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United States General Accounting Office
GAO
Report to the Chairman, Committee on
Finance, U.S. Senate
November 1993
SOCIAL SECURITY
Increasing Number of
Disability Claims and
Deteriorating Service
UNITED
STATES
ACCOUNTING OFFICE GENERAL
GAO/HRD-94-11
GAO
United States
General Accounting Office
Washington, D.C. 20548
Human Resources Division
B-249865
November 10, 1993
The Honorable Daniel Patrick Moynihan
Chairman, Committee on Finance
United States Senate
Dear Mr. Chairman:
This report, prepared at the request of the former Chairman, examines the disability programs
of the Social Security Administration (SSA), which are jointly administered with state agencies
called state disability determination services. The request was prompted by a significant
increase in benefit claims, which in turn has caused an unprecedented increase in pending
claims and processing delays.
We examined the operating conditions at the states and SSA actions taken and planned to
improve service. We are recommending that the Secretary of Health and Human Services (HHS)
develop a plan to (1) reduce the backlog of disability benefit claims and (2) resume the
performance of continuing disability reviews to the level necessary to comply with Social
Security Act provisions.
As arranged with your office, we are sending copies of this report today to interested
congressional committees, the Secretary of HHS, the Commissioner of SSA, and other interested
parties and will make copies available to others on request.
Please contact me at (202) 512-7215 if you or your staff have any questions concerning this
report. Other major contributors to this report are listed in appendix V.
Sincerely,
Jane L.Ross
Jane L. Ross
Associate Director
Income Security Issues
ashington
Executive Summary
In recent years, disability claims for benefits under Social Security's
Disability Insurance (DI) and Supplemental Security Income (SSI) programs
have increased significantly and at an unprecedented rate. Much of the
increase has occurred in the SSI program and was caused by poor
economic conditions, changes in program rules, and other factors. In turn,
the surge in claims has created a significant number of pending claims and
lengthy processing times at state agencies called disability determination
services (DDSS). These organizations determine whether claimants are
disabled according to program rules.
Because of these events, the former Chairman of the Senate Committee on
Finance requested that GAO assess (1) the operating conditions at the DDSS
and (2) the actions taken and planned by the Social Security
Administration (SSA) to reduce the number of pending claims. In
addressing these issues, GAO analyzed DDS performance data and various
SSA studies and reports. GAO also conducted a nationwide survey of state
DDS administrators about the operational problems confronting them.
The DI program provides income replacement for disabled persons who
Background
have enough work experience to be insured under Social Security. The SSI
program provides assistance to the aged, blind, and disabled whose
income and resources are below a specified amount, regardless of insure
status under Social Security.
In fiscal year 1992, the DI program paid about $31 billion to 3.5 million
disabled workers and 1.4 million of their dependents. The SSI program pa
$21 billion to about 5.5 million recipients in fiscal year 1992, 4.0 million a
whom were disabled.
SSA administers both programs with the help of the DDSS, which make the
initial decisions on whether the claimants meet the programs' definition
disability. A claimant initially denied benefits can appeal the decision to
several levels of review. SSA and the DDSS also periodically review the
continued eligibility of program participants to determine if they meet ti
disability criteria for the programs. These reviews, which are required b)
the Social Security Act, are called continuing disability reviews (CDRS).
Results in Brief
Claim backlogs and processing times for the DI and SSI programs reache
an all-time high in fiscal year 1992. SSA and the DDSS have not been able
keep up with the high rate of claims submitted for benefits, which has
Page 2
GAO/HRD-94-11 Service and SSA Disability Pro
Executive Summary
continued into fiscal year 1993. From fiscal year 1990 to fiscal year 1992,
processing times increased nearly 50 percent, and some states have taken
more than 5 months to process a claim. In fiscal year 1992, DDSS in the
more populous states generally tended to be the poorest performers,
according to a number of key program performance indicators.
SSA has undertaken numerous short-term initiatives to keep up with
claims-most significantly, the funding of DDS overtime. The high
workloads of the last several years have stressed many of the DDSS
considerably. Staff are overworked according to the DDS administrators,
and overtime use is at an all-time high.
SSA also diverted staff resources from doing CDRS to processing initial
claims. As a result, many ineligible individuals have received and are
continuing to receive program benefits, which, according to SSA, will cost
the program at least $1.4 billion.
These short-term initiatives resulted in a relatively small reduction in
pending claims and processing times. SSA also has established a number of
long-term initiatives to improve its disability programs; however, exactly
how, when, and to what extent these initiatives will improve service is not
known at this point. Consequently, the Secretary of Health and Human
Services needs to develop a plan to reduce the backlog of benefit claims in
SSA'S disability programs and resume the performance of mandated CDRS.
Principal Findings
DDSs-Organizations
Service to beneficiaries has deteriorated significantly in recent years.
Under Stress
During most of the 1980s, the average claim processing time was about 75
days, but, in the last 3 years, the time has increased significantly. For fiscal
year 1992, the average processing time was 112 days. Further, processing
times involving 10 of the largest DDSS-which account for 60 percent of all
pending claims-averaged 127 days.
GAO'S survey of DDS administrators disclosed numerous other indicators of
organizational stress in the DDSS during fiscal year 1992. For example,
according to the administrators,
the majority (85 percent) of DDSS are understaffed;
Page 3
GAO/HRD-94-11 Service and SSA Disability Programs
Executive Summary
funding in key functional areas-such as, automated data processing,
training, and the purchase of medical examinations-is often inadequate;
supervisors and quality assurance personnel are often detailed to process
claims rather than performing their normal duties;
many employees may not be willing to continue working overtime to try to
keep up with incoming claim receipts;
in fiscal year 1992, most DDSS staged claims (that is, set claims aside and
did not assign them to staff because of their high workloads) whereas only
five DDSS staged claims in 1990; and
employee morale is not good and is declining primarily because of
workload pressures.
Limited Success in
As early as fiscal year 1990, to improve service, SSA started reducing the
Reducing the Number of
number of CDRS to be done by the states and diverting these resources to
Pending Claims
claim processing. Reducing the number of CDRS has resulted in significant
payments to individuals ineligible for benefits. According to SSA, the net
cost of not performing required CDRS for the DI program in fiscal years 199
through 1993 is $1.4 billion, projected through 1997.
In January 1992, SSA initiated a program to reduce the number of pending
claims. SSA took initiatives to increase the productivity of the DDSS, such as
streamlining certain claim processing requirements and transferring
workloads between DDSS and SSA facilities to help process claims. Also,
since the start of the program through September 1993, the DDSS made
extensive use of overtime to improve service.
Although DDS productivity has increased significantly since early 1992, the
reduction in pending initial claims was modest, from a high of 638,000 in
February 1992 to 555,000 through September 1993-a reduction of 83,000
claims or 13 percent below the February peak. Also, in fiscal year 1993,
processing times were reduced about 10 days.
Long-Range Plans to
For the long term, SSA has undertaken several initiatives, most notably th
Improve Service
development of a strategic plan to guide the agency as it moves toward
year 2000. As part of its plan, five strategic priorities have been
established, two of which specifically address improvements in the
agency's disability programs. The plan covers a wide variety of initiative
to improve service and increase SSA and DDS productivity, including the
integration of state-of-the-art computer technology into all of SSA and DO
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GAO/HRD-94-11 Service and SSA Disability Prof
Executive Summary
operations. Exactly how, when, and to what extent this planning and these
initiatives will pay off, however, is not known now.
Recommendations
Because of the limited progress achieved by SSA and the uncertainties
associated with its long-range planning, GAO recommends that the
Secretary of Health and Human Services develop a plan to (1) reduce the
backlog of disability benefit claims made in SSA'S disability programs and
(2) assure the performance of continuing disability reviews to the level
necessary to comply with Social Security Act provisions. The plan should
be submitted to the Congress and include a request for additional staffing
and funding, if deemed necessary.
Agency Comments
GAO requested written comments from the Department of Health and
Human Services, but none was provided. However, GAO did discuss its
basic findings with agency officials and considered their comments in
finalizing the report.
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GAO/HRD-94-11 Service and SSA Disability Programs
Contents
Executive Summary
2
Chapter 1
8
Introduction
Background
8
Rising DDS Workloads
10
Objectives, Scope, and Methodology
13
Chapter 2
15
High Workloads
Administrators Report That DDSs Are Under Stress
15
Decisional Accuracy May Be Adversely Affected by Workload
Create Problems at
18
Pressures
DDSs
Performance of DDSs Varies
18
Chapter 3
21
SSA's Actions and
SSA Actions Reduce Pending Claims Somewhat
21
Long-Term Initiatives to Improve Service
25
Plans to Improve
Conclusions
26
Service
Recommendation to the Secretary of Health and Human Services
27
Appendixes
Appendix I: Questionnaire for DDS Administrators
28
Appendix II: Selected DDS Performance Data for Fiscal Year 1992
47
Appendix III: Modified Claim Processing Procedures Approved
51
by SSA Commissioner
Appendix IV: Examples of SSA's Strategic Planning Initiatives
53
Appendix V: Major Contributors to This Report
55
Related GAO Products
56
Table
Table 2.1: Selected DDS Performance Data for Initial Claims,
19
Fiscal Year 1992
Figures
Figure 1.1: DDS Work-Years, Fiscal years 1980 to 1993
9
Figure 1.2: Initial DI and SSI Claim Receipts
10
Figure 1.3: Initial DI and SSI Pending Claims
12
Figure 1.4: Initial Claim Processing Times
13
Figure 2.1: DDS Performance by Defined Category, Fiscal Year
20
1992
Figure 3.1: Initial DI and SSI Pending Claims by Month
24
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GAO/HRD-94-11 Service and SSA Disability Programs
Contents
Abbreviations
ALJ
administrative law judge
CDR
continuing disability review
DDS
disability determination service
DI
Disability Insurance
HHS
Department of Health and Human Services
PPWY
production per work year
SSA
Social Security Administration
SSI
Supplemental Security Income
WWOH
weeks work on hand
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GAO/HRD-94-11 Service and SSA Disability Programs
Chapter 1
Introduction
In the last several years, the disability programs administered by the Social
Security Administration (SSA) have experienced unprecedented growth in
the number of claims, which has created large numbers of pending claims
and high claim processing times. This report addresses the operating
conditions of the programs and the action SSA has taken or plans to take to
improve service.
Background
SSA administers two disability programs that have the same eligibility
criteria. One is the Disability Insurance (DI) program, and the other is the
needs-based Supplemental Security Income (SSI) program. For both DI and
SSI, state agencies, called disability determination services (DDSS),
determine whether applicants meet established criteria for disability.¹
In 1992, an average of 4.9 million persons received about $31 billion in
benefit payments under the DI program. Under the SSI program, benefit
payments amounted to about $21 billion in fiscal year 1992, a portion of
which includes benefits for the aged. Of the 5.5 million people receiving SSI
benefits at the end of fiscal year 1992, 27 percent qualified because of age,
and the remainder qualified for reasons of disability.
Individuals seeking DI or SSI benefits on the basis of disability must file an
application with an SSA field office. A key part of the application is the
disability report, which includes a description of the applicant's disability
and a medical history. The SSA field office then forwards an application
package to a state DDS, which in turn assigns it to one of its disability
examiners. The examiner reviews the report for accuracy and
completeness and sends letters to medical providers requesting
documentation of the applicant's disability. If necessary, the examiner will
also set up a consultative medical examination for the applicant to
document the disabling conditions. Upon receipt of all medical evidence,
the examiner, in consultation with a DDS physician, determines whether
the applicant is disabled according to program rules.
Applicants who are denied benefits have several appeal levels available.
The first level is a reconsideration of the initial decision, which is
administered by a DDS. The second is a face-to-face hearing given by a
federal administrative law judge (ALJ). The third level is SSA'S Appeals
Council, and the last recourse for denied applicants is the federal court
system.
'DDSs number 54, one in each state, the District of Columbia, Puerto Rico, and Guam. South Carolina
also has a separate agency for the blind.
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GAO/HRD-94-11 Service and SSA Disability Programs
Chapter 1
Introduction
Most DDS resources (nearly 80 percent in fiscal year 1992) were devoted to
the processing of initial claims, with most of the remainder used for
reconsiderations and continuing disability reviews (CDRS). The latter are
periodic reviews to determine whether an individual continues to meet
program criteria for disability.
For fiscal year 1992, the operating budget for the DDSS was $1.034 billion,
involving 13,225 work-years. Figure 1.1 shows the work-years devoted to
DDS operations since 1980.
Figure 1.1: DDS Work-Years, Fiscal Years 1980 to 1993
Work-Years
13302
13225
13298
13074
12887
12924
12513
12502
11963
11738
11634
11
11177
11
10794
10000
9701
)
9000
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
Years
As shown in figure 1.1, DDS staffing increased steadily from 1980 to 1986,
reaching a high point in that year. Beginning in 1987, DDS staffing
decreased steadily through 1990, reaching a 9-year low in that year. After
1990, staffing levels increased. The DDS cuts in the late 1980s generally
paralleled significant reductions in SSA staff. From fiscal year 1985 to 1991,
SSA staff was cut by about 21 percent or 17,000 positions.
