji provided methodological assistance, Vanessa Taylor
assessed the reliability of data used in the report, and Jessica Orr
assisted in report development.
[End of section]
Related GAO Products:
High Risk Series: An Update. [hyperlink,
http://www.gao.gov/products/GAO-09-271]. Washington, D.C.: January
2009. Social Security Administration: Service Delivery Plan Needed to
Address Baby Boom Retirement Challenges. [hyperlink,
http://www.gao.gov/products/GAO-09-24]. Washington, D.C.: January 9,
2008.
Social Security Disability: Management Controls Needed to Strengthen
Demonstration Projects. [hyperlink,
http://www.gao.gov/products/GAO-08-1053]. Washington, D.C.: September
26, 2008.
Federal Disability Programs: More Strategic Coordination Could Help
Overcome Challenges to Needed Transformation. [hyperlink,
http://www.gao.gov/products/GAO-08-635]. Washington, D.C.: May 20,
2008.
Social Security Administration Field Offices: Reduced Workforce Faces
Challenges as Baby Boomers Retire. [hyperlink,
http://www.gao.gov/products/GAO-08-737T]. Washington, D.C.: May 8,
2008.
Social Security Disability: Better Planning, Management, and Evaluation
Could Help Address Backlogs. [hyperlink,
http://www.gao.gov/products/GAO-08-40]. Washington, D.C.: December 7,
2007.
SSA Disability Representatives: Fee Payment Changes Show Promise, but
Eligibility Criteria and Representative Overpayments Require Further
Monitoring. [hyperlink, http://www.gao.gov/products/GAO-08-5].
Washington, D.C.: October 15, 2007.
Disability Programs: SSA Has Taken Steps to Address Conflicting Court
Decisions, but Needs to Manage Data Better on the Increasing Number of
Court Remands. [hyperlink, http://www.gao.gov/products/GAO-07-331].
Washington, D.C.: April 5, 2007.
Social Security Disability Programs: Clearer Guidance Could Help SSA
Apply the Medical Improvement Standard More Consistently. [hyperlink,
http://www.gao.gov/products/GAO-07-8]. Washington, D.C.: October 3,
2006.
Electronic Disability Claims Processing: SSA Is Proceeding with Its
Accelerated Systems Initiative but Needs to Address Operational Issues.
[hyperlink, http://www.gao.gov/products/GAO-05-97]. Washington, D.C.:
September 23, 2005.
Social Security Administration: More Effort Needed to Assess
Consistency of Disability Decisions. [hyperlink,
http://www.gao.gov/products/GAO-04-656]. Washington, D.C.: July 2,
2004.
Social Security Administration: Strategic Workforce Planning Needed to
Address Human Capital Challenges Facing the Disability Determination
Services. [hyperlink, http://www.gao.gov/products/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. [hyperlink,
http://www.gao.gov/products/GAO-04-14]. Washington, D.C.: November 12,
2003.
Social Security Disability: Reviews of Beneficiaries' Disability Status
Require Continued Attention to Achieve Timeliness and Cost-
Effectiveness. [hyperlink, http://www.gao.gov/products/GAO-03-662].
Washington, D.C.: July 24, 2003.
SSA and VA Disability Programs: Re-Examination of Disability Criteria
Needed to Help Ensure Program Integrity. [hyperlink,
http://www.gao.gov/products/GAO-02-597]. Washington, D.C.: August 9,
2002.
Social Security Disability: Disappointing Results from SSA's Efforts to
Improve the Disability Claims Process Warrant Immediate Attention.
[hyperlink, http://www.gao.gov/products/GAO-02-322]. Washington, D.C.:
February 27, 2002.
Social Security Administration: Status of Achieving Key Outcomes and
Addressing Major Management Challenges. [hyperlink,
http://www.gao.gov/products/GAO-01-778]. Washington, D.C.: June 15,
2001.
Social Security Disability: Backlog Reduction Efforts Under Way;
Significant Challenges Remain. [hyperlink,
http://www.gao.gov/products/GAO/HEHS-96-87]. Washington, D.C.: July 11,
1996.
[End of section]
Footnotes:
[1] GAO, High-Risk Series: An Update, [hyperlink,
http://www.gao.gov/products/GAO-03-119] (Washington, D.C.: January
2003), and High-Risk Series: An Update, [hyperlink,
http://www.gao.gov/products/GAO-09-271] (Washington, D.C.: January
2009).
