Social Security Disability
Management of Disability Claims Workload Will Require Comprehensive Planning Gao ID: GAO-10-667T April 27, 2010For years, the Social Security Administration (SSA) has been challenged to manage its large disability claims workload. Difficulties in making timely and accurate decisions have contributed to backlogs accumulating at different levels of the claims process. These backlogs have occurred most often at the hearings level, the level at which initial claims that were denied are appealed and await a hearing before an administrative law judge. Claimants often experienced long waits for a decision on their claim because of this backlog. In May 2007, SSA released a plan designed to eliminate its hearings-level backlog. GAO was subsequently asked by Congress to evaluate this plan and issued a report in September 2009 (GAO-09-398). This testimony discusses SSA's backlog reduction plan and the challenges the agency faces in managing its overall claims workload. It draws primarily from GAO's September 2009 report as well as from SSA's Fiscal Year 2009 Performance and Accountability Report, its Annual Performance Plan for Fiscal Year 2011 and Revised Final Performance Plan for Fiscal Year 2010, its fiscal year 2011 budget request documents, and recent reports issued by SSA's Office of the Inspector General (OIG).
In September 2009, GAO reported that SSA's backlog reduction plan should help reduce the hearings backlog, but that SSA's ability to eliminate it by the agency's target date of 2013 would require SSA to achieve all of its key workforce and performance goals. GAO found that these goals set higher levels of performance than the agency has ever experienced. GAO also found that SSA's 2007 Plan did not include performance goals and measures or cost estimates for many initiatives. Finally, GAO reported that the 2007 Plan, which could pose some risks to the quality of hearings decisions and to other operations, lacked an appropriate risk assessment with contingency plans. GAO recommended that SSA develop additional performance goals and measures and cost estimates for the initiatives it considered most critical, conduct analyses of risks associated with the Plan's implementation, and identify strategies to address them. In response, SSA noted that it was expanding its risk analysis capabilities. The agency also agreed to examine the Plan's potential impact on other SSA operations. However, SSA did not believe additional performance goals and measures and cost estimates were necessary since the agency was tracking plan initiatives to ensure that they were on schedule and had developed total cost estimates as part of its budget process. Since September 2009, SSA has reported progress toward eliminating its hearings-level backlog--defined as reducing the number of pending cases to SSA's target of 466,000. In March 2010, SSA reported that pending cases were down to 697,437 from 760,000 in fiscal year 2008. SSA also reported additional backlog reduction strategies in its 2010 and 2011 annual performance documents. One strategy is to relieve pressure on the hearing offices by reinstituting the Disability Determination Services (DDS) reconsideration process in 10 states where it had previously been eliminated as a pilot project. SSA also announced that it will open two new centralized operations to help the hearing offices with administrative tasks. Meanwhile, SSA also reported in its 2011 annual performance plan that it will develop strategies to deal with potential backlogs at the initial claims level. At the end of fiscal year 2009, about 780,000 initial claims were pending at state DDS offices and the agency projects that number will exceed 1 million by the end of fiscal year 2010. In its 2011 annual performance plan, SSA outlined several other remedies, including hiring, increasing overtime, and simplifying policies. Finally, SSA requested additional funds to help with its continuing disability reviews, which were reported by SSA's OIG to be backlogged at 1.5 million cases at the end of fiscal year 2009. GAO has yet to assess the agency's new strategies, but GAO's prior work suggests that changes to any one operation in the disability program can affect work flow in unexpected ways at other stages. Therefore, given its many growing pressure points, effective management of the disability claims process will require comprehensive and integrated planning.
GAO-10-667T, Social Security Disability: Management of Disability Claims Workload Will Require Comprehensive Planning
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Testimony:
Before the Subcommittees on Social Security and Income Security and
Family Support, Committee on Ways and Means, House of Representatives:
United States Government Accountability Office:
GAO:
For Release on Delivery:
Expected at 2:00 p.m. EDT:
Tuesday, April 27, 2010:
Social Security Disability:
Management of Disability Claims Workload Will Require Comprehensive
Planning:
Statement of Daniel Bertoni, Director:
Education, Workforce, and Income Security:
GAO-10-667T:
GAO Highlights:
Highlights of GAO-10-667T, a testimony before the Subcommittees on
Social Security and Income Security and Family Support, Committee on
Ways and Means, House of Representatives.