Page 9
GAO/HRD-94-11 Service and SSA Disability Programs
Chapter 1
Introduction
Rising DDS
In recent years, the number of disability benefit applications has risen
Workloads
dramatically, as shown in figure 1.2.
Figure 1.2: Initial DI and SSI Claim Receipts
) Number of Claims (thousands)
2564
2400
2393
)
2000
2015
1800
1746
1737
1644
)
1585
1594
1589
1526
1481
1435
1400
)
)
82
83
84
85
66
87
88
89
90
91
92
93
Fiscal Year
From fiscal years 1982 through 1989, the DI and SSI programs combined
averaged 1,575,000 initial claims per year, with total claims received in
most years ranging between 1.4 and 1.6 million. In only 2 years did receipts
exceed 1.6 million-1.75 million in 1986 and 1.64 million in 1987.
From 1990 through 1992, however, the number of receipts increased 9, 16,
and 19 percent, respectively, with 1992 receipts amounting to 2.4 million.
The 1992 level represents about a 50-percent increase over the average
number of applications received during the last 8 years of the 1980s. Also,
the increase in claims started when DDS staffing was the lowest in 9 years.
For fiscal year 1993, claim receipts also increased, up about 7 percent from
the 1992 level. For fiscal year 1994, SSA expects the increase in claims to
continue.
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GAO/HRD-94-11 Service and SSA Disability Programs
Chapter 1
Introduction
The largest increase in claims occurred in the SSI program. Although the
precise reasons for the increase are not known, the poor performance of
the economy, an increase in children's claims resulting from a Supreme
Court decision,² changes in program rules, and increased SSI outreach are
among the reasons frequently cited by SSA and others.³ In fiscal year 1992,
SSI claims accounted for 47 percent of the 2.4 million disability claims
received, while DI and concurrent claims (both SSI and DI) accounted for 28
and 25 percent, respectively.
The increase in applications has resulted in a larger number of pending
initial claims at the DDSS and increased claim processing times. From 1982
through 1989, the number of pending initial claims at the DDSS averaged
around 266,000. In 1991 through 1993, the number of pending initial claims
more than doubled, averaging about 550,000.
Similarly, processing times during the mid-to-late 1980s averaged around
75 days but increased dramatically in recent years, averaging 112 days in
1992.4 This time represents nearly a 50-percent increase over the
processing times achieved during the 1980s and sharply contrasts until
SSA'S established processing time goal of 60 days. In fiscal year 1993,
processing times were reduced about 10 days. Figures 1.3 and 1.4 illustrate
these trends.
'On February 20, 1990, the U.S. Supreme Court ruled that regulations for evaluating impairments for
children under SSI were inconsistent with the standard in the Social Security Act. The act provides
that a child will be considered disabled if he or she has an impairment of comparable severity to one
that would render an adult disabled.
"We are currently reviewing the causes for the increase in disability claims and will issue the results in
late 1993.
"Processing times in this report are measured from the date of application to DDS clearance. Most time
involves DDS processing.
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GAO/HRD-94-11 Service and SSA Disability Programs
Chapter 1
Introduction
Figure 1.3: Initial DI and SSI Pending Claims
Number of Claims (thousands)
577
555
523
400
385
316
296
307
275
263
235
228
206
100
0
82
B
84
85
86
87
88
89
90
91
92
93
Fiscal Year
Page 12
GAO/HRD-94-11 Service and SSA Disability Programs
Chapter 1
Introduction
Figure 1.4: Initial Claim Processing Times
125
Number of Days
120
111
104
100
=
:
=
88
61
B
78
77
77
78
79
75
74
71
74
89
70
70
65
59
50
25
0
0
0
82
83
84
85
86
87
:
:
90
91
92
93
Year
DI
SSI
Note: SSI processing times generally are longer than those of DI claims. For the most part, this is
attributed to the longer claim development time required because SSI applicants tend to have
less medical documentation to support their claims. Also, DI processing times were not available
for 1982 and 1983; they were measured for the first time in 1984.
The increase in disability claims also directly impacts other DDS workloads
such as CDRS and reconsiderations. Further, disability claims directly
impact other SSA components such as SSA field offices-which take the
initial claims-and SSA'S Office of Hearings and Appeals. Regarding the
latter, the number of appeals to ALJS have increased significantly in recent
years. Cases pending before ALJS increased 44 percent, from 142,000 at the
end of fiscal year 1989 to 205,000 by the end of fiscal year 1992.
Objectives, Scope,
The objectives of our review were to examine the operating conditions at
and Methodology
the DDSS during fiscal year 1992 and SSA actions taken and planned to
Page 18
GAO/HRD-94-11 Service and SSA Disability Programs
Chapter 1
Introduction
reduce the number of disability pending claims. We based our review on
analyses of routinely generated SSA/DDS performance data, which included
claim receipts, pending claims, productivity, staffing levels, and processing
times.
We also visited six DDSS and discussed with the administrators the
operational problems they were experiencing because of the high claims
workload. To obtain a more broadly based view of DDS operations and
problems, we sent a nationwide questionnaire (see app. I) to DDS
administrators. Fifty-two of the 53 DDSS we surveyed responded to the
questionnaire.⁶
In reviewing SSA'S actions, we examined its plans, as well as reports and
studies on their impact. We also obtained DDS views on the actions taken.
Concerning future plans, we examined SSA'S strategic planning process to
gain an understanding of the activities planned and their potential impact
on productivity and service quality.
We requested written comments on this report from the Department of
Health and Human Services, but none was provided. However, we did
discuss our basic findings with agency officials and considered their
comments in finalizing this report. We conducted our review between
June 1992 and June 1993 in accordance with generally accepted
government auditing standards.
We did not survey the South Carolina Commission for the Blind, and Guam did not respond to our
questionnaire.
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GAO/HRD-94-11 Service and SSA Disability Programs
Chapter 2
High Workloads Create Problems at DDSs
The DDS administrators we surveyed generally painted a negative picture of
conditions at their state agencies. Overall, the DDSS can be characterized as
organizations under a considerable amount of stress. Moreover, many
administrators believed that workload pressures are adversely affecting
the accuracy of claim decisions.
While processing times and the number of pending claims in general are
very high, the performance of individual DDSS varies widely. In fiscal year
1992, a group of 10 DDSS performed at a level much lower than the national
average for all DDSS, and the performance of a group of 23 DDSS was much
better than the performance for the program overall.
Administrators Report
The results of our survey of DDS administrators indicate that many DDSS
have significant staff shortages, and funding in key operational areas is
That DDSs Are Under
insufficient. This situation in turn is contributing to several other DDS
Stress
problems, including declining morale and a reduction in the extent and
quality of training.
The vast majority of DDS administrators said that their agencies are
understaffed, and a third characterized the understaffing as significant.
Understaffing was particularly apparent in key DDS positions. On average,
the administrators said that the maximum claim caseload per disability
examiner should be about 100 cases, while the actual average caseload
during fiscal year 1992 was 134. Twenty-nine administrators also said they
had too few medical consultants. Compounding this shortage, about a
third of the administrators said that they had a great deal of difficulty in
recruiting these consultants. The number of clerical staff and disability
examiner supervisors, however, generally did not appear to be a problem.
Many administrators said that their DDSS were underfunded in key areas.
For example, more than half of them said that funding for automated data
processing (for example, computers and printers) was less than or
considerably less than adequate during fiscal year 1992. About a third of
the administrators said that funding for training and equipment was too
low, and about a fourth said that funding for medical examinations was
not adequate.
Employees Are Not
Certain DDS staff spent time processing claims instead of performing their
Performing Their Normal
normal duties. For example, seven administrators said that staff who
Duties
normally perform quality assurance functions spent between 41 and
Page 15
GAO/HRD-94-11 Service and SSA Disability Programs
Chapter 2
High Workloads Create Problems at DDSe
60 percent of their time processing claims; six said that their quality
assurance staff spent 81 to 100 percent of their time in this manner. Many
administrators (25) also reported that disability examiner supervisors
spent no more than 20 percent of their time on claims processing rather
than supervising, and 12 said that their supervisors spent 21 to 40 percent
of their time in this manner.
Quality of Training Could
In fiscal year 1992, the administrators reported that disability examiners
Be Improved
received an average of 24 hours of post-entry level training. In commenting
on the extent to which the training kept examiners current with policy and
procedural changes, 23 administrators said that it did to a great or very
great extent. The other 28 administrators said that the training was not as
good; 20 said the training kept the examiners current to a moderate extent;
7 said to some extent, and one said to little or no extent. Administrators
cited high workload most frequently as the principal reason for the less
than adequate training; because of the current workload pressure, training
has been deferred. Comparing the training to that provided in 1989, about
half said the quality was about the same; 7 said it was somewhat better or
much better, and 17 said it was somewhat worse or much worse.
Claims Are Being Set Aside
In situations where DDSS cannot keep up with incoming claim receipts,
claims often are "staged;" that is, they are set aside until a disability
examiner is free to process the claim. The stated rationale for this practice
is that disability examiners can generally manage a caseload of 100 claims,
and beyond this, the caseload becomes unmanageable.
In fiscal years 1989 and 1990, the number of DDSS that staged claims were
two and five, respectively. In fiscal year 1991, the number increased to 26
and in 1992, to 33. Of those that staged claims in 1992, the average percent
of all-claim receipts staged was 41. Further, the claims were staged an
average of 26 days until they were assigned to an examiner. Although the
number of DDSS that staged claims increased significantly from 1989 to
1992, the number dropped to 11 in fiscal year 1993, according to SSA.
All but one DDS that staged claims said that they exempt certain priority
claims from staging. Common examples are those involving terminal
illness, homelessness, and certain children's claims. Also, although a
staged claim is not immediately assigned to an examiner, 24 DDSS reported
that some preliminary work is started on the claims, such as initiating
requests for medical documentation.
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GAO/HRD-94-11 Service and SSA Disability Programs
Chapter 2
High Workloads Create Problems at DDSs
Willingness to Work
In fiscal years 1991 and 1992, the DDSS used overtime extensively to keep
Overtime May Decline
up with claim receipts-68,758 days in 1991 and 156,462 days in 1992. By
comparison, the DDSS averaged 12,345 days of overtime per fiscal year
from 1984 through 1990. In fiscal year 1992, the DDS administrators
reported that, on average, two-thirds of their disability examiners worked
overtime.
While the use of overtime can be extremely useful in meeting short-term
requirements, the reliance on overtime, especially over the long term, can
be problematic. First, not all employees are interested in working
overtime. The administrators reported that, on average-given an
availability of unlimited resources-only two-thirds of their examiner staff
would be willing to work overtime.
Also, the willingness to work overtime may diminish as the number of
overtime hours increases or the duration of the use of overtime lengthens.
Half of the administrators reported that their examiners would be willing
to work the same amount of overtime in fiscal year 1993 to a great or very
great extent. The other half characterized examiner willingness as
moderate or less. When asked if examiners would be willing to work more
overtime in 1993, only 7 administrators described their examiners'
willingness as great or very great; 34 described examiners as having some,
little, or no such willingness.
DDS Morale Is Not High
According to DDS administrators, the morale of DDS employees is not high
and Has Declined
and has declined in the last several years. None of the administrators
described employee morale as very high, and only nine described it as
high. Most described the morale as moderate, and 11 described it as low or
very low. Compared to 1989, 8 of the administrators said that morale
improved considerably while 10 said that it improved somewhat. Nineteen
said that morale declined somewhat, and 10 said that it declined
considerably. In commenting on the reasons for the declining morale, the
administrators most frequently cited high workloads.
Automated Systems
Other than funding for staffing, the most serious funding deficiency cited
Support Is Inadequate
by the DDS administrators was funding for automated systems support for
claims processing. More than half said that funding was a problem during
fiscal year 1992, with 18 saying that it was less than adequate and 9 saying
that it was considerably less than adequate.
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GAO/HRD-94-11 Service and SSA Disability Programs
Chapter 2
High Workloads Create Problems at DDSs
Sixteen administrators said that their current computerized processing
systems meet DDS needs to a great or very great extent. Conversely, 15 said
that their systems met their needs to a moderate extent, another 15 said
that they did to some extent, and 2 said that they did to little or no extent.
SSA plans to improve automation in the DDSS. Through 1995, SSA is requiring
DDSS to automate six baseline functions.¹ Beyond 1995, SSA plans to start its
implementation of an enhanced modernized disability system in the DDSS.
This system is intended to fully integrate DDS operations into SSA'S by
providing the DDSS with the same intelligent workstations, local area
networks, and software applications used by SSA.
Decisional Accuracy
Historically, decisional accuracy for the disability programs has been
relatively stable, with the accuracy rate for allowances higher than the rate
May Be Adversely
for denials. In fiscal year 1992, the accuracy rate for allowances declined
Affected by Workload
0.2 of 1 percent, from 97.2 percent to 97.0. For denials in fiscal year 1992,
the accuracy rate improved from 92.4 to 92.9. The improved accuracy for
Pressures
denials ended a 3-year decline in accuracy since 1988, when the rate was
93.4 percent.
