Improving the Disability Determination Process

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Improving the Disability Determination Process

http://www.ssa.gov/disability-new-approach/

NPRM Published On July 26, 2005, Jo Anne B. Barnhart, Commissioner of

Social Security, announced publication of a notice of proposed rule

making (NPRM) in the Federal Register which sets out her plan to

improve the disability determination process. This NPRM was developed

after an extensive outreach program the Commissioner launched to let

interested parties know what she was considering and to listen to

their reaction. Individuals and organizations may submit comments on

this NPRM during the 90 day comment period that ends on October 25,

2005.

NPRM Highlights The proposed regulations would:

Establish a Quick Disability Determination process through which

State agencies will expedite initial determinations for claimants who

are clearly disabled; Create a Federal Expert Unit to augment and

strengthen medical and vocational expertise for disability

adjudicators at all levels of the disability determination process;

Eliminate the State agency reconsideration step and terminate the

disability prototype that we are currently conducting in 10 States;

Establish Federal reviewing officials to review State agency initial

determinations upon the request of claimants; Preserve the right of

claimants to request and be provided a de novo hearing, which will be

conducted by an Administrative Law Judge (ALJ); Close the record

after the ALJ issues a decision, but allow for the consideration of

new and material evidence under certain circumstances; Gradually

shift certain Appeals Council functions to a newly established

Decision Review Board; and, strengthen in-line and end-of-line

quality review mechanisms at the State agency, reviewing official,

hearing, and Decision Review Board levels of the disability

determination process.

Background:

When the Commissioner first presented her proposed plan to improve

the disability determination process before Congress on September 25,

2003, she announced that she wanted to hear the views and suggestions

of all interested parties. She wanted to take them into account as

she continued to refine and develop proposed rules to improve the

disability process. She established this Internet site in order to

hear and consider a wide variety of perspectives as she continued to

develop the proposed rules. In addition, she has met with hundreds of

interested organizations, groups, and individuals regarding their

views on her proposed plan to improve the disability determination

process, including:

Members of Congress and congressional staff; Groups and organizations

representing claimants, beneficiaries, retired individuals, and

members of the public; Organizations representing legal and medical

professionals, including Federal judges and Administrative Law

Judges; and, Organizations representing Social Security and State

agency employees who are engaged in the disability determination

process.

Social Security also received hundreds of emails from individuals

currently receiving disability benefits, individuals currently

applying for benefits, and other interested citizens providing

recommendations on how to improve the process.

As a result of these discussions, the Commissioner has made changes

based on what was heard. For instance:

Social Security initially believed that Quick Disability

Determination claims should be adjudicated in regional units across

the country, and not in the State agencies. However, many of the

groups we met with and numerous individuals who submitted suggestions

asserted that the State agencies could effectively adjudicate these

claims. Accordingly, we have proposed that the State agencies be

allowed to adjudicate Quick Disability Determination claims.

Several organizations and numerous individuals also urged us to allow

the State agencies to continue to use State agency medical

consultants when making initial disability determinations under the

proposed plan. While we agree that the State agencies should continue

to employ medical and psychological consultants, we believe that it

is essential that every medical and psychological expert meet our

qualification standards in order to participate in the disability

process.

A number of the groups we spoke with asked that we consider providing

for good cause exceptions to closing the record after the issuance of

the ALJ decision. We agreed. Consequently, although we intend to

close the administrative record after the ALJ issues his or her

decision, we also intend to provide for limited good cause exceptions

to closing the record.

Another area of concern involved our plans to eliminate the Appeals

Council step of the administrative review process. For example, some

thought that if claimants could not request administrative review

with the Appeals Council, the Federal courts would see a large influx

of Social Security disability cases following the ALJ hearing level.

Accordingly, a number of organizations and groups asked us to retain

the Appeals Council until we could be sure that the proposed new

process was working as intended. As a result:

The NPRM will not only make it clear that we intend to roll out the

new process gradually on a region-by-region basis, but also that we

intend to retain the Appeals Council and continue its operations in

those regions where the new process has not yet been implemented.

This gradual implementation also will provide us with the opportunity

to assess the effects of the elimination of the Appeals Council and

to make any necessary adjustments.

We are deeply indebted to all of the individuals and organizations

who expended substantial time and resources both to consider and

analyze the current disability determination process and to share

with us their views, suggestions, and recommendations about how to

improve that process. Our ability to propose an effective and

comprehensive strategy for improving the disability determination

process was greatly enhanced by these views, suggestions, and

recommendations.