Why GAO Did This Study:
For years, the Social Security Administration (SSA) has been
challenged to manage its large disability claims workload.
Difficulties in making timely and accurate decisions have contributed
to backlogs accumulating at different levels of the claims process.
These backlogs have occurred most often at the hearings level, the
level at which initial claims that were denied are appealed and await
a hearing before an administrative law judge. Claimants often
experienced long waits for a decision on their claim because of this
backlog. In May 2007, SSA released a plan designed to eliminate its
hearings-level backlog. GAO was subsequently asked by Congress to
evaluate this plan and issued a report in September 2009 (GAO-09-398).
This testimony discusses SSA‘s backlog reduction plan and the
challenges the agency faces in managing its overall claims workload.
It draws primarily from GAO‘s September 2009 report as well as from
SSA‘s Fiscal Year 2009 Performance and Accountability Report, its
Annual Performance Plan for Fiscal Year 2011 and Revised Final
Performance Plan for Fiscal Year 2010, its fiscal year 2011 budget
request documents, and recent reports issued by SSA‘s Office of the
Inspector General (OIG).
What GAO Found:
In September 2009, GAO reported that SSA‘s backlog reduction plan
should help reduce the hearings backlog, but that SSA‘s ability to
eliminate it by the agency‘s target date of 2013 would require SSA to
achieve all of its key workforce and performance goals. GAO found that
these goals set higher levels of performance than the agency has ever
experienced. GAO also found that SSA‘s 2007 Plan did not include
performance goals and measures or cost estimates for many initiatives.
Finally, GAO reported that the 2007 Plan, which could pose some risks
to the quality of hearings decisions and to other operations, lacked
an appropriate risk assessment with contingency plans. GAO recommended
that SSA develop additional performance goals and measures and cost
estimates for the initiatives it considered most critical, conduct
analyses of risks associated with the Plan‘s implementation, and
identify strategies to address them. In response, SSA noted that it
was expanding its risk analysis capabilities. The agency also agreed
to examine the Plan‘s potential impact on other SSA operations.
However, SSA did not believe additional performance goals and measures
and cost estimates were necessary since the agency was tracking plan
initiatives to ensure that they were on schedule and had developed
total cost estimates as part of its budget process.
Since September 2009, SSA has reported progress toward eliminating its
hearings-level backlog”defined as reducing the number of pending cases
to SSA‘s target of 466,000. In March 2010, SSA reported that pending
cases were down to 697,437 from 760,000 in fiscal year 2008. SSA also
reported additional backlog reduction strategies in its 2010 and 2011
annual performance documents. One strategy is to relieve pressure on
the hearing offices by reinstituting the Disability Determination
Services (DDS) reconsideration process in 10 states where it had
previously been eliminated as a pilot project. SSA also announced that
it will open two new centralized operations to help the hearing
offices with administrative tasks. Meanwhile, SSA also reported in its
2011 annual performance plan that it will develop strategies to deal
with potential backlogs at the initial claims level. At the end of
fiscal year 2009, about 780,000 initial claims were pending at state
DDS offices and the agency projects that number will exceed 1 million
by the end of fiscal year 2010. In its 2011 annual performance plan,
SSA outlined several other remedies, including hiring, increasing
overtime, and simplifying policies. Finally, SSA requested additional
funds to help with its continuing disability reviews, which were
reported by SSA‘s OIG to be backlogged at 1.5 million cases at the end
of fiscal year 2009. GAO has yet to assess the agency‘s new
strategies, but GAO‘s prior work suggests that changes to any one
operation in the disability program can affect work flow in unexpected
ways at other stages. Therefore, given its many growing pressure
points, effective management of the disability claims process will
require comprehensive and integrated planning.
View [hyperlink, http://www.gao.gov/products/GAO-10-667T] or key
components. For more information, contact Daniel Bertoni at (202) 512-
7215 or bertonid@gao.gov.