Many DDS administrators expressed concern about the effect of workload
pressures on decisional accuracy, particularly with respect to claim
denials. We asked the administrators to what extent fiscal year 1992
workload and staffing pressures contributed to inaccurate decisions.
Regarding denials, 7 administrators said that these pressures contributed
to decisional inaccuracies to a great or very great extent, while 15 said that
the extent was moderate. In comparison, only three administrators said
that workload and staffing pressures contributed to decisional
inaccuracies in allowances to a great or very great extent and seven said
that the extent was moderate.
Performance of DDSs
In fiscal year 1992, the performance of DDSS varied widely. To facilitate
analysis of the DDSS, we grouped them into three categories. Category I
Varies
comprises 23 states, and the sole criterion for inclusion in this group was a
weeks work on hand (WWOH) of 10 weeks or less. Category II comprises 19
states whose WWOH was more than 10 weeks and that had fewer than
13,000 pending claims. Finally, category III comprises 10 states; the criteria
The six functions are (1) case receipt and assignment; (2) disability examiner interface and
worksheets; (3) medical evaluation reports, consultative examinations, and fiscal/accounting; (4) DDS
internal administrative and management information; (5) case closure; and (6) data and word
processing.
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GAO/HRD-94-11 Service
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Chapter 2
High Workloads Create Problems at DDSs
for inclusion in this group were an initial claims' WWOH of more than 10
weeks and 17,000 or more pending initial claims. Appendix II categorizes
the 50 states as well as the District of Columbia and Puerto Rico in the
three groups. Comparative data presented at the end of fiscal year 1992
include numbers of pending claims, processing times, and accuracy rates.
The 23 states in category I generally are smaller states and better
performers. Their WWOH on average was 8.4, which was almost half that of
the category III states. Also, their production was the highest among the
three categories, and their claim processing time was the lowest.
Conversely, category III states generally are the most populous states and
the poorest performers. Programwide, they accounted for 60 percent of all
pending initial claims and half of all DDS work-years expended in fiscal
year 1992. Their WWOH for initial claims averaged 15.4. Their combined
production levels for fiscal year 1992 was the lowest among the three
categories;² their claim processing time was the highest; and their
accuracy rate was the lowest. Table 2.1 summarizes, by category, the
performance of the DDSS for fiscal year 1992.
Table 2.1: Selected DDS Performance
Data for Initial Claims (by Defined DDS
Category I
Category II
Category III
All DDSs
Categories), Fiscal Year 1992
Number of DDSs
23
19
10
52
Processing times
(in days)
84
110
127
112
WWOH
8.4
12.0
15.4
12.8
Accuracy rates
95.3%
95.1%
93.3%
94.7%
PPWY
253
235
228
236
Note: PPWY is based on DDS operations overall and not just initial claims. Processing time is
measured from the date of application to the date of clearance by the DDS. Most time involves
DDS processing.
Figure 2.1 shows the overall performance of individual states, using the
above category definitions.
SSA measures production as the number of cases produced per DDS each work-year, or production
per work-year (PPWY).
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GAO/HRD-94-11 Service and SSA Disability Programs
Chapter 2
High Workloads Create Problems at DDSs
Figure 2.1: DDS Performance by Defined Category, Fiscal Year 1992
Category I
Category II
Category III
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GAO/HRD-94-11 Service and SSA Disability Programs
Chapter 3
SSA's Actions and Plans to Improve Service
In the short term, SSA has taken several actions to maintain service levels
in its disability programs. These include reallocating resources from CDRS
to initial claim workloads and implementating a plan to reduce the number
of pending claims. These actions have produced some progress in
reducing pending claims and processing times, but, as mentioned earlier,
their cost has been a lowering of morale in the DDSS and a cutback in other
DDS workloads.
SSA has under way numerous initiatives that over the long term are
intended to improve service and productivity in its disability programs.
Exactly how, when, and to what extent these initiatives will pay off is not
known at this point. Further, an ongoing GAO review of SSA management
has disclosed several problems regarding SSA'S long-term planning.
Because of the relatively little progress made to date in reducing the
claims pending and the uncertainty of SSA'S long-range efforts, the
Secretary of Health and Human Services should develop a plan to
(1) reduce the backlog of disability claims and (2) assure the performance
of CDRS to the level necessary to comply with Social Security Act
provisions.
SSA Actions Reduce
As early as 1990, to keep up with increasing claim receipts, SSA began
Pending Claims
reducing the number of CDRS it expected DDSS to perform. During the 3
years before 1990, DDSS devoted an average of about 1,300 work-years to
Somewhat
CDRS. In 1990, SSA cut the CDR effort by almost a third to 879 work-years.
The effort was cut again in 1991 to 321 work-years and again in 1992 to 246
work-years.
SSA estimates that not performing required DI CDRS¹ during fiscal years 1990
to 1993 will result in about $1.4 billion in benefits paid to ineligible
persons, projected through fiscal year 1997. This loss does not include
savings that could have resulted from CDRS that were not done before 1990
but should have been done Also, although data were not readily available
to make similar estimates for the SSI program, the likely impact on that
program is significant.
According to SSA, at least 300,000 to 400,000 CDRS should be done each year
to keep pace with the legislative requirement. Additionally, the current
'Generally, the Social Security Act requires that SSA review the continuing eligibility of DI
beneficiaries at least every 3 years, except in cases where disabilities are considered permanent. As
required under the law, regulations were issued that require that those with permanent disabilities are
to be reviewed every 7 years.
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GAO/HRD-94-11 Service and SSA Disability Programs
Chapter 8
SSA's Actions and Plans to Improve Service
backlog of statutorily required CDRS is about 1.1 million. In the last 4 years,
the most CDRS done in a given year was 367,000 in 1989. In 1990, 195,000
were done, and 73,000 were done in each of fiscal years 1991 and 1992.
Currently, SSA plans for about 73,000 CDRS to be done in each of fiscal years
1993 and 1994.2
Plan to Reduce Backlogs
On January 31, 1992, the Commissioner of SSA approved a plan for
reducing the backlog of disability claims. Key ingredients of the plan
included short-term initiatives and the use of SSA'S $100 million
contingency fund for fiscal year 1992. The initiatives, begun in
February 1992, were to be in effect for 6 months; subsequently, they were
continued indefinitely.
Two key initiatives in the plan involved (1) reducing claim development
and documentation requirements and (2) having certain DDSS and SSA
components process claims for DDSS with large backlogs. Also, as part of
the plan, SSA sought from HHS and the Office of Management and Budget
the release of its $100 million contingency fund to support the use of
overtime in DDSS. The contingency fund was released in March 1992, and
the DDS share was about $66 million.
Modification of the claim development and documentation requirements
involved 15 specific types of claims (see app. III), and, with one exception,
they applied to claims that appeared to be allowable. An internal SSA study
of the implementation of the modified requirements showed that they
were applied to about 7 percent of all claims processed between
March and July 1992 and that they had no adverse impact on the accuracy
of claim decisions. For example, the study showed that the decisional
accuracy rate for the claims studied was 98.3 percent while the rate for all
allowances in fiscal year 1992 was 97.0 percent. Further, the accuracy
rates for the claims studied were higher than or equal to the 1992 accuracy
rates of allowance decisions involving 12 of the 14 individual body systems
(for example, cardiovascular, digestive, pulmonary).
Our survey of the DDS administrators generally corroborated the results of
SSA'S study. The administrators said that SSA'S initiatives and other actions
The failure of SSA to perform CDRs and the related cost to the agency was the subject of a hearing
held March 9, 1993, by the Select Committee on Aging, U.S. House of Representatives. Our testimony,
GAO/T-HRD-93-9, Social Security: SSA's Processing of Continuing Disability Reviews, suggested that
SSA should examine ways to refine its CDR process and increase the number of reviews beyond
current levels.
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GAO/HRD-94-11 Service and SSA Disability Programs
Chapter 8
SSA's Actions and Plans to Improve Service
to reduce backlogs did not contribute to any great extent to inaccuracies
in allowance decisions (see app. II, questions 81 and 82).
Regarding the initiative to provide assistance to DDSS with large backlogs,
23 DDS administrators surveyed said that they sent more than 58,700 claims
to other states or federal organizations for processing. About 81 percent of
the claims were sent to SSA organizational components, including regional
quality assurance units and SSA headquarters. The remainder were sent to
other states. Thirteen administrators also reported receiving staff on a
246,
temporary basis from other states or federal organizations to help process
claims. The number of employees detailed was 41, and the average detail
lasted about 9.3 weeks. While 8 DDSS that sent or received cases for
processing said that the process worked very well, 13 DDSS said that the
process went moderately well, 14 said that it went somewhat well, and 3
said "not well."
For those DDSS that transferred or received workloads, we asked the
administrators to describe what problems, if any, they had with the
process. Problems mentioned included (1) relatively significant start-up
efforts, (2) differences in case development procedures, (3) confusion for
claimants because some other state was processing their claims, and
(4) increased processing times.
Impact of Actions Taken
Since initiation of the plan to reduce the backlogs, DDS productivity has
increased considerably, but the number of pending claims has decreased
only slightly. Overall, the DDS'S average PPWY for fiscal year 1992 was 235,
which amounts to an 8.3 percent increase over 1991. For comparison
purposes, the PPWY levels in fiscal years 1988, 1989, and 1990 were 210, 215,
and 220, respectively.
The increase in the PPWY during fiscal year 1992 generally coincides with
the implementation of the short-term initiatives in February and the
release of the contingency funds in March. The average PPWY for
October 1991 through February 1992 was 210, compared to an average
PPWY of 256 during March to September 1992. For fiscal year 1993, the PPWY
was 261.
When we asked the DDS administrators to what extent their fiscal year 1992
productivity improved as the result of the short-term initiatives, only three
said that their productivity increases resulted from the initiatives to a great
or very great extent. In contrast, 35 administrators said that their DDSS'
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GAO/HRD-94-11 Service and SSA Disability Programs
Chapter 8
SSA's Actions and Plans to Improve Service
productivity increases resulted to a great or very great extent from the
release of the contingency fund, which was used in large part to fund
overtime pay.
For the first 5 months of fiscal year 1992, the DDSS averaged 8,449 days of
overtime. During the last 7 months of the fiscal year, overtime use nearly
doubled, averaging 16,410 days per month. Relatively high overtime use
continued in fiscal year 1993, averaging 12,414 days per month. Pending
initial claims were reduced from the high in February 1992 of 638,000 to
555,000 through September 1993. This represents a reduction of 13
percent. Also, in fiscal year 1993, processing times were reduced about 10
days compared to 1992 levels. The initial claims pending by month for
fiscal year 1990 through fiscal year 1993 are shown in figure 3.1.
Figure 3.1: Initial DI and SSI Pending Claims by Month
e
0
Number of Claims
00
550000
00
450000
400000
350000
300000
250000
200000
10/89
1/90
4/90
7/90
10/90
1/91
4/91
7/91
10/91
1/92
4/92
7/92
10/92
1/93
4/93
7/93
9/93
Month
While progress has been made in reducing the claims pending, it is
questionable how much more progress can be made or how long claims
can be kept from rising. As discussed earlier, many DDSS appear to be
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GAO/HRD-94-11 Service and SSA Disability Programs
Chapter 3
SSA's Actions and Plans to Improve Service
considerably stressed. Further, the decline in claims pending has tended to
level off since December 1992.
We also asked the DDS administrators what further actions SSA can
take-other than an increase in funding or staffing-to reduce the number
of pending disability claims. Forty administrators offered a total of 153
suggestions or recommendations on a wide variety of issues and topics.
They included, for example, simplifying claim forms, procedures, and
processes; placing more responsibility on the claimants to develop their
claims; additionally modifying case development requirements; and giving
the DDSS more authority or discretion in making claim decisions.
On January 22, 1993, we provided SSA officials a copy of the DDS
recommendations and our analysis of them. They said they would review
the recommendations to determine which might warrant further study or
implementation.
Long-Term Initiatives
SSA has numerous initiatives under way with the potential to make
long-term improvements to service and increase productivity in its
to Improve Service
disability programs. Some examples appear in appendix IV.
In 1991, SSA released its strategic plan, which provides a framework for
agency planning and action to be completed by the year 2005. The
planning document articulates, for example, the agency's mission and its
service delivery goals and objectives. The plan also establishes five
strategic priorities that are considered to be of paramount importance to
the agency's future. These priorities are (1) improving the disability
process, (2) improving the appeals process, (3) improving access to SSA,
(4) turning SSA into a "paperless" agency, and (5) establishing a
"cooperative processing architecture."
Following the issuance of the strategic plan, the next step in SSA'S planning
process was the issuance of strategic priority transition guidance in
June 1992. This guidance identifies numerous specific initiatives that must
be undertaken during the strategic planning period to accomplish the
agency's goals and objectives.
