Improving the Disability Determination Process

[Guest guest]

SOCIAL SECURITY

News Release

Commissioner

Barnhart Presents Her Approach to Improving the Disability Determination

Process

Jo Anne Barnhart, Commissioner of Social Security, today

presented an approach to improving the disability determination process that

would shorten decision times, pay benefits to people who are obviously disabled

much earlier in the process and test new incentives for those with disabilities

who wish to remain in, or return to, the workforce.

“Clearly, the current process for determining

eligibility must change. People are waiting too long to get

benefits,” Commissioner Barnhart said. “Today I present an

approach that uses 21st century technology to speed up processing

times and to create accountability at every step in the disability

process.”

Commissioner Barnhart’s approach is the result of more

than a year and a half of study and discussions with groups involved in the

disability process – including Social Security employees from across the

country, state Disability Determination Services (DDS), Administrative Law

Judges (ALJs), health care providers, the federal courts, claimant attorneys

and representatives, claimant advocacy groups, Members of Congress and

concerned members of the public.

Under the current process, it takes an average of 628 days

for a Social Security disability application that is denied and appealed at

each step to reach final agency action. (To read more about the current

disability process and associated delays, visit www.socialsecurity.gov/disability/disability_process_welcome.htm).

“My goals for improving the disability program are to

make the correct decision as early in the process as possible and to expand

employment opportunities for people with disabilities,” Commissioner

Barnhart said. “My approach would enable us to do that.”

“Designing my approach for improving the process is

the first step of what I believe must be – and will continue to make

– a collaborative process,” said Commissioner Barnhart.

“I will work within the Administration, with Congress, the state

Disability Determination Services and interested organizations and advocacy

groups before putting pen to paper to write proposed regulations. To be

successful, perspectives from all parts of the system must be

considered.”

None of the suggested changes would require legislative

action; none would adversely affect the employment status of current Social

Security or DDS employees.

Commissioner Barnhart’s approach is predicated on

successful rollout of the Accelerated electronic Disability process

(AeDib). AeDib creates an electronic folder for the claimant’s

application, medical information and other data. AeDib will eliminate

numerous time delays and financial costs related to locating the paper file,

maintaining its contents and mailing them from office to office. The

Social Security Administration is currently piloting AeDib in three states, and

will phase in its use nationwide during an 18-month roll-out.

At a hearing before the House Ways and Means Subcommittee on Social

Security, Commissioner Barnhart described highlights of her approach.

They include:

The

establishment of expert units and screening for “quick decision.” New medical expert units

would be organized by areas of clinical specialty (e.g., orthopedic,

pediatric, psychiatric) and located in Social Security Regional

offices. These units would provide assistance for disability

decision makers at all levels of the determination process (DDS examiners,

ALJs, etc). Through a “quick decision” process, these

units would screen claims for applicants who are obviously significantly

disabled (e.g., ALS, end-stage renal disease, aggressive cancers) and

approve them before they are sent to a state DDS.

DDS examiners

would be required to more fully document and explain the basis for a

decision to deny a disability claim. The DDS reconsideration stage of the

current appeal process would be eliminated. Federal Disability

Quality Branches, which presently review DDS decisions, will be replaced

by an in-line quality review and a centralized quality control. As a

result of “quick decision” and elimination of reconsideration,

the DDS would be able to devote freed-up resources to better documentation

of decisions.

The creation

of the Federal Reviewing Official position. If a claim is denied by

the DDS, the claimant would be able to ask for an independent review by a

Federal Reviewing Official. The Reviewing Official, an attorney,

after a thorough examination of the record, would either approve or deny

the claim. If the claim is not allowed, the Reviewing Official would

prepare a written report outlining the reasons the claim should be denied

or outlining the evidence needed to successfully support the claim.

This report would be provided to the claimant. If the

Reviewing Official’s decision is appealed, a de novo hearing would be scheduled

before an ALJ, who would also receive a copy of the report.

Closing the record

following the ALJ hearing. Following a hearing, the ALJ will issue a

written opinion explaining the basis for the decision, and the record will

be closed. The Appeals Council stage of the current process is

eliminated.

Quality

control for disability claims will be centralized, with end-of-the-line reviews and an Oversight Panel.

An Oversight Panel, consisting of two ALJs and one Administrative Appeals

Judge, would examine the case after quality review. If the Oversight

Panel affirms the ALJ decision, that decision would become a final agency

action. If the Oversight Panel reverses the ALJ decision, that

decision would become a final agency action. Claimants would

continue to be able to appeal any final agency action to Federal district

court.

Social Security has developed a Service Delivery Plan to

eliminate backlogs within a 5-year period. The President’s FY 2004

Budget Request provides significant additional funding to begin to eliminate

these backlogs. Backlogs at the DDS have already been reduced.

Progress is being made at hearing and Appeals Council levels.

Social Security plans to conduct several demonstration

projects aimed at helping people with disabilities return to work. These

projects would support the President’s New Freedom Initiative and provide

work incentives and opportunities earlier in the process. They would

include: early intervention

demonstration projects that provide medical and cash benefits and employment

supports to applicants who elect to pursue work rather than disability

benefits; temporary allowance

demonstration projects that provide immediate cash and medical benefits for a

specified period to applicants who are highly likely to benefit from aggressive

medical care; interim medical benefits

demonstration projects that provide health insurance coverage to certain

uninsured applicants whose medical condition is likely to improve with medical

treatment; and ongoing employment supports

to assist beneficiaries who wish to obtain and sustain work will also be tested.

Much Love,

Deanna

LUPUS Serenity Prayer...

Lord,

grant me the serenity to accept the things I cannot change, the courage to

change the things I can, and the wisdom to hide the bodies of doctors I shot

when they said, You're perfectly healthy, it's all in your head "