[End of section]
Mr. Chairmen and Members of the Subcommittees:
I am pleased to be here today to discuss the Social Security
Administration's (SSA) efforts to reduce its disability claims
backlogs. Each year, millions of Americans who believe they can no
longer work because of severe physical or mental impairments apply for
cash benefits through SSA's two disability programs--Disability
Insurance and Supplemental Security Income. Historically, SSA has
experienced large numbers of cases that are pending at one or more of
the four levels of its disability claims process. When the number of
cases exceeds what the agency considers optimal for managing workflow,
they are recognized as a "backlog." Over the years, such backlogs have
resulted in long waits for claimants to learn whether they qualify to
obtain disability benefits. In recent years, SSA's disability claim
workloads have been most problematic at the hearings level, the step
at which claimants whose requests for benefits have been denied by
Disability Determination Services (DDS) are awaiting a hearing before
an administrative law judge (ALJ). Backlogged claims at the hearings
level rose from 12,000 cases in 1999 to nearly 295,000 cases at the
close of fiscal year 2008. In that year, claimants waited, on average,
almost a year and a half after they requested a hearing to receive a
decision on their claim.
Today, I will discuss (1) SSA's efforts to eliminate its hearings-
level backlog and (2) ongoing challenges SSA faces with its disability
claims workloads. My statement draws primarily from our September 2009
report assessing SSA's current plan for eliminating the hearings-level
backlog by fiscal year 2013 and preventing its recurrence.[Footnote 1]
We conducted the work for our September 2009 report 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. For this testimony we also reviewed prior GAO reports,
SSA's Fiscal Year 2009 Performance and Accountability Report, its
Annual Performance Plan for Fiscal Year 2011 and Revised Final
Performance Plan for Fiscal Year 2010, its fiscal year 2011 budget
request documents, and recent SSA Office of the Inspector General
(OIG) reports.
Background:
Under the Social Security Act, SSA administers both the Disability
Insurance and Supplemental Security Income programs.[Footnote 2]
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 3]
The process to obtain SSA disability benefits can involve up to four
steps--two steps at the state level--(1) an initial determination and
(2) an opportunity for reconsideration of this determination--and two
steps for appeal at the federal level--(3) the SSA hearing office and
(4) the Appeals Council, which is SSA's final administrative level of
appeal. 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 SSA field offices for payment. (See figure 1.)
Figure 1: SSA's Claims 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 is forwarded to state DDS
initial claims level.
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: see below;
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: see below;
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: see below;
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: see below.
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, the Los Angeles area of California, Colorado,
Louisiana, Michigan, Missouri, New Hampshire, New York, and
Pennsylvania) as part of the Prototype Initiative. In these states,
claimants who want to appeal their initial DDS determination must
appeal for review before an ALJ.
[End of figure]
Individuals who are awarded disability benefits must periodically
undergo continuing disability reviews (CDR) to determine whether they
remain medically eligible for benefits. SSA generally determines when
beneficiaries will undergo such reviews--called medical CDRs--based on
their potential for medical improvement.[Footnote 4] The law generally
requires that these CDRs be performed at least once every 3 years.
[Footnote 5]
Over the years, SSA has faced disability claims processing challenges
and has taken actions to address them. In a prior report on SSA
disability claims, we noted that while backlogs have accumulated at
different levels of the claims process from fiscal years 1997 to 2006,
they had occurred most often at the hearings level.[Footnote 6] Also
in prior reports, we described backlogged claims, lengthy processing
times, and other processing challenges attributable, in part, to a
range of factors: significant increases in disability applications,
substantial turnover and losses in personnel throughout the disability
process, budget constraints, and SSA management weaknesses, as
evidenced by poor planning and implementation of prior initiatives
intended to remedy disability backlogs. Over the years, SSA has taken
a number of backlog reduction actions, including those at the hearings
level. In the past, however, these actions have yielded mixed results.
Most recently, SSA issued a multi-initiative "Plan" in May 2007 to
eliminate the backlog at the hearings level by 2013. In May 2009, SSA
issued a draft update to this plan, known as the Appomattox Plan.