For these initiatives, SSA will develop 159 tactical plans to identify the
specific activities required, including time frames for their completion and
preliminary estimates of the denied benefits. SSA will revise the tactical
Page
GAO/HRD-94-11 Service
SSA 1
lity Programs
Chapter 8
SSA's Actions and Plans to Improve Service
plans annually; the plans will provide input to the development of SSA'S
annual budget.
From its long-term strategy, SSA expects benefits in increased efficiency
and productivity, cost avoidance, and improved service to the public.
However, the precise nature and extent of the benefits to be realized from
the more than 150 initiatives are not known at this point. The long-term
nature of the undertaking and the fact that much study and development
remains to be done makes it difficult to predict ultimate outcomes.
According to SSA, it will develop more precise estimates of benefits as part
of the annual budget process, which identifies those initiatives and
activities that SSA is confident will produce a given result.
In addition to its strategic planning initiatives, SSA has also recently begun
a special study of disability claim processes. The study will attempt to
identify ways to reengineer current processes and procedures to achieve
greater efficiency and improved service. According to SSA, the initial phase
of this study, along with recommendations, is to be completed by
March 31, 1994.
Three GAO studies completed in 1987, 1989, and 1991 have raised several
issues concerning the adequacy of SSA'S long-range planning.³ More
recently, an ongoing GAO review of SSA management has raised additional
concerns. We communicated these concerns to SSA in August 1993 in a
draft report titled Social Security: Sustained Effort Needed to Improve
Management and Prepare for the Future.
Conclusions
The administration of SSA'S disability programs has reached a crisis stage.
Service is poor and billions of dollars in payments to ineligible individuals
will be wasted if mandated CDRS are not resumed. SSA'S short-term efforts
to reduce the number of pending claims have been largely unsuccessful.
Further, long-range SSA plans are uncertain about when and to what extent
service will improve. The Secretary of HHS needs to act to address this
crisis.
Social Security Administration: Stable Leadership and Better Management Needed to Improve
Effectiveness (GAO/HRD-87-39, Mar. 18, 1987); Social Security: Status and Evaluation of Agency
Management Improvement Initiatives (GAO/HRD-89-42, Jul. 24, 1989); and SSA Computers:
Long-Range Vision Needed to Guide Future Systems Modernization Efforts (GAO/IMTEC-91-44,
Sept. 24, 1991).
Page
GAO/HRD-94-11
vice
SSA ]
bility Programs
Chapter 8
SSA's Actions and Plans to Improve Service
Recommendation to
We recommend that the Secretary of Health and Human Services develop
the Secretary of
a plan to (1) reduce the backlog of SSA disability benefit claims and
(2) assure the performance of CDRS to the level necessary to comply with
Health and Human
Social Security Act provisions. The recommended plan should be
Services
forwarded to the Congress and should establish a specific time frame for
achieving SSA'S stated goal of 60-day claim processing times for its
disability programs and identify to what extent, if any, additional staffing
and funding may be needed for implementation.
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GAO/HRD-94-11 Service and SSA Disability Programs
Appendix I
Questionnaire for DDS Administrators
U.S. General Accounting Office
Questionnaire for State Directors of Disability Determination Services
Please make corrections, if any,
to the mailing label
Note: There are 54 DDSs, including two in South Carolina,
and one each in the other 49 states, the District of Columbia,
Guam and Puerto Rico. This questionnaire was sent to all but
the South Carolina Commission for the Blind. of the 53 DDSs
receiving the questionnaire, only Guam did not respond.
L
This questionnaire is part of a study being conducted by the
U.S. General Accounting Office (GAO), an agency of the
U.S. Congress. GAO has been asked by the Chairman of
Please give the name, title, and telephone number of the
the Senate Finance Committee to gather information on the
person with whom we should speak if we need to clarify
conditions and problems in states' Disability Determination
any responses in this questionnaire:
Services (DDS).
Name:
Your answers will provide valuable information for our
report to the Committee. Copies of this questionnaire are
Title:
also being mailed to all state DDS directors to obtain
information on their experiences.
Telephone:
Unless otherwise instructed, please answer questions based
on the recently completed federal fiscal year 1992. Also,
please answer all questions from the perspective of your
DDS and not from that of the national program.
This questionnaire has seven sections:
-Staffing and Funding
-Employee Issues
92.10.105371HRD.MJO
-Staging Cases
-SSA Case Development
-SSA's Short-term Initiatives
-State Policies and Regulations
-General
The questionnaire can be completed within one hour Please
return your completed questionnaire in the enclosed
preaddressed, prepaid envelope within 14 days of receipt.
Our return address is
Mr. Gary Turt
U.S. GENERAL ACCOUNTING OFFICE
Suite 1500
1445 Ross Avenue
Dallas, TX 75202
If you have any questions, please call Gary Tutt at
214-855-2724 (Dallas) or Tom Smith at 410-965-8964
(Baltimore).
Questionnaire for State Directors of Disability Determination Services, 1992 [105371]
1
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GAO/HRD-94-11 Service and SSA Disability Programs
Appendix I
Questionnaire for DDS Administrators
Staffing and Funding
7. What is the maximum number of Disability Examiners
1. Which of the following best characterizes the overall
that you believe a Supervisor can manage effectively?
number of budgeted DDS staff in fiscal year 1992
(Enter number) (N=51)
relative to the fiscal year 1992 caseload? (Check one)
(N=52)
8
maximum number of Examiners per Supervisor
Range 5-20 examiners per supervisor
1. 17 Significantly too few staff
2 27 Somewhat too few staff
8. What was the average number of Disability Examiners
3. 7 About the right number of staff
per supervisor during fiscal year 1992? (Enter number)
4. 1 Somewhat too many staff
(N=51)
5. o Significantly too many staff
&
average number of Examiners per Supervisor
Range 4-18 examiners per supervisor
2 What percent of your DDS's current Disability
Examiners have four or more years of experience as
9. What do you believe is the ideal ratio of clerical staff
examiners? (Enter percent, rounding to the nearest
per examiner? (Enter number) (N=49)
whole percent) (N=51)
&
number of clerical staff per examiner
61 % Range 14-100%
Range .1-3 clarical staff per examiner
10. What was the actual ratio of clerical staff per examiner
3. Following entry level training, how many months must a
in fiscal year 1992? (Enter number)
"typical" Disability Examiner work before you would
(N=50)
say be or she is proficient in adjudicating disability
claims? (Enter number of months) (N=52)
I
number of clerical staff per examiner
Range .1-3 clerical staff per examiner
16 months Range 7-30 months
11. Once your DDS is given authority to hire a new
Disability Examiner, on average, about how many weeks
4. What percent of your DDS's current Disability
elapse from the day the authority is given to the day a
Examiners would you classify as proficient? (Enter
candidate is selected for employment? (Enter number)
percent) (N=51)
(N=52)
77% Range 39-100%
11
number of weeks to hire a Disability Examiner
Range 2-45 weeks
5. What is the maximum number of cases a proficient
12. Which of the following best characterizes the overall
Disability Examiner can manage effectively at any one
number of budgeted medical consultants, on DDS staff
time? Count an individual's concurrent claims as one
and under contract, in fiscal year 1992 relative to the
case. (Enter number) (N=52)
fiscal year 1992 caseload? (Check one) (N=52)
100
maximum number of cases a proficient
1. 4 Significantly too few medical consultants
Disability Examiner can manage
2. 25 Somewhat too few medical consultants
Range 70-150 cases
3. 23 About the right number of medical
consulta
nts
6. What was the average caseload per Disability Examiner
4. 0 Somewhat too many medical consultants
during fiscal year 1992? Count an individual's
5. o Significantly too many medical consultants
concurrent claims as one case. (Enter number) (N=52)
134
average number of cases per Examiner
Range 78-245 cases
2
Questionnaire for State Directors of Disability Determination Services, 1992 [105371]
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GAO/HRD-94-11 Service and SSA Disability Programs
Appendix I
Questionnaire for DDS Administrators
13. Overall, to what extent does your DDS have difficulty
16. Once your DDS is given authority to put into place a
in recruiting medical consultants? (Check one) (N=52)
contract with a new medical consultant, on average, how
many weeks elapse from the day the authority is given
1. 7 Very great extent
to the day a candidate is selected for contracting? (Enter
2. 9 Great extent
number) (N=44)
3. 24 Moderate extent (GO TO QUESTION 15)
4. 7 Some extent (GO TO QUESTION 15)
&
number of weeks to contract with a medical
5. 5 Little or no extent (GO TO QUESTION 15)
consultant
Range 1-18 weeks
14. Which medical specialty(ies) is the most difficult to
17. Following entry level training, how many months must a
recruit? (Print name(s) of specialty(ies)) (N=16)
"typical" medical consultant work before you would say
he or she is proficient? (Enter number of months)
Orthopedic
11
(N=50)
Prychiatric
10
Pediatric
9
&
months
Neurology
7
Range 2-23 months
Cardiology
5
Prychology
3
Internal medicine
3
Other
4
15. Once your DDS is given authority to hire a new medical
consultant, on average, how many weeks elapse from
the day the authority is given to the day a candidate is
selected for employment? (Enter number) (N=39)
2 number of weeks to hire a medical consultant
Questionnaire for State Directors of Disability Determination Services, 1992 [105371]
3
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GAO/HRD-94-11 Service and SSA Disability Programs
Appendix I
Questionnaire for DDS Administrators
Range 1-26 weeks
18. During fiscal year 1992, what percent of the time did the following non-examiner DDS staff spend processing disability
claims rather than performing their normal duties? (Check one box for each position)
Position
1-20%
21-40%
41-60%
61-80%
81-100%
Not
Applicable
Professional Relations Staff
(N=51)
10
8
3
1
2
27
Disability Hearings Officer
(N=52)
5
4
5
7
20
11
Disability Examiner Supervisor (N=52)
25
12
5
2
I
7
Quality Assurance Staff
(N=51)
16
8
7
6
6
8
Other Staff (Please specify)
(N=18)
10
7
2
1
I
Administrative/clerical
5
Director/depaty
4
Case aide/consultant
3
Training staff
3
Other
6
19. During fiscal year 1992, how adequate was your DDS funding for each of the following items? (Check one box for each
activity)
Consider-
More than
Adequate
Less than
Consider-
ably more
adequate
(About the
adequate
ably less
than
right
than
DDS activity
adequate
amount)
adequate
Medical exam costs
(N=52)
0
1
35
12
4
Applicant travel
(N=52)
0
I
44
7
o
Travel
(N=52)
0
0
48
3
1
Equipment
(N=52)
0
1
33
14
4
Training
(N=52)
0
1
32
17
2
Space rental
(N=52)
0
1
48
3
0
Communications
(N=52)
0
o
48
3
I
EDP/ADP
(N=52)
0
2
23
18
9
Contracting out
(N=51)
0
1
45
5
0
Other activity (Please specify)
(N=9)
0
0
2
4
3
Staff/personnel
7
Overtime
I
Overall funding
1
4
Questionnaire for State Directors of Disability Determination Services. 1992 [105371]
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Appendix I
Questionnaire for DDS Administrators
Employee Issues
20. Overall, how would you characterize the current morale
24. To what extent, if any, did post-entry level, on-going
of the DDS employees in your state? (Check one)
training from your DDS keep Disability Examiners
(N=52)
current with policy and procedural changes during fiscal
year 1992? (Check one) (N=51)
1. 0 Very high
2 9 High
1. I Very great extent (GO TO QUESTION 26)
3. 32 Moderate
2. 22 Great extent (GO TO QUESTION 26)
4. 10 Low
3. 20 Moderate extent
5. 1 Very low
4. 7 Some extent
5. 1 Little or no extent
21. Which of the following best characterizes the morale of
your state's DDS employees since 1989? (Check one)
25. Please elaborate on why you believe post-entry level,
(N=52)
on-going training from your DDS did not keep
Disability Examiners current with policy and
1. 8 Improved considerably since 1989
procedural changes to any great extent. (N=25)
2. 10 Improved somewhat since 1989
3. 5 Remained about the same since 1989
Heavy caseloads/pressure
15
4. 19 Declined somewhat since 1989
Frequent/complex program changes
7
5. 10 Declined considerably since 1989
Inadequate SSA materials/policy
7
Lack of training staff/emphasis
4
Inadequate/inexperienced staff
2
22. What factors, do you believe, contributed the most to
changing or maintaining employee morale since 1989?