[2] Pub. L. No. 111-5, 123 Stat. 115, 185 and Pub. L. No. 111-8, 123
Stat. 524, 800-01. The American Recovery and Reinvestment Act of 2009
funds were expected to allow SSA to process its claims in a timely
manner and accelerate activities to reduce its backlog. H. R. Rep. No.
111-16, at 461 (Conf. Rep.)
[3] GAO, Combating Terrorism: Evaluation of Selected Characteristics in
National Strategies Related to Terrorism, [hyperlink,
http://www.gao.gov/products/GAO-04-408T] (Washington, D.C.: Feb. 3,
2004), and Executive Guide: Effectively Implementing the Government
Performance and Results Act, [hyperlink,
http://www.gao.gov/products/GAO/GGD-96-118] (Washington, D.C.: June
1996).
[4] The Appomattox Plan is SSA's May 2009 draft update to the Plan.
[5] A teleservice center has SSA representatives who answer beneficiary
questions about eligibility for benefits and SSA's programs.
[6] Hearings-level dispositions include decisions made by ALJs as a
result of a hearing, decisions based solely on a review of the claim
file by ALJs or attorney advisors, or hearings-level dismissals, such
as when a claimant does not show for a hearing or claims are returned
to state DDS offices.
[7] Throughout this report, when we refer to SSA disability claims, we
are referring to claims filed under the Disability Insurance and
Supplemental Security Income programs.
[8] Eligibility for SSI is restricted to individuals who have countable
resources, determined monthly, that do not exceed $2,000 ($3,000) for a
couple) as well as limited income based on certain criteria. 42 U.S.C.
§ 1382(a)(3).
[9] 42 U.S.C. § 416(d)(1)(A). Substantial gainful activity is work
activity involving significant physical or mental activities and
usually done for pay or profit, whether or not a profit is realized. 20
C.F.R. §§ 404.1572 and 416.972 (2009).
[10] 42 U.S.C. § 421(i)(1) and 20 C.F.R. § 416.990 (2009).
[11] Hearings-level receipts include, among other things, requests for
hearings resulting from claims denied by DDS offices, as well as
remands to the hearings level, or claims that are sent back for
additional action from the Appeals Council and federal courts.
[12] While we were able to assess the reliability of these data for
fiscal years 2005 through 2008, we were unable to assess their
reliability for fiscal years 2003 and 2004 because they are archived in
systems that SSA no longer uses to input and house hearings-level
average processing time data. SSA officials told us that there is no
basic difference in the way they calculated these data in fiscal years
2003 through 2004 and 2005 through 2008, but we were not able to
validate them. See appendix I for more information about our data
reliability efforts.
[13] Social Security Administration, Strategic Plan: Fiscal Years 2008
through 2013 (September 2008).
[14] SSA provided detailed rationales for changing its definition of
the optimal number of pending claims in May 2007 and fiscal year 2008.
However, we did not test the validity of SSA's new definitions of the
optimal number of pending claims.
[15] GAO, Social Security Disability: Backlog Reduction Efforts
Underway; Significant Challenges Remain, [hyperlink,
http://www.gao.gov/products/GAO/HEHS-96-87] (Washington, D.C.: July 11,
1996).
[16] GAO, Social Security Disability: Better Planning, Management, and
Evaluation Could Help Address Backlogs, [hyperlink,
http://www.gao.gov/products/GAO-08-40] (Washington, D.C.: Dec. 7,
2007).
[17] See GAO, Federal Disability Programs: More Strategic Coordination
Could Help Overcome Challenges to Needed Transformation, [hyperlink,
http://www.gao.gov/products/GAO-08-635] (Washington, D.C.: May 20,
2008), and SSA and VA Disability Programs: Re-Examination of Disability
Criteria Needed to Help Ensure Program Integrity, [hyperlink,
http://www.gao.gov/products/GAO-02-597] (Washington, D.C.: Aug. 9,
2002).
[18] 73 Fed. Reg 11,349 (Mar. 3, 2008). SSA had previously discontinued
this program in April 2001.
[19] Attorney advisors include Senior Attorneys, Hearing Office
Directors, Group Supervisors, and attorneys in Regional Offices at the
GS-13 level or above. In general, the Attorney Advisor Program
decisions helped to increase total hearings-level dispositions.
However, it did not provide a one-for-one increase in hearings-level
dispositions in fiscal year 2008 because some of the decisions would
have been made by ALJs in that fiscal year if the program had not been
reestablished, although we could not determine how many.
[20] Even though SSA hired 190 ALJs during fiscal year 2008, the number
of on-duty ALJs increased by only 107 during fiscal year 2008 because
of ALJ attrition.