SSA's Backlog Reduction Plan Has Helped to Reduce the Hearings Backlog
but Poses Some Risks to Hearings and Other Operations:
In September 2009, we reported that while SSA's backlog reduction plan
should help to eliminate the hearings-level backlog by 2013, its
success would depend largely on the agency's ability to achieve its
key workforce and performance goals.[Footnote 7] To eliminate the
hearings-level backlog, SSA's goal is to reduce the number of claims
pending from more than 760,000 in fiscal year 2008 to 466,000 by the
end of fiscal year 2013. We noted in our report that to substantially
achieve this goal, SSA's assumptions at that time regarding ALJ
productivity, hiring, and availability would need to be fully
realized. We also noted, however, that these assumptions projected
higher levels of performance than the agency had historically or even
recently experienced as of April 2009. If SSA did not achieve its ALJ
productivity goals of approximately 570 dispositions annually per ALJ,
we estimated that the agency's chances of eliminating its backlog by
2013 would be reduced by more than half, even if the agency met its
goals for ALJ hiring and availability.
Meanwhile, we also found that while SSA's May 2007 Plan included
important elements of sound planning,[Footnote 8] it did not provide
some key management information that could facilitate effective plan
management. The Plan contained 38 initiatives aimed at (1) allowing
claims to be decided more quickly and accurately, (2) improving
hearing office procedures, (3) increasing adjudicatory capacity, and
(4) increasing efficiency through automation and improved business
processes.[Footnote 9] However, the Plan did not include performance
goals and measures for about half of the initiatives and cost
estimates for many. Such planning elements would allow SSA to evaluate
the initiatives' progress and determine resource allocations and
return on investment.
Therefore, we recommended that SSA develop performance goals and
measures for initiatives that did not have them, and that it also
develop cost estimates for plan initiatives that the agency considered
critical to eliminating the hearings-level backlog. SSA disagreed that
it should develop additional performance goals and measures beyond
those it had already developed, noting instead that the agency was
tracking milestones to ensure that all initiatives were on schedule
for implementation. SSA also disagreed that it should develop cost
estimates, noting that it had conducted and incorporated into its
fiscal years 2009 and 2010 budgets, a full evaluation of the costs
associated with implementing all major aspects of the Plan.
Nevertheless, we continue to believe that it is important to establish
performance goals and measures and cost estimates for individual
initiatives to determine whether each is accomplishing what is
expected and to determine the return on investment.
Finally, we found that the Plan could have unintended effects on
hearings-level performance and on the workloads of other SSA offices.
For example, we noted that the Plan's emphasis on rapidly increasing
ALJ productivity could affect the workloads of the offices that
process claim payments as well as the accuracy and quality of ALJ
decisions themselves, which, if appealed, could then increase
workloads for the offices that must review them. In fiscal year 2009,
SSA's goal was for ALJs to produce an average of 570 decisions
annually. In addition, we cautioned that SSA's focus on implementing
its hearings-level backlog reduction plan could potentially divert
resources from other critical processes, particularly its CDR work--
the agency's key activity for maintaining program integrity by
ensuring that only those eligible continue to receive benefits. We
also noted that the Plan did not identify risks involved in its
implementation or any strategies to address them, although SSA
officials stated that they had discussed risk management prior to Plan
implementation. Therefore, we recommended that SSA move forward to
formally assess the risks involved in the Plan's implementation,
including those that would hinder the Plan's success and those that
could cause adverse effects or trade-offs related to hearings-level
performance and other SSA operations. In commenting on our report, SSA
agreed with our recommendation and stated that the agency is
developing a system that will aid in performing risk analyses. SSA
also agreed that it needed to take a look at how an estimated 20
percent increase in ALJ productivity would affect other SSA
operations.[Footnote 10]
SSA Has Reported Progress in Reducing Its Backlog but Faces Additional
Challenges:
SSA Has Reported Progress in Reducing Its Backlog and Has Introduced
Additional Backlog Reduction Strategies:
Since we issued our September 2009 report, SSA has reported progress
toward reducing its hearings-level backlog. In November 2009, SSA
released its Fiscal Year 2009 Performance and Accountability Report,
which noted that the agency had hired almost 150 ALJs--bringing the
total number on board as of the end of fiscal year 2009 to 1,238. We
previously reported that SSA's goal was to hire enough ALJs to reach a
cadre of about 1,450 in fiscal year 2011. According to the Fiscal Year
2009 Performance and Accountability Report, SSA's goal is now to have
1,500 ALJs on board by early 2012. SSA also hired over 850 support
staff in fiscal year 2009, and plans to hire additional support staff
going forward to maintain a national ratio of at least 4.5 support
staff to each ALJ.