(List up to three factors) (N=51)
26. How did post-entry level, on-going training from your
Negative factors:
DDS in fiscal year 1992 compare to that in fiscal year
Increased workload
33
1989 for keeping Disability Examiners current with
Low pay/no raises
15
policy and procedural changes? (Check one) (N=51)
Inadequate number of staff/funds
13
Complexity/program changes
13
1. 2 Much better in FY92
State personnel policies
4
2. 5 Somewhat better in FY92
Other negative factors
3
3. 26 About the same in FY92
Positive factors:
4. 12 Somewhat worse in FY92
Administrative/personnel policy changes
15
5. 6 Much worse in FY92
Additional staff/upgrades
14
New space/equipment
13
Increased pay/benefits/OT
10
27. How timely was post-entry level, on-going training for
Staging/controlled cases
4
Disability Examiners from your DDS in fiscal year
Short-term initiatives
4
1992? (Check one) (N=51)
Other positive factors
s
1. 3 Much too late
2. 15 Somewhat too late
23. On average, how many hours of post-entry level, on-
3. 33 About the right time (GO TO QUESTION 29)
going training did Disability Examiners receive from
4. 0 Somewhat too early
your DDS in fiscal year 1992? (Enter number) (N=51)
5. 0 Much too early
24
average number of hours
Range 2-104 hours
Questionnaire for State Directors of Disability Determination Services, 1992 [105371]
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Appendix I
Questionnaire for DDS Administrators
28. Please elaborate on why you believe post-entry level,
34. What is the maximum number of overtime hours a DDS
on-going training for Disability Examiners from your
employee can work during any given pay period? (Enter
DDS was given either too early or late. (N=18)
number of hours) (N=19)
Heavy caseloads/pressure
9
32
maximum number of overtime hours per pay
Inadequate SSA materials/policy
8
period
Lack of training staff/emphasis
4
Range 9-84 hours
Other
3
35. How many regular work hours are in your DDS's pay
period? (Enter number) (N=51)
29. When Disability Examiners left the employ of your
DDS in fiscal year 1992, on average, how many years
93
regular hours per DDS pay period
had they worked for the DDS? (Enter number of years,
Range 38-176 hours
rounded to the nearest whole year) (N=50)
36. Does your DDS have any policy or criteria that
Z
years employed with DDS Range 9-20 years
precludes a DDS employee from working overtime?
(For example, "poor performers" or inexperienced
10 Not applicable; no-one left in fiscal year 1992
employees) (Check one) (N=52)
1. 33 Yes
30. Since 1989, how has the average number of years of
2 19 No (GO TO QUESTION 38)
service changed for retiring or departing Disability
Examiners for your DDS? (Check one) (N=51)
37. Please describe under what conditions your DDS's
1. 4 Years of service have increased greatly
policy or criteria would preclude employees from
2. 14 Years of service have increased somewhat (GO
working overtime. (N=33)
TO QUESTION 32)
3. 22 Years of service have remained about the same
Poor performance
28
(GO TO QUESTION 32)
Trainees/inexperienced staff
11
4. 8 Years of service have decreased somewhat (GO
Supervisors can't work or
4
TO QUESTION 32)
Other
10
S. 3 Years of service have decreased greatly
38. During fiscal year 1992, approximately, what percent of
31. What reasons do you believe explain the great increase
your Disability Examiners worked any overtime? (Enter
or decrease in the years of service employees had at the
percent) (N=51)
time of their leaving your DDS since 1989? (N=7)
65 % Range 0-100%
Economy/higher pay
3
Productivity pressure
2
Lack of opportunities
2
39. Does either your DDS or state have a mandatory
Other
6
overtime policy? (Check one) (N=52)
1. 10 Yes
32. Does either your DDS or state have a policy that allows
2 42 No (GO TO QUESTION 41)
DDS employees to work overtime? (Check one) (N=51)
1. 48 Yes
2 3 No
33. Does either your DDS or state have a policy that limits
the amount of overtime a DDS employee can work
during any given pay period? (Check one) (N=52)
1. 21 Yes
2. 31 No (GO TO QUESTION 35)
6
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Appendix I
Questionnaire for DDS Administrators
40. Approximately, what percent, if any, of the overtime
worked during fiscal year 1992 was mandatory? (Enter
Staging Cases
percent. rounded to the nearest whole percent) (N=9)
l %
In the following set of questions, we use the term staging
We define the term staging to mean receiving a disability
case and, upon receipt, setting is aside before assigning
41. If your DDS were authorized to approve unlimited
the case to a Disability Examiner.
overtime, what percent of the Disability Examiners,
would you estimate, would be willing to work overtime?
(Enter percent, rounded to the nearest whole percent)
44. For each fiscal year listed below, indicate whether or
(N=51)
not your DDS staged any disability cases. (Check one
box for each fiscal year) (N=52)
66 % Range 1-100%
Disability Cases Staged During Fiscal
42. In your opinion, to what extent, if any, will Disability
Year?
Examiners in your DDS be willing to work the same
Yes
No
number of overtime hours in fiscal year 1993 that they
worked in fiscal year 1992? (Check one) (N-48)
FY92
33
19
1. 11 Very great extent
FY91
26
26
2 13 Great extent
FY90
5
47
3. 16 Moderate extent
4. 6 Some extent
FY89
2
50
5. 2 Little or no extent
43. In your opinion, to what extent, if any. will Disability
Examiners in your DDS be willing to work more
overtime hours in fiscal year 1993 than they worked in
45. Approximately, what percent of the disability claims
fiscal year 1992? (Check one) (N=48)
your DDS received during fiscal year 1992 were staged?
(Enter number) (N=31)
1. 2 Very great extent
2. 5 Great extent
41 percent of cases staged during FY92
3. 7 Moderate extent
Range 1-99 percent
4. 19 Some extent
19 Not applicable: no cases staged in FY92
5. 15 Little or no extent
2 Don't know
46. On average, how many days were disability cases staged
in your DDS during fiscal year 1992, measured from the
time they were received to the time they were assigned
to a Disability Examiner? (Enter number) (N=31)
26 average number of days cases staged
Range 3-95 days
19 Not applicable; no cases staged in FY92
2 Don't know
Questionnaire for State Directors of Disability Determination Services, 1992 [105371]
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Appendix I
Questionnaire for DDS Administrators
47. Does your DDS expect to stage cases during fiscal year
51. Indicate whether or not each of the following steps is
1993? (Check one) (N=51)
taken during the time a case is staged. (Check one box
for each item) (N=24)
1. 21 Yes
2. 30 No
Not
Processing steps
Taken
Taken
48. Are any types of disability claims exempt from staging?
Verify medical treatment(s)
8
16
(Check one) (N=36)
Request medical documentation
21
3
1. 35 Yes
Verify data with SSA
10
14
2. 1 No (GO TO QUESTION 50)
Verify data with claimant
8
16
Other (Please describe) (N=3)
49. Indicate whether or not each of the following items is a
Request recational documentation 1
criterion to exempt disability claims from being staged.
Request ADL* information
1
Screen v immediate decision - be
(Check one box for each item) (N=35)
made
1
*Activities of Daily Living
Criteria
Yes
No
Terminal illness
35
0
AIDS
33
2
Homelessness
23
12
Reconsideration
12
23
Receipts from OHA
17
18
Zebley case
26
9
Presumptive disability
27
8
Congressional request
17
18
Other (Please specify) (N=11)
Probable allowance
3
Special project/request
.....
3
Chronically ill/neonatal
3
Other
11
50. While cases are staged in your DDS, is any work done
on them? (Check one) (N=36)
1. 24 Yes
2 12 No (GO TO QUESTION 52)
8
Questionnaire for State Directors of Disability Determination Services, 1992 (105371)
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GAO/HRD-94-11 Service and SSA Disability Programs
Appendix I
Questionnaire for DDS Administrators
56. Excluding the SSA Form 3368. overall. how has the
SSA Case Development
quality changed, if at all, of other documentation your
DDS received from SSA for disability cases since fiscal
year 1989? (Check one) (N=51)
52. How would you rate the overall quality, that is, accuracy
and completeness, of the Disability Reports (SSA Form
1. 1 Quality has increased substantially
3368) your DDS received from SSA during fiscal year
2 12 Quality has increased somewhat
1992? (Check one) (N=52)
3. 30 Quality has remained about the same
4. s Quality has decreased somewhat
1. 0 Very high quality
5. o Quality has decreased substantially
2. 5 High quality
3. 38 Moderate quality
4.
, Low quality
5. o Very low quality
53. Overall, what percentage of the SSA Form 3368s your
DDS received from SSA in fiscal year 1992 would you
estimate were of a high or very high level of quality?
(Enter percent) (N=51)
32%
Range 0-97%
54. Overall, how has the quality of SSA Form 3368s
changed, if at all, since fiscal year 1989? (Check one)
(N=52)
1. 6 Quality has increased substantially
2 18 Quality has increased somewhat
3. 16 Quality has remained about the same
4. 12 Quality has decreased somewhat
5. o Quality has decreased substantially
55. Excluding the SSA Form 3368, how would you rate the
overall quality, that is, accuracy and completeness, of
other documentation your DDS received from SSA for
disability cases during fiscal year 1992? (Check one)
(N=52)
1. 0 Very high degree of quality
2. 7 High degree of quality
3. 36 Moderate degree of quality
4.
9 Low degree of quality
5. o Very low degree of quality
Questionnaire for State Directors of Disability Determination Services. 1992 (105371)
9
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GAO/HRD-94-11 Service
SSA D
bility Programs
Appendix I
Questionnaire for DDS Administrators
SSA's Short-term Initiatives
57. In a January 31, 1992 memorandum to all Deputy and Regional Commissioners, SSA Commissioner Gwendolyn S. King set
out a Comprehensive Plan to address workload issues in the Disability program. This plan contained a series of initiatives
grouped into short- mid- and long-term initiatives. The table below contains the nine short-term initiatives described by
Commissioner King. For each initiative, (1) check one box that indicates the extent, if any. it has improved your DDS's
productivity in fiscal year 1992 and (2) whether or not you believe the initiative should be made permanent.
To what extent did the initiative improve your DDS's productivity
Should the
in fiscal year 1992? (Check one)
initiative be
made
Little
Some
Moderate
Great
Very Great
permanent?
Initiative
or No
1. Assistance from other States and
24 Yes
Federal Components
30
7
8
3
2
12 No
(N=50)
11 Don't Know
2. Regional Office Operational
21 Yes
Assistance to Troubled DDSs
33
11
3
2
o
15 No
(N=49)
11 Don't Know
3. Field Offices/Teleservice Centers
17 Yes
Requesting Medical Evidence
32
8
4
I
0
15 No
(N=45)
11 Don't Know
4. Strengthening Relations with State
28 Yes
Governments
36
7
6
0
1
6 No
(N=50)
11 Don't Know
5. Enhancing Teamwork with the
29 Yes
DDSs Through Weekly
25
15
9
2
0
7 No
Communications/Reporting
10 Don't Know
(N=51)
6. Better Managing CDR Processing
33 Yes
(N=48)
25
10
7
5
I
0 No
13 Don't Know
7. Requiring New Policies and
43 Yes
Procedures Only When Critical
8
16
17
9
I
3 No
(N=51)
2 Don't Know
8. Refinement of
45 Yes
Development/Documentation
2
15
20
14
1
0 No
Procedures
(N=52)
2 Don't Know
9. Ensure that Quality Assurance
37 Yes
Review Development Requests
24
13
10
3
0
I No
are More Productive
(N=50)
10 Don't Know
10
Questionnaire for State Directors of Disability Determination Services, 1992 [105371]
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Appendix I
Questionnaire for DDS Administrators
58. For those initiatives that you believe should not be made permanent, please explain why. (If more than one initiative, please
indicate its corresponding item number in the previous table.) (N=29)
Initiative 1: Short-term solution to a long-term problem (6); Slow process (2); Generates unnecessary work (2); Requires
too many resources (1); Disabled deserve local service (1).
Initiative 2: Not a long-term solution (4); SSA lacks staff/expertise (3); Micromanagement is counterproductive, Too many
components involved, Regional office assistance more nuisance than help, Hard to track/locate cases, Higher SSA pay
demoralizes DDS staff (1 each).
Initiative 3: Raises fiscal/accounting issues (3); Much rework had to be done (3); Should be done by the DDSs (2); Not a
long-term solution, Little positive impact, Different computer systems caused dual efforts (1 each).
Initiative 4: Saw no evidence of this initiative, Should be done only upon request of the DDS (I each).
Initiative 5: Weekly reporting/monitoring unnecessary (4); Little or no positive impact (2); Duplication of effort (2); Did
not allow for ideas to improve productivity (1).
Initiative 6: No responses.
Initiative 7: If policies need to be changed, they should not be deferred, Not good on a crisis baris-only adds to
confusion/poor quality work, As a long-term strategy, creates rather than solves problems (I each).
Initiative 8: No responses.
Initiative 9: No responses.