[21] To estimate its likelihood of eliminating the backlog by its
target date, SSA developed a model that is used in concert with a
forecasting and risk analysis software program called Crystal Ball. The
Crystal Ball program produced results by running thousands of
simulation trials in which the program randomly selected values for
workload, performance, and staffing inputs from ranges that SSA
prespecified.
[22] Recent experience is based on fiscal year 2008 through April 2009.
[23] SSA agreed that 570 with a plus or minus 3 percent variation is a
fair representation of the productivity it assumed in its model. See
appendix II for more explanation about productivity as used in SSA's
model.
[24] [hyperlink, http://www.gao.gov/products/GAO/GGD-96-118].
[25] GAO, GAO Cost Estimating and Assessment Guide: Best Practices for
Developing and Managing Capital Program Costs, GAO-09-3SP (Washington,
D.C.: March 2009).
[26] GAO, Homeland Security: Applying Risk Management Principles to
Guide Federal Investments, [hyperlink,
http://www.gao.gov/products/GAO-07-386T] (Washington, D.C.: Feb. 7,
2007).
[27] In February 2008, SSA's OIG concluded that federal law does not
prevent SSA from establishing a performance accountability process
wherein ALJs are held to reasonable production goals, as long as those
goals do not infringe on ALJs' qualified decisional independence. SSA'
Office of the Inspector General, Administrative Law Judges' Caseload
Performance, A-07-07-17072 (February 6, 2008). SSA officials told us
that they considered average ALJ production in developing the current
500-700 case per ALJ goal.
[28] [hyperlink, http://www.gao.gov/products/GAO/HEHS-96-87].
[29] GAO, SSA Disability Decision Making: Additional Steps Needed to
Ensure Accuracy and Fairness of Decisions at the Hearings Level,
[hyperlink, http://www.gao.gov/products/GAO-04-14] (Washington, D.C.:
Nov. 12, 2003).
[30] GAO, Social Security Administration Field Offices: Reduced
Workforce Faces Challenges as Baby Boomers Retire, [hyperlink,
http://www.gao.gov/products/GAO-08-737T] (Washington, D.C.: May 8,
2008).
[31] In our draft report, we listed 38 Plan initiatives; SSA combined 4
initiatives related to compassionate allowances and now refers to the
result as fast-tracked initial decisions. SSA has added another
initiative, called automated noticing, which will be in planning and
analysis in fiscal year 2010. Thus, SSA now has 35 initiatives.
[32] Throughout this appendix, when we refer to SSA disability claims,
we are referring to claims filed under the Disability Insurance and
Supplemental Security Income programs.
[33] SSA implemented the Informal Remand initiative in June 2007; thus
data for this initiative do not exist prior to fiscal year 2007.
[34] SSA implemented the reestablished Attorney Advisor Program in
November 2007, thus data for this initiative do not exist between
fiscal years 2003 and 2007. 73 Fed. Reg 11,349 (Mar. 3, 2008).
[35] [hyperlink, http://www.gao.gov/products/GAO-04-408T] and
[hyperlink, http://www.gao.gov/products/GAO/GGD-96-118].
[36] A teleservice center has SSA representatives who answer
beneficiary questions about eligibility for benefits and SSA's
programs.
[37] Region 10 (Seattle) represented about 3 percent of total
backlogged hearings claims at the end of fiscal year 2007.
[38] Although Region 10 (Seattle) performed above average according to
regional backlog performance factors, we reported in GAO-08-40 that
about half of the dispositions rendered in fiscal year 2006 in regions
5 (Chicago) and 10 (Seattle) took on average between 600 and 999 days.
Processing times in region 4 (Atlanta) appeared consistent with
national averages.
[39] Pub. L. No. 111-5, 123 Stat. 115, 185-86.
[40] The number of claims backlogged could range from -199,355 to
171,318.
[41] The number of claims backlogged could range from -155,151 to
195,925.
[42] The number of claims backlogged could range from -125,897 to
228,092.
[43] The GAO draft report, pages 44-47, lists 38 hearings backlog plan
initiatives. The first four refer to compassionate allowances, which we
now refer to as fast-tracked initial decisions. As the draft report
notes, these four initiatives were not included in our FY 2008 year end
annual report of the plan, as they either had indirect effects on the
hearings backlog or did not relate to the backlog-reduction effort.
Another initiative called automated noticing, i.e., the generation of
notices via CPMS, is not listed in the GAO draft report but will be in
planning and analysis in FY 2010. Thus, we discuss in these comments a
total of 35 hearings backlog plan initiatives.
[End of section]
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