In a March 2010 news release, SSA announced that it had reduced the
number of pending hearings-level cases to 697,437--the lowest number
since June 2005. As we have previously noted, the number of pending
claims was over 760,000 in fiscal 2008, and SSA's target for 2013 is a
reduction to 466,000 claims.
Also, since we issued our report in September 2009, SSA has outlined
at least two new strategies to achieve its backlog reduction target.
In February 2010, SSA issued its Annual Performance Plan for Fiscal
Year 2011 and Revised Final Performance Plan for Fiscal Year 2010,
[Footnote 11] in which it identifies several new initiatives to help
eliminate the hearings-level backlog. One new strategy is to restore
the reconsideration step at DDS offices in the 10 states where--as a
pilot project--it had been eliminated in fiscal year 2000 to speed
cases through those offices. In essence, claimants in these states who
received an initial DDS denial can appeal directly to an ALJ at the
hearings level, by passing any further administrative reviews of their
claim at DDS offices. SSA plans to reverse that change first in the
Michigan DDS, which, according to SSA, has one of the worst hearings-
level backlogs in the nation. The underlying strategy is to
reinstitute the reconsideration process and eliminate unnecessary
hearings. While GAO has yet to assess this or other new SSA
strategies, it should be noted that our prior work found that the
processing of reconsideration claims could be subject to delay at
times when the initial claims workload has increased.[Footnote 12] For
example, a DDS official in one region we visited told us that several
DDS offices had either slowed or temporarily stopped conducting
reconsideration reviews to concentrate on reviewing initial claims.
Should DDS workloads increase significantly in the future, pending
claims at the reconsideration level could also increase.
Another new strategy announced in SSA's annual performance plan is to
open two centralized units that would assist the hearing offices with
various tasks, such as pulling files and writing decisions. SSA also
reported that it plans to open 16 new hearing offices and expand 2
existing hearing offices in fiscal year 2010. According to SSA, the
number and location of new hearing offices it can open in fiscal year
2011 will be driven by the level of funding the agency receives.
In its 2011 annual performance plan, SSA also reported that it will
continue a number of its original 2007 plan initiatives, including
those that would expand its adjudicatory capacity. Among these is the
plan to use senior attorney adjudicators to issue fully favorable
decisions on certain types of claims without a hearing before an ALJ.
In fiscal year 2009, senior attorney adjudicators decided over 36,000
cases. The agency now plans to increase that number and implement a
virtual screening unit to help identify claims that are good
candidates for this program. Regarding the agency's informal remand
initiative, on the other hand, it is unclear to us whether the agency
plans to continue this initiative beyond 2010. Under the initiative,
claims that were previously denied by DDS offices are screened by
hearing offices for characteristics that make them good candidates for
a favorable determination and then returned to DDS offices where staff
take a second look at them--as an intervention to reduce the hearings-
level caseload. DDS offices are expected to conduct these reviews
outside of regular work hours, using overtime funds that are set aside
especially for this purpose. In fiscal 2009, the informal remand
initiative resulted in almost 15,000 favorable determinations.
Meanwhile, SSA has reported discontinuing its e-pulling initiative, a
method of automating file assembly to prepare claims for ALJ review,
as of August 2009, given a determination by SSA's OIG that it should
be fully assessed in terms of its productivity before it is expanded
to additional hearing offices.[Footnote 13]
SSA Is Confronted with Growing Numbers of Initial Disability Claims:
While SSA has achieved some success in reducing its hearings-level
backlog, it has experienced significant increases in initial
disability claims. As of the end of fiscal year 2009, approximately
780,000 initial claims were pending at state DDS offices; 40 percent
more than in fiscal year 2007, according to SSA's 2011 annual
performance plan. SSA expects that the number of claims pending will
exceed 1 million by the end of fiscal year 2010. Agency officials have
attributed this increase to, among other things, a growth in recent
applications and to state personnel furloughs, which affected DDS
worker productivity.[Footnote 14] In its Fiscal Year 2009 Performance
and Accountability Report, SSA reported that about a dozen states had
furloughed federally funded state workers who make disability
decisions for SSA. The agency also estimated that initial claims will
continue to increase and remain at historically high levels for the
next several years.