59. Compared to fiscal year 1991, did your DDS's FY92
61. Overall, to what extent, if any, do you believe your
Production Per Work Year (PPWY) increase, decrease
FY92 PPWY was improved as a result of SSA's release
or stay about the same? (Check one) (N=52)
of contingency funds? (Check one) (N=51)
1. 45 Increased
1. 14 Very great extent
2. 5 Stayed about the same
2. 21 Great extent
3. 2 Decreased
3. 6 Moderate extent
4. 9 Some extent
5. 1 Little or no extent
60. Overall, to what extent, if any, do you believe your
FY92 PPWY was improved as a result of the nine short-
term initiatives? (Check one) (N=51)
62. Did your DDS send any of its disability cases to other
state DDSs or to any federal organizations for
1. o Very great extent
processing assistance during fiscal year 1992? (Check
2 3 Great extent
one) (N=52)
3. 18 Moderate extent
4. 21 Some extent
1. 23 Yes
5. 9 Little or no extent
2 29 No (GO TO QUESTION 66)
Questionnaire for State Directors of Disability Determination Services, 1992 [105371]
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Appendix I
Questionnaire for DDS Administrators
63. In the table below, (1) print the name of each state and
federal organization to which your DDS sent disability
67. In the table below, (1) print the name of the other
cases for processing during fiscal year 1992 and (2). the
state(s) for which your DDS provided disability case
number of cases you sent to each. (Enter names and
processing assistance, if any, during fiscal year 1992
numbers) (N=23)
and (2), the number of cases your DDS processed for
each. (Enter names and numbers) (N=15)
States or federal
Number of Cases
organization to which your
sent in FY92
DDS sent disability cases
Number of Cases
in FY92
States for which your DDS
Your DDS
provided case processing
Processed during
13 DDSs sent cases to 1
22 DDSs reported
assistance during FY92
FY92
DDS or SSA unit
sending 58,775 cases
to other DDSs or
10 DDSs assisted 1 DDS
14 DDSs reported
5 DDSs sent cases to 2
SSA units for
processing 9,280
DDS: or SSA units
processing (1 DDS
4 DDS: assisted 2 DDSs
cases for other
2 DDSs sent cases to 3
was unable to
I DDS assisted 3 DDS:
DDS: (1 DDS was
DDS: or SSA units
estimate the number
unable to estimate
sent)
how many cases
2 DDSs sent cases to 4
they processed for
DDSs or SSA units
others)
1 DDS sent cases to 8
DDS: or SSA units
68. Overall, how well did it work to have your DDS receive
and process other states' disability cases in FY92?
(Check one) (N=15)
64. Overall, how well did it work to have other states or
federal organizations process your disability cases in
1. 2 Very well
FY92? (Check one) (N=23)
2 6 Moderately well
3. 6 Somewhat well
1. 6 Very well
4. 1 Not well
2. 7 Moderately well
3. 8 Somewhat well
4. 2 Not well
69. Please describe what problems, if any, you may have
had with the procedure in which your state DDS
processed other states' disability cases in FY92.
65. Please describe what problems, if any, you may have
(N=10)
had with the procedure in which other states or federal
organizations processed your disability claims in FY92.
Different case development procedures
10
(N=15)
Delayed processing
2
Significant start-up effort
2
Delayed Processing
9
Other
4
Tracking/locating cases
7
Different case development procedures
6
Significant start-up effort
3
70. Were any persons from other states or federal
Confusion for claimants
2
organizations detailed to your DDS during fiscal year
Other
2
1992 to assist your DDS in processing cases? (Check
one) (N=52)
66. Did your DDS process any disability cases for another
1. 13 Yes
state during fiscal year 1992? (Check one) (N=52)
2. 39 No (GO TO QUESTION 72)
1. 15 Yes
2 37 No (GO TO QUESTION 70)
12
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Appendix I
Questionnaire for DDS Administrators
71. In the table below, (1) print the name of the other
73. In the table below, (1) print the name of the other
state(s) that detailed their employee(s) to your DDS to
state(s) to which your DDS employee(s) were detailed
provide processing assistance during fiscal year 1992,
to provide processing assistance during fiscal year 1992,
(2). the number of individuals they detailed to your
(2), the number of individuals that were detailed and
DDS and (3), the aggregate number of weeks their
(3), the aggregate number of weeks their details lasted.
details lasted. (Enter names and numbers) (N=13)
(Enter names and numbers) (N=9)
Aggregate
Number of
Aggregate
Number of
Number of
Your DDS
Number of
States that detailed
Employees
Weeks
States to which your
Employees
Weeks
employees to your
Detailed
Detail(s)
employees were
Detailed
Detail(s)
DDS during FY92
lasted
detailed during FY92
lasted
9 DDS: had detailees
9 DDSs
9 DDSs
8 DDSs detailed
9 DDSs
9 DDSs
from 1 DDS or SSA
reported 41
reported
employees to 1 DDS
reported
reported
unit
employees
383 weeks
or SSA unit
detailing
218 weeks
detailed to
worked by
2 DDSs had detailees
32
worked by
their DDSs
detailes (4
1 DDS detailed
from 2 DDSs or SSA
employees
employees
(4 DDSs
DDSs
employees to 3 DDSs
to other
units
they
were
were
or SSA units
DDSs
detailed
I DDS had detailees
unable to
unable to
from 3 DDSs or SSA
estimate)
estimate)
units
1 DDS had detailees
from 5 DDS or SSA
units
72. Were any of your DDS employees detailed to other state
DDS offices or federal organizations during fiscal year
1992 to assist them in processing cases? (Check one)
(N=52)
1. 9 Yes
2 43 No (GO TO QUESTION 74)
Questionnaire for State Directors of Disability Determination Services, 1992 [105371]
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GAO/HRD-94-11 Service and SSA Disability Programs
Appendix I
Questionnaire for DDS Administrators
State Policies and Regulations
74. Although DDSs are federally funded, we recognize that they are state agencies and may be subject to state regulations and
requirements. For each of the following. indicate the extent, if any, state regulations and requirements make it more difficult
to manage your DDS's program. (Check one box for each item)
Extent of Difficulty
Little
Some
Moderate
Great
Very
State Regulations and Requirements
or No
Great
Promotions
(N=50)
14
15
15
1
5
Salary levels
(N=50)
7
8
12
s
15
Bonuses
(N=50)
8
5
6
5
21
Use of overtime
(N=50)
31
3
7
5
2
Staff utilization
(N=50)
32
5
5
6
2
Recruiting
(N=50)
14
9
17
6
4
Hiring
(N=50)
10
7
13
14
6
Training
(N=50)
39
6
2
1
2
ADP purchasing rules
(N=49)
12
14
10
9
4
Contracting for Services
(N=50)
13
11
12
8
6
Furloughs
(N=48)
32
3
2
3
7
Labor/management agreements
(N=49)
27
9
4
4
4
Other (Please explain)
(N=4)
o
1
2
I
0
Leasing procedures
2
Staffing
2
Grievance procedures
I
14
Questionnaire for State Directors of Disability Determination Services, 1992 [105371]
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Appendix I
Questionnaire for DDS Administrators
75. For each item you selected "Great" or "Very Great" in the preceding table, please elaborate on your reasons. (N=39)
Promotions: Restricted to layoff recalls and upward mobility, Freezes, A jungle of bureaucracies (1 each).
Salaries: Low salaries (8); Pay set outside the DDS (5); No pay raises (3); Only union employees got pay raises last 2
years (2); No supervisory overtime pay, Hard to reward/penalize due to combination of merit pay and union contract (1
each).
Bonuses: No bonuses allowed (15); Bonuses limited/difficult to give (5).
(Continued on page 18)
79. To what extent, if any, did fiscal year 1992 workload
General
and staffing pressures contribute to inaccuracies in DDS
disability decisions for allowances? (Check one) (N=51)
76. Excluding situations where work experience is
1. 1 Very great extent
substituted for education, what is the minimum
2 2 Great extent
educational requirement for your DDS Disability
3. 7 Moderate extent
Examiner position? (Check one) (N=51)
4. 14 Some extent
5. 27 Little or no extent
1. 3 High school graduate or equivalent
2. 0 Associate degree
3. 44 Bachelor degree
80. To what extent, if any, did fiscal year 1992 workload
4. I Masters degree
and staffing pressures contribute to inaccuracies in DDS
5. 0 Doctoral degree
disability decisions for denials? (Check one) (N=50)
6. 3 Other (Please specify): (N=3)
Civil service exam required
I
1. 4 Very great extent
No education requirement
1
2 3 Great extent
Knowledge, skills and abilities equal to
3. 15 Moderate extent
batchelor's degree
1
4. 10 Some extent
5. 18 Little or no extent
77. To what extent, if any, does your DDS's computerized
data processing system (both hardware and software)
currently meet the needs of your DDS? (Check one)
81. Did any of the Commissioners' initiatives and other
(N=51)
actions taken to reduce claim backlogs in fiscal year
1992 contribute to inaccuracies in DDS disability
1. 2 Very great extent
decisions for allowances? (Check one) (N=52)
2 14 Great extent
3. 15 Moderate extent
1. 10 Yes
4. 15 Some extent
2 41 No (GO TO QUESTION 83)
5. 2 Little or no extent
1 Don't know
3 No EDP
78. Approximately, what percentage, if any, of your DDS's
disability claims process is automated? (Check one)
(N=51)
1. 13 0-20%
2. 10 21-40%
3. 12 41-60%
4. 11 61-80%
5. 4 81-100%
I Don't Know
Questionnaire for State Directors of Disability Determination Services, 1992 [105371]
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Appendix I
Questionnaire for DDS Administrators
82. To what extent did the Commissioners' initiatives and
86. What are your major difficulties in recruiting physicians
other actions taken to reduce claim backlogs in fiscal
for medical consultative examinations (CEs)? (N=32)
year 1992 contribute to inaccuracies in DDS disability
decisions for allowances? (Check one) (N=10)
Lack of sources/interest
31
Low fees
27
1. o Very great extent
Bureaucracy/requtrements
13
2. 0 Great extent
Hostile/problem clients
7
3. 1 Moderate extent
Other
5
4. 6 Some extent
5. 3 Little or no extent
87. Are there any medical specialties that your DDS has
particular problems in recruiting? (Check one)
83. Did the Commissioners' initiatives and other actions
(N-49)
taken to reduce claim backlogs in fiscal year 1992
contribute to inaccuracies in DDS disability decisions
1. 49 Yes-> Please print the name of the
for denials? (Check one) (N=52)
specialty(ies) your DDS has difficulty
in recruiting:
1. 2 Yes
2. 49 No (GO TO QUESTION 85)
Orthopedic
40
I Don't know
Neurology
31
Prychiatric
21
Pediatric
19
84. To what extent did the Commissioners' initiatives and
Cardiology
9
other actions taken to reduce claim backlogs in fiscal
Ophthalmology
8
year 1992 contribute to inaccuracies in DDS disability
Prychology
7
decisions for denials? (Check one) (N=2)
Other
12
2. 0 No
1. o Very great extent
2. 0 Great extent
3. I Moderate extent
4. I Some extent
5. 0 Little or no extent
85. How easy or difficult is it for your DDS to recruit
physicians for medical consultative examinations (CEs)?
(Check one) (N=52)
1. 0 Very easy (GO TO QUESTION 87)
2 1 Easy (GO TO QUESTION 87)
3. 19 About equally easy as difficult (GO TO
QUESTION 87)
4. 23 Difficult
5. 9 Very difficult
16
Questionnaire for State Directors of Disability Determination Services, 1992 [105371]
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GAO/HRD-94-11 Service and SSA Disability Programs
Appendix I
Questionnaire for DDS Administrators
88. Please use this and the remaining pages to describe things that you believe SSA can do, that it is not already doing, other than
an increase in funding or staffing. to reduce the current disability case backlog and/or adjudicate cases in a more timely
manner. (N-40)
Forty DDS Administrators provided 153 suggested actions. Our analysis showed that these suggestions could be grouped
into the following 16 categories. We provided a complete list of the suggestions to SSA.
1. Case development (27)
2. Forms improvement (17)
3. Budget/funding (13)
4. SSA guidelines/policies (13)
5. Quality assurance (12)
6. Special initiatives (11)
7. More DDS authority (9)
& More claimant involvement (8)
9. Automation (7)
10. Changes in law/regulations (6)
11. Appeals (6)
12. Program Operations Manuals (6)
13. Continuing disability reviews (5)
14. Training (5)
15. Frivoious claims (4)
16. Outreach (4)
Questionnaire for State Directors of Disability Determination Services, 1992 [105371]
17
Page 44
GAO/HRD-94-11 Service and SSA Disability Programs
Appendix I
Questionnaire for DDS Administrators
Question 75 responses continued:
Use of Overtime: Difficult to obtain state approval (4); Subject to collective bargaining agreement, Professionals not
eligible for overtime (1 each).
Staff Utilization: DDS losing positions/spending authority due to state downstzing, Cannot work people out of classifications.
Fair Labor Standards Act causes problems, Requires modification of job duties resulting in grievances, State imposed 5 percent
cut in personnel services-2 FTEs for the DDS (1 each).
Recruiting: State requirements too restrictive (2); Process takes too long (2); Salaries too low (1)
Hiring: Process too slow, too long (8); Hiring requirements set by others (4); Hiring freezs (3); Lack of positions (1).
Training: Lack of good candidates requires more investment in training, No travel approved for training (1 each).
ADP Purchasing Rules: Lengthy process controlled by others (8); Established by parent agency, Protects us from ourselves (1
each).
Contracting for Services: Cumbersome process (6); Union rules (2); Not enough flexibility, Limited use (1 each).
Furloughs: Furioughs limit federal work (3); Some DDS layoffs due to funding problems, Furloughs not acceptable in public
agencies (1 each).
Labor/Management Agreements: Creates difficulty in managing/evaluating staff (5); State closely regulated by labor contracts
(2); Limits contracting for services, Negotiations seem interminable, Supervisors/Senior examiners cannot work overtime (I
each).
Other-State requirements for leased office space: Complex/time consuming process, SSA/State requirements conflict (1 each).
18
Questionnaire for State Directors of Disability Determination Services. 1992 [105371]
Page 45
GAO/HRD-94-11 Service and SSA Disability Programs
Appendix I
Questionnaire for DDS Administrators
Please complete and return within : weeks to
Mr. Gary Tutt
U.S. GENERAL ACCOUNTING OFFICE
Suite 1500
1445 Ross Avenue
Dallas, Texas 7502
Page 46
GAO/HRD-94-11 Service and SSA Disability Programs
Appendix II
Selected DDS Performance Data for Fiscal
Year 1992
The following tables display the state DDSS grouped into three categories
according to their initial pending claims and their weeks work on hand at
the end of fiscal year 1992. Category I includes all DDSS with 10 or fewer
WWOH, regardless of the size of their pending claims. Category II includes
DDSS with more than 10 WWOH but with less than 13,000 initial pending
claims. Finally, Category III includes DDSS with a WWOH greater than 10 and
initial pending claims of more than 17,000. States appear in descending
order on the basis of weeks work on hand.
The tables also include other fiscal year 1992 DDS performance
indicators-the production per work-year, the number of work-years,
overall decisional accuracy rates, and overall claim processing times. The
latter are measured from the date of application to DDS clearance. The
PPWY and work-years are based on total DDS workloads while all other data
are based on initial claims only.
Page 47
GAO/HRD-94-11 Service and SSA Disability Programs
Appendix II
Selected DDS Performance Data for Fiscal
Year 1992
Category I DDSs (23)
Pending
Work-years
DDS
Accuracy
Processing
claims
used
WWOH
PPWY
rates
times (days)
Connecticut
4,351
104
10.0
275
94.9%
89
Delaware
869
27
9.9
209
95.6%
109
lowa
3,730
107
9.8
242
94.9%
80
Tennessee
11,642
371
9.7
237
96.7%
89
Nebraska
1,872
60
9.4
223
95.5%
70
Massachusetts
10,035
283
9.3
254
95.7%
93
Florida
21,532
646
9.2
255
95.9%
79
Arkansas
6,205
178
9.1
277
95.9%
89
District of Columbia
1,255
41
8.8
227
95.6%
124
Minnesota
4,317
141
8.7
238
95.3%
88
Maine
1,783
56
8.6
255
93.9%
76
Washington
5,689
207
8.5
227
94.8%
109
Alaska
423
18
8.4
189
96.4%
115
Utah
1,502
48
8.4
222
96.2%
150
Montana
1,045
41
7.7
245
94.6%
76
South Dakota
830
29
7.7
254
95.4%
85
North Carolina
9,162
335
7.3
265
95.6%
67
Wyoming
431
14
6.8
297
96.8%
65
Missouri
7,762
284
6.8
285
92.3%
71
North Dakota
449
22
6.7
215
95.6%
76
Vermont
650
27
6.4
242
96.2%
102
Virginia
6,158
271
6.3
256
96.1%
77
Idaho
943
46
4.9
276
96.1%
75
Category I subtotals
102,635
3,356
8.4
253
95.3%
84
Percent of total
18%
26%
Page 48
GAO/HRD-94-11 Service and SSA Disability Programs
Appendix II
Selected DDS Performance Data for Fiscal
Year 1992
Category II DDSs (19)
Pending
Work-years
Accuracy
Processing
DDS
claims
used
WWOH
PPWY
rates
times (days)
Hawaii
2,110
32
18.5
206
95.8%
163
West Virginia
8,131
181
16.2
217
93.4%
106
Nevada
2,689
48
15.2
245
96.4%
153
Rhode Island
2,043
42
14.0
235
94.8%
108
Puerto Rico
4,338
155
13.8
172
95.8%
100
New Hampshire
1,744
34
13.7
247
95.5%
102
Wisconsin
10,464
225
13.5
227
96.0%
110
Maryland
8,698
205
13.0
219
94.4%
113
Arizona
7,570
162
12.8
236
94.4%
147
Indiana
12,162
258
12.6
256
96.3%
96
New Mexico
3,966
102
12.5
216
94.9%
113
Alabama
12,922
318
12.4
240
94.6%
118
Oregon
3,836
116
12.4
195
95.4%
123
Kentucky
12,433
325
11.9
250
96.0%
103
Mississippi
10,437
253
11.2
266
93.8%
89
Kansas
4,009
123
11.0
194
94.7%
109
South Carolina
8,092
204
10.8
255
96.3%
102
Colorado
5,178
130
10.4
248
94.7%
117
Oklahoma
5,783
164
10.1
259
96.7%
116
Category II subtotals
126,605
3,077
12.0
235
95.1%
110
Percent of total
22%
23%
Page 49
GAO/HRD-94-11 Service and SSA Disability Programs
Appendix II
Selected DDS Performance Data for Fiscal
Year 1992
Category III DDSs (10)
Pending
Work-years
Accuracy
Processing
DDS
claims
used
WWOH
PPWY
rates
times (days)
Ohio
39,595
545
21.7
214
93.8%
138
California
84,945
1,483
18.9
214
94.1%
157
Loi ana
25,759
495
17.0
211
94.7%
135
New Jersey
17,922
376
15.8
193
94.5%
158
Michigan
26,969
461
15.6
255
93.6%
116
New York
51,209
1,028
15.0
220
92.9%
118
Georgia
17,105
388
12.7
246
94.4%
94
Illinois
28,228
628
12.6
247
94.8%
105
Texas
37,367
835
12.4
249
94.5%
121
Pennsylvania
18,745
550
10.1
241
93.8%
105
Catetory III subtotals
347,844
6,789
15.4
228
93.3%
127
Percent of total
60%
51%
To
, all categories
577,084
13,222
12.8
236
94.7%
112
Percent, all categories
100.0%
100.0%
Page 50
GAO/HRD-94-11 Service and SSA Disability Programs
Appendix III
Modified Claim Processing Procedures
Approved by SSA Commissioner
1. Completion of the Psychiatric Review Technique Form:
For allowances, the DDS physician/psychologist does not have to complete
the form beyond the point at which an allowance is apparent. When this
procedure is used, the form must include a summary statement addressing
the areas that affect the allowance.
2. Completion of the Residual Functional Capacity Assessment Forms:
For allowances, the DDS physician/psychologist does not have to complete
the forms beyond the point at which an allowance is apparent. When this
procedure is used, the form must include a summary statement.
3. Establishment of Alleged Onset Date as the Onset Date in DI Cases:
The alleged date may be used as the established onset date in DI cases
without full onset documentation when (1) the date is within 3 years of the
current date; (2) other evidence in file clearly supports an allowance; and
(3) nothing in file suggests that the impairment was not disabling as of the
alleged date.
4. Adverse Vocational Factors:
The DDS adjudicator may make an allowance determination with less than
ideal medical documentation if the claimant has adverse vocational factors
(e.g., closely approaching retirement age with a high school education or
less and no transferable work skills).
5. Chest Pain Description:
The DDS adjudicator may make an allowance determination in
cardiovascular cases involving chest pain without a detailed description of
the chest pain, provided other objective medical findings in the file
support a finding of disability.
6. Cancer Pathology Reports:
The DDS adjudicators may make an allowance determination in a cancer
case without pathology reports, provided other evidence in the file shows
that the medical criteria are met.
7. X Ray Evidence:
The DDS adjudicator may make an allowance determination without X ray
evidence when severe joint damage is readily apparent by other signs and
clinical findings.
8. Pulmonary Function Studies:
The DDS adjudicator may make an allowance determination in a
Page 51
GAO/HRD-94-11 Service and SSA Disability Programs
Appendix III
Modified Claim Processing Procedures
Approved by SSA Commissioner
respiratory impairment case without purchasing pulmonary function
studies when other medical evidence in file supports a disabling
pulmonary impairment.
9. History/Physical:
The DDS adjudicator may make an allowance determination without a
thorough medical history and physical examination when severe chronic
disease is otherwise documented by laboratory findings and other
objective findings.
10. Chronic Renal Disease:
The DDS adjudicator may make an allowance determination on the basis of
a treating physician's description of chronic renal disease and evidence of
ongoing dialysis.
11. Activities of Daily Living:
The DDS adjudicator may make an allowance determination in cases
involving pain and mental impairments without a complete description of
the activities of daily living when other evidence in the file supports a
finding of disability.
12. Deferred Medical Development:
The DDS adjudicator may make favorable determinations involving
impairments such as heart attacks and strokes without waiting for the
impairment to stabilize provided that the evidence in file shows the
claimant has little or no chance of regaining significant function.
13. Obesity:
The DDS adjudicator may make an allowance determination on the basis of
excess weight alone when other evidence in file supports an allowance.
14. Completion of Individualized Functional Assessment:
For an allowance involving SSI childhood disability claims, the DDS
adjudicative team does not have to complete every applicable section of
the assessment.
15. Visual Impairment:
The DDS adjudicative team may make a denial determination when the
medical evidence of record is based on automated perimetry devices
showing no loss of visual fields and there is no other impairment alleged
or documented.
Page 52
GAO/HRD-94-11 Service and SSA Disability Programs
Appendix IV
Examples of SSA's Strategic Planning
Initiatives
The initiatives planned to improve the disability and appeals processes, as
well as all other initiatives, involve a wide variety of activities. The
following describes briefly some of these initiatives.
Improving Claims
SSA is testing ways to improve the timeliness and quality of disability
claims intake and development.
Intake
One model being tested involves providing claims representatives with
intensified medical training to permit them to initiate medical evidence
development earlier in the claims process. The expected benefits are
reduced claim processing times and increased decisional accuracy. SSA is
piloting the approach at several locations in one state and will make
recommendations regarding national implementation after completing the
final evaluation report.
Another model being tested in at least three states involves giving
applicants the opportunity to gather their own medical evidence. The
principal advantage for applicants who choose to apply for benefits in this
manner is shorter processing time. Also, it may be possible to save some
of the administrative costs associated with DDS development of medical
evidence.
Face-to-Face
A face-to-face interview enables applicants or their representatives to
present their full case in person and allows decisionmakers to make direct
Interviews
observations about the alleged impairment(s) and tailor the interview
accordingly. Generally, the earliest that applicants are afforded a
face-to-face interview with a decisionmaker is when they have appealed an
adverse decision to the Administrative Law Judge level.
SSA plans to test several models that would provide for a face-to-face
interview earlier in the disability determination process, such as a
predenial interview by the disability determination service. The potential
benefit of such a change is that more ultimate decisions would be made
earlier in the process. Testing of several options is targeted to begin
following publication of the final regulations that will establish the specific
authority to conduct these tests.
Automating DDSs
SSA plans to provide all DDSS with at least a baseline level of automation
through 1995. Beyond 1995, SSA plans to implement an enhanced
Page 53
GAO/HRD-94-11 Service and SSA Disability Programs
Appendix IV
Examples of SSA's Strategic Planning
Initiatives
modernized disability system in the DDSS. By using the same computerized
workstations, local area networks, and software applications used by SSA,
DDSS will be fully integrated with SSA systems and be able to communicate
directly with SSA field offices, program service centers, teleservice centers,
other DDSS, ALJS, and SSA headquarters. Standard software and hardware
would also facilitate the introduction of such processing enhancements as
"paperless processing," voice-to-print technology for medical and
vocational information, and the capacity to readily shift workloads among
the DDSS and other SSA components.
SSA expects modernized automation to have a substantial impact on
improving timeliness, decisional accuracy and consistency, and
productivity. National implementation is expected to start in 1996 and be
completed by 2005.
Page 54
GAO/HRD-94-11 Service and SSA Disability Programs
Appendix V
Major Contributors to This Report
Human Resources
Barry Tice, Assistant Director, (410) 965-8920
Tom Smith, Assignment Manager
Division,
Washington, D.C.
Dallas Regional Office
Sherrill H. Johnson, Issue Area Manager
Louis G. Tutt, Evaluator-in-Charge
Page 55
GAO/HRD-94-11 Service and SSA Disability Programs
Related GAO Products
Social Security Disability: SSA Needs to Improve Continuing Disability
Review Program (GAO/HRD-93-109, July 8, 1993).
Social Security: Rising Disability Rolls Raise Questions That Must Be
Answered (GAO/T-HRD-93-15, Apr. 22, 1993).
Social Security: SSA Needs to Improve Service for Program Participants
(GAO/T-HRD-93-11, Mar. 25, 1993).
Social Security Disability: Growing Funding and Administrative Problems
(GAO/T-HRD-92-28, Apr. 27, 1992).