Therefore, in its 2011 annual performance plan, SSA reported that
while it continues to consider the hearings backlog to be its top
priority, it is also developing strategies to reduce the number of
initial claims that are pending. These strategies are outlined as (1)
working with states to avoid hiring freezes and furloughs, (2) hiring
additional DDS employees, (3) increasing DDS overtime to provide
maximum flexibility to address increasing workloads, (4) simplifying
policies to make adjudicating claims easier, and (5) adding personnel
to staff both federal and state units that handle initial disability
claims for areas of the country that have been hit particularly hard.
Meanwhile, according to SSA's Fiscal Year 2009 Performance and
Accountability Report, the agency has already hired 2,600 new DDS
employees. In April testimony of this year, the SSA Commissioner also
reported that the agency plans to hire about 1,400 additional DDS
employees using fiscal year 2010 funds. It is our understanding that
the agency expects to provide more information in the future on its
new strategies for handling this impending workload.
SSA Faces a Backlog of CDRs:
SSA has also experienced significant increases in its medical CDR
workload. As we have previously reported, these reviews are SSA's key
means of ensuring that only those who are 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
disability eligibility requirements. SSA has reported that although it
performed nearly 40,000 more CDRs in fiscal year 2008 than in fiscal
year 2007 (when it conducted 210,000), the overall number of CDRs
conducted annually had decreased by approximately 65 percent between
fiscal years 2004 and 2008. As a result, the number of pending CDRs
has increased. SSA's OIG reported in March 2010 that at the end of
fiscal year 2009, SSA had a backlog of almost 1.5 million CDRs.
[Footnote 15] Even with the increase in performance that SSA expects
to achieve in fiscal years 2010 and 2011, the OIG estimated a CDR
pending workload of over 1.5 million through 2011. As a result, SSA
could potentially pay millions of dollars in benefit payments to
individuals who are no longer eligible.
In its fiscal year 2011 budget, SSA requested $796 million to conduct
program integrity activities that include CDRs. While increased
funding should help, we noted in the past that CDRs may be delayed or
deferred when DDS offices have to deal with increasing numbers of
initial claims.[Footnote 16] For example, in fiscal year 2009, SSA
reported that it had scaled back the number of CDRs conducted due,
among other things, to increases in other competing workloads.
Concluding Remarks:
Over the years, the disability claims workload has been difficult to
manage for a number of reasons, including budget constraints and
staffing challenges. SSA's backlog reduction plan, with its many
initiatives to remedy the severe backlog at the hearings level, may
represent one of the agency's most ambitious efforts to date to tackle
this difficult workflow. Since the plan was launched, the agency has,
indeed, made a significant dent in the backlog of cases. It remains to
be seen, of course, whether SSA can continue to make enough progress
to reduce the number of pending cases to acceptable levels by 2013.
The agency has not lacked for new strategies to deal with its
backlogs. However, we have noted that it is important that these
strategies should rest on a foundation of thorough and comprehensive
planning, and that they include performance goals and measures, and
analyses of the costs and risks to the system as a whole. Urgency can
dictate a pattern of attacking workloads at one or another phase, only
to be confronted with a backflow elsewhere in the pipeline. For
example, the agency's latest announcement for stemming the flow of
cases to the hearings level by reinstituting reconsiderations in DDS
offices in 10 states could create or increase backlogs at these
offices.
DDS offices are responsible for several workloads, including
conducting CDRs, which will increase, according to SSA's fiscal year
2011 budget request. In addition, some DDS offices also participate in
SSA's informal remand initiative. Such multiple workloads are likely
to grow larger with increases in initial claims receipts and pose
significant challenges, not only for the 10 states where
reconsiderations will start up again, but for other DDS offices as
well. In fact, given the current trajectory in DDS workloads, SSA's
most significant backlogs could shift from the hearings level to DDS
offices, where large numbers of both initial and reconsideration
pending claims could accumulate.