SSA Computers: Long-Range Vision Needed to Guide Future Systems
Modernization Efforts (GAO/IMTEC-91-44, Sept. 24, 1991).
Social Security: Status and Evaluation of Agency Management
Improvement Initiatives (GAO/HRD-89-42, July 24, 1989).
Social Security: Effects of Budget Constraints on Disability Program
(GAO/HRD-88-2, Oct. 28, 1987).
Social Security Administration: Stable Leadership and Better Management
Needed to Improve Effectiveness (GAO/HRD-87-39, Mar. 18, 1987).
(105371)
Page 56
GAO/HRD-94-11 Service and SSA Disability Programs
Meeting on Disability -- Friday, February 4
Proposed Agenda
1.
Short term. HHS has a major reengineering project underway with report due
March 31. Expectation is that the reengineering team will share broad blueprint
which will lead to pilots in fall of 1995 and fuller implementation in fall of 1996.
Question: This timeframe for improvement seems slow in view of possible political
problems from growing backlogs and lengthening claims/appeals processing time
(Slated to be 145 days for initial claims in FY 1994, up from 75 day average in
1980s; and 330 days for appeals, up from about 200 days in mid-1980s). What steps
can be taken in the interim which would materially reduce delays and improve service
while not being inconsistent with the longer-term reengineering enterprise? What
should/could be the role of DPC/OMB in cooperation with HHS and SSA to make
such improvements happen, and what might such a project look like? (See attachment
for discussion of one possible approach).
2.
Longer term. The dramatic but poorly understood rise in disability claims and their
associated budget costs, as well as the coming insolvency of the DI trust fund, make
broader reexamination of SSI and DI a fiscal and policy imperative. Assuring that the
needy are handled compassionately and with dispatch is critical. At the same time,
however, some are concerned that SSI in particular is becoming a safety valve of first
resort for states looking to lower their general assistance costs. With welfare reform
aiming to get people back into the workforce, it may also be time to attempt to
improve the highly ineffective "rehabilitation" aspects of disability. (In FY 1991,
232,000 cases were referred for rehabilitative services out of a caseload of 7.1 million
recipients. During that time 6,032 were able to resume work). This effort would
require a better understanding of why the disabled rolls are spiralling and who the
disabled are. In addition, any broader policy reform may want to address both the
fact and the perception that taxpayer money is being misspent on those who never
were or who no longer are disabled.
Question: Should the Administration launch a major policy development effort on
disability reform? Potential forms such an effort might take include:
Joint DPC/OMB-led task force on disability with strong HHS/SSA
participation (along with early input from WH political shops)
A Commission on Disability (like the one on Head Start) to build consensus
while educating constituencies. (The National Academy of Social Insurance
launched a three-year commission on disability in March 1993 which plans to
share a one year status report in late February. Could this panel's work be
leveraged somehow? Or is their timetable too long and charter/structure
insufficiently political to be relevant as anything other than a resource to the
Administration?)
Draft 2/2
DISCUSSION OUTLINE: POSSIBLE SHORT-TERM DISABILITY PROJECT
Criteria for Project
Several criteria should govern a decision to pursue a joint HHS/DPC/OMB
management initiative or "workout" on disability. Arguably, such an effort should only be
undertaken if:
(1) we have strong hypotheses of recommendations or changes that will materially reduce
processing time/backlogs before the reengineering effort bears fruit;
(2) these changes could be implemented fast and not be inconsistent or interfere with the
reengineering project;
(3) DPC/OMB can play an important role in assisting HHS with outside pressure to change
current SSA practices or in mobilizing relevant resources across agencies or the White House
(e.g. Intergovernmental Affairs).
Possible Project that Meets Criteria: "Key States Disability Initiative"
Ten of the most populous (and politically important) states account for 60% of initial
claims and have by far the worst service levels. (GAO, for example, found that in 1992
these states averaged 127 days processing time for initial claims, as opposed to 84 days for
the 23 best performing states). These include California, Texas, New York, Illinois,
Michigan, Ohio, Pennsylvania, Georgia and Florida. A "workout" team targeting all or
several of these key states (under the direction of policy group comprised of the HHS Deputy
Secretary and Assistant Secretary for Management and Budget, the Commissioner of Social
Security, the White House Assistant for Domestic Policy, and the OMB Deputy Director)
might address the following areas as part of a charge to return with recommendations by
April 15:
Initial Claims Processing. More aggressive shifting of claims work from
overburdened states to other states with less backlog might reduce processing times
significantly. A variant might be to pick just a few key states (selected for political
reasons) for such "relief," so that the relative burden shifted to "recipient states" was
small and politically acceptable. Upfront negotiation and buy-in between the White
House/SSA and key governors might break expected bureaucratic logjams in such an
effort. Key states might also be given immediate waivers to test immediately ideas
emerging from the reengineering group (i.e. allowing the federal SSA office to make
the initial determination itself in clear "approve" cases -- e.g. the person has lost a
leg -- rather than sending to state DDS for processing that takes weeks). There may
even be creative ways to condition other waivers sought by states on cooperation in
assisting their neighbors with disability backlogs.
Automation Acceleration. Despite severe need, SSA is apparently reluctant to begin
automation installation in OHA and the DDSs because without underlying system
design they are subject to criticism from GAO and others. However, even patching
current operations with hardware and available software might improve interim
productivity. Redirecting resources within SSA's strategic priority investments
toward accelerated automation for OHA and the key states might improve results in
the short-run prior to implementation of the Modernized Disability System in FY
1996-98.
OHA. Total annual appeals have risen over 50% since FY 1990. ALJ's average
only two decisions per day, while no overtime is paid and work process inefficiencies
are believed to be high. The SSA appeals process has been the subject of over 37
studies with little perceptible change. It appears that the reengineering project is not
making OHA a priority; many also believe the OHA culture is highly insular and
resistant to change. HHS might develop a team, including appropriate judicial/legal
authorities who carry weight with the ALJ community, to identify areas for short-term
improvement and possibly benchmarks for productivity. At a minimum, a review of
the many previous studies by an independent, HHS-led team might help jumpstart a
set of sensible reforms.
Payment cycling. Although this idea has application beyond the disability context at
SSA, it can be a major component of any reinventing effort and dovetails well with
efforts to smooth the peaks and valleys in current workloads that invariably affect
claims processing and other services offered. Methods to accelerate phase-in of such
cycling could be studied as part of the project.
Possible Next Steps?
If a short-run project like the one described seems attractive:
-
guidance on goals, scope and approach to project need to be refined by
principals
staffing needs and a detailed workplan would need to be prepared quickly, so
that project could be completed for consideration at same time reengineering
blueprint is under discussion.
consultation with other relevant WH senior staff, agency officials, and
potentially governors should take place
*
Coopers
&Lybrand
Defining BPR
TRUMANSERVICES.
USA
HEALTH
OF
DEPARTMENT
Business Process Reengineering is a fundamental rethinking
and radical redesign of an entire "core business process" -
The business processes, jobs, organizational structures,
management systems, beliefs and values - to achieve
dramatic improvements in critical measures of
performance.
31018.s2
Copyright ©
Coopers & Lybrand, 1993
2-2
DISABILITY RE-ENGINEERING
Executive staff decision for dramatic
improvement
DIB process from individual expression o1
intent to file through final administrative
appeal decision/payment effectuation
All steps - initial, recon, hearing, A/C
Medical, non-medical aspects, auxiliaries
included
DISABILITY RE-ENGINEERING TEAM
Started October 4
18 members
People with and without disability
experience
High level report by March 31 to the
Commissioner
Executive Steering Committee
overseeing effort
4
SCOPE OF PROJECT
Keep disability definition as it stands
Not addressing vocational
rehabilitation
Post eligibility continuing disability
reviews not included
ALJs presiding over an administrative
hearing
IT
WORKLOAD EXPLOSION
1994
1993
1989
Initial 2.7 M
2.5 M
1.7 M
Recon 777 T
755 T
526 T
ALJ
522 T
509 T
291 T
A/C
75 T
66 T
50 T
AM
ALLOWANCE RATES
1993
1992
INITIAL
39%
43%
RECON
14%
17%
ALJ
75%
75%
NOTE: 20% ON-THE-RECORD
A/C
4% (27% REMAND)
5% (35% REMAND)
COURT
13% (42 REMAND)
12% (39% REMAND)
OBJECTIVES TO BE MEASURED
Make the right decision
(with awareness of program costs)
Make the decision as quickly as
possible
Make the decision as efficiently as
possible
Make the process as "user-friendly" as
possible for claimants, employees and
third parties
SSA'S BUSINESS PROCESS
REENGINEERING
FEB-16-94 WED 13:45
Phase 1
Phase 2
Phase 3
Phase 4
Project Planning
Develop
Evaluate
Implement
High Level
and Decide
Process
Redesign
Redesign
Improvements/
Innovations
Select process
Organize team
Public dialogue/
Implement process
feasibility
improvements
Establish
Benchmarking
analysis
parameters
Initial implemen-
Process analysis
Work with
tation sites
oversight groups/
Process redesign
unions/States
Decision point #2
Cost/benefit
Develop detailed
Implement process
analysis
design document
innovations
Complete redesign
Decision point #1
paper
FAX NO. 00000000000000000000
P. 03
PROCESS ANALYSIS
Analyze "as is" process
Conduct internal/external scans
Obtain public focus group results
SITE VISIT ACCOMPLISHMENTS
Conducted 3,000 + interviews:
front-line employees, managers,
and executives
SITE VISIT ACCOMPLISHMENTS
Visited 367 sites in 29 states
-- 10 regional offices
-- 63 field offices/teleservice centers
-- 37 state disability determination
services
-- 27 hearing offices
--
9 large installations
-- SSA central office
SITE VISIT ACCOMPLISHMENTS
625 + parties external to SSA
-Medical community
-Legal aid
--Advocates
--Interest groups
-Executive Branch and
congress'onal stakeholders
FEEDBACK: INTERNAL AND
EXTERNAL SCANS
Fragmented process results in poor
service to disability applicants
Reconsideration process and results
viewed with little confidence
Face-to-face contact is controversia
Layers zt DLT pale.
Claimants could assume more
responsibility
FEEDBACK: INTERNAL AND
EXTERNAL SCANS
Higher ALJ allowance rates result in
perception of differing standards at
appeals and DDS levels
Current quality review system could
be improved
Role of Appeals Council should
change
VIVI
FEEDBACK: FOCUS GROUPS
Wait too long for a decision
Do not understand the program
or the process
View initial and reconsideration
denials as bureaucratic precursors
to final approval at the ALJ level
FEEDBACK: FOCUS GROUPS
Resent hiring and paying an
attorney to maneuver through the
process
Want more active involvement in
pursuit of claim
THE LAW OFFICES OF
ALLAN IANNACONE
HEREFORD LAW CENTER
presents seminar on
"Myths About Social Security
Disability Claims"
February 17, 1994, 7:30-9:00 p.m.
"There's no point in trying because I've already been denied.
Social Security is well known for initially denying meritorious claims that
later are approved by an Administrative Law Judge. Don't let a bureaucrat
determine your future. Keep appealing until you get a judge.
"I've appealed once and lost, so there's no point in appealing
again.
Social Security disability claims have to be appealed twice in order to get an
Administrative Law Judge. The first appeal is decided only by another
bureaucrat. Keep appealing until you get a judge.
"Social Security disability is only for people who on't be able to
work for the rest of their lives.
Not true. Social Security disability is for perosn who have been or are
expected to be disabled for a yes: or more. Benefits can be awarded for a
closed period if you successfully return to work.
"I can't afford to pay a lawyer to help me.
Wrong. Lawyers are not allowed to charge up front for Social Security
disability claims. Under federal regulations, a lawyer is not owed any fee
unless you win. If you do win, then the governments pays your lawyer 25%
of the money that it owes you for past due benefits, up to a maximum of
$4,000.
Call for Reservations
Hereford Center
329-6822
Suite 200
Above Library
Limited Seating
in Hereford on York Rd.
EMPLOYEE FEEDBACK
Need more staff
Process is broken
Nothing will happen
Pleased to be asked for input
EMPLOYEE EXPECTATIONS
Maximize skills through
empowerment
Better working environment with
adequate staffing
No forced reassignments, downsizi ng
or RIFs
Simplification
Career opportunities
NOTE FOR ATTENDEES OF FRIDAY DISABILITY MEETING WITH ALICE RIVLIN
From:
Matt Miller
Date:
February 3, 1994
Re:
Agenda
Here's an agenda and an attached two-pager for you to read before the meeting.
February 4, 1994
DI AND SSI OUTLAY GROWTH
Outlays, 1978 to 1995 ($ billions)
1978
1980
1985
1990
1995E
DI 12.3
14.9
18.8
24.3
40.6
SSI 5.2
5.9
8.6
11.5
26.1
TOTAL 17.5
20.8
27.4
35.8
66.7
Compound annual growth rates - percent
Both
DI Only
SSI Only
1978-1995
8.2
7.3
9.9
1985-1995
9.3
8.0
11.7
1990-1995
13.0
10.8
17.8