Certainly it is good news--as noted in the agency's 2011 annual
performance plan--that SSA will begin to focus on reducing the number
of initial claims that are pending in DDS offices. The new five-part
strategy cited for doing so has yet to be fully detailed. At this
point, however, successful management of SSA's disability workloads
will require an integrated and comprehensive plan that considers the
entire disability process as well as how actions at each stage of the
process affect other offices.
Mr. Chairmen, this concludes my prepared statement. I will be pleased
to answer any questions that you or other Members of the Subcommittees
may have at this time.
GAO Contact and Staff Acknowledgments:
For further information, please contact Daniel Bertoni at (202) 512-
7215 or bertonid@gao.gov. Contact points for our Offices of
Congressional Relations and Public Affairs may be found on the last
page of this testimony. Also contributing to this statement were
Shelia Drake, Julianne Hartmann Cutts, and Susan Bernstein. Advisors
included Barbara Bovbjerg, Jessica Gray, Mehrzad Nadji, Nhi Nguyen,
and Walter Vance. Craig Winslow provided legal advice.
[End of section]
Related GAO Products:
Social Security Disability: Additional Performance Measures and Better
Cost Estimates Could Help Improve SSA's Efforts to Eliminate Its
Hearings Backlog. [hyperlink, http://www.gao.gov/products/GAO-09-398].
Washington, D.C.: September 9, 2009.
Social Security Administration: Further Actions Needed to Address
Disability Claims and Service Delivery Challenges. [hyperlink,
http://www.gao.gov/products/GAO-09-511T]. Washington, D.C.: March 24,
2009.
High-Risk Series: An Update. [hyperlink,
http://www.gao.gov/products/GAO-09-271]. Washington, D.C.: January 22,
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,
2009.
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.
[End of section]
Footnotes:
[1] GAO, Social Security Administration: Additional Performance
Measures and Better Cost Estimates Could Help Improve SSA's Efforts to
Eliminate Its Hearings Backlog, [hyperlink,
http://www.gao.gov/products/GAO-09-398] (Washington, D.C.: Sept. 9,
2009).
[2] 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.
[3] Eligibility for Supplemental Security Income 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).
[4] 20 C.F.R. § 416.990 (2009). 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.
[5] 42 U.S.C. § 421(i)(1).
[6] GAO, Social Security Disability: Better Planning, Management, and
Evaluation Could Help Address Backlog, [hyperlink,
http://www.gao.gov/products/GAO-08-40] (Washington, D.C.: Dec. 7,
2007).
[7] We also considered SSA's draft Appomattox Plan.
[8] 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. See 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).
[9] While we listed 38 initiatives from SSA's backlog reduction plan
in our report, SSA subsequently combined four initiatives and added
one, resulting in a total of 35 initiatives.
[10] SSA's success in eliminating the hearings-level backlog by fiscal
year 2013 is heavily dependent on increasing ALJ productivity about 20
percent in fiscal years 2010 through 2013 over fiscal year 2008 levels.
[11] Throughout this report we refer to SSA's Annual Performance Plan
for Fiscal Year 2011 and Revised Final Performance Plan for Fiscal
Year 2010 as SSA's annual performance plan.
[12] [hyperlink, http://www.gao.gov/products/GAO-08-40].
[13] This decision and the OIG's determination were reported in SSA's
Fiscal Year 2009 Performance and Accountability Report.
[14] New applications are expected to reach 3.3 million in fiscal year
2010.
[15] Social Security Administration, Office of the Inspector General,
Full Medical Continuing Disability Reviews: Evaluation Report, A-07-09-
29147 (Mar. 30, 2010). According to the OIG's report, SSA defines this
"backlog" as CDRs due and selectable that are not able to be released
for processing or are in process, but resources are not sufficient to
complete them in a timely fashion.
[16] GAO, 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.: Jan. 9,
2009).
[End of section]
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