Articles from prior issues of The Advocate

May/June 2000

Program Concerns And Changes Fill The Mid-Year Board's Agenda
by Ken Forbes, Pacific Regional Director

THIS YEAR THE NADE BOARD of Directors met in Washington, DC on March 9. There were a number of speakers including William Halter, Principal Deputy Commissioner for the Social Security Administration.

Office Of Employment Services Jeff Funk Mr. Funk began his presentation with some bad news: only one half of one percent of all the people on the disability rolls ever go back to work.

Congress passed a new law that provides a “ticket to work” for those on the rolls. In essence, this will allow recipients of benefits to return to work without losing their medical coverage (at least not right away). Naturally, there is a lot more involved, including the establishment of contracts with “managers of employment networks.”

Another aspect of the law establishes that we will use the 301 provisions to determine whether a person should continue receiving benefits. If the program they are enrolled in is expected to result in return to work, benefits will continue.

There is a workload impact for DDSs in this (did you doubt it?) There is a six month provisional pay situation after a person returns to work during which we have to decide whether they are still disabled.

Learn more about this exciting development by reaching out and touching www.ssa.gov/work or, reach out to Jeff at : Jeff.Funk.ttwwa@ssa.gov

NCDDD Mike Brennan And Tommy Warren

One of the NCDDD areas of focus is the QA process. Based on all the input they have received, SSA has hired a contractor (the Lewin Group) to perform an analysis of the QA process. This group is currently gathering information. They are visiting the Denver, Chicago, Atlanta and Philadelphia regions.

At some point, NCDDD would like to see the QA process move completely into the DDS and out of the DQB.

The big issue, for everyone, is BUDGET! NCDDD is trying to see if there is some way of changing the way money gets distributed in the agency. Mike mentioned that they are talking to Congress about this.

If no additional funds are made available, we will run out of money before the end of the fiscal year. Therefore, we need to keep costs down as much as possible. We need to find ways to reduce costs for procuring medical information.

On the issue of certification, Mr. Brennan described his perspective. He believes this is a much needed step forward. According to Brennan, NCDDD has been requesting training for some time. He said DDS Administrators need a way to establish the credentials of applicants for jobs. If SSA establishes this training program, analysts can earn a Masters Degree in disability evaluation. This will then certify the graduating analysts and will clearly qualify them for these positions.

Tommy Warren provided an update on Prototype progress. In a nutshell, we are not where we were expected to be at five months into the program. He used Alabama as an example of the program to date. They provided 110 hours of training, while still doing 110% of the workload and ended up burning out the analysts.

The number one problem is the rulings. While they have been on the books for a long time, it is difficult to get people to change the way they do business, specially when they have not had to change to get their jobs done. How do we change the mindset of 80% of the people doing the job? Prototype as practiced in Alabama does not include a face-to-face interview. Nor does it involve describing the decision to the claimant. It does include an additional information solicitation, as required.

It is clear that the elimination of reconsiderations will not be enough to pay for the new process.

He doesn’t believe we will ever go back to doing this work the way it was done before.

Legislative Issues Subcommittee On Social Security

Beverly Crawford, Legislative Assistant, (for Kim Hildred, Staff Director) addressed the board and provided an update on issues befor the Subcommittee on Social Security. Ms. Hildred was called to a meeting with Chairman Shaw.

Crawford said they have been very busy with their oversight role. They are planning a hearing on service delivery in the near future. They plan to take a very positive approach to the whole issue. They have focused on the SSA Advisory Board report on service delivery because it laid out issues so well.

She said that recent legislation has changed the earnings test, which raises an issue about substantial gainful employment. There will be a hearing soon. The disability program looks to be a prime issue for the subcommittee all year long. Fraud and abuse will be another hot topic. They want to provide the tools that will allow analysts to weed out abusers before we ever initiate payment.

What else is on the agenda? Well, there are issues surrounding the use of Social Security numbers and identity theft. They are talking about looking at fundamental principles upon which the whole disability program is built. They are also going to be asking the GAO to do some analysis of the surviving redesign issues. William Halter Principal Deputy Commissioner

Mr. Halter addressed the budget issue. He recognizes this as a major hot topic for everyone this year. The budget SSA is pursuing for next year includes additional funding for the disability program.

Why does he think that we will get more money? SSA is doing a much better job of lobbying than in the past. However, he stated there is a built in handicap for SSA because they compete directly against other social programs for dollars. In other words, one dollar appropriated to Social Security is one dollar that cannot be appropriated to health research or education.

One ace that SSA is trying to play is that the program funding comes directly out of the administrative fund and not out of the same general funds that all other programs compete for. If they could get Congress and the President to agree, funding for the SSA would not be part of the limitation on federal spending and appropriate additional money could be allocated to run the programs.

Another way of looking at SSA is this: it is a huge organization more complex than any other. There are about 65,000 employees in SSA and an additional 15,000 in the DDSs. Each group has multiple and varied relationships with each other and with other state, federal, private, and local government entities. SSA represents 30% of the income of the federal government, 25% of the expenditures and 100% of the federal surplus.

Mr. Halter is adamant that change is inevitable and that we really need to get out in front to accept and adapt to the changes or we will be replaced by some other organization that can do it all better, faster and cheaper than we can.

He invited all of us, individually and as an organization, to provide him with innovative ways of using our resources more efficiently.

Office Of Inspector General Jane Vecaris, Deputy Director

We were introduced to the new Deputy Inspector General, Jane Vecaris, and heard from Pat O’Carroll, Assistant Inspector General for Investigations.

The first thing they discussed was the future vision the agency has been working on. They see most of the disability program moving toward a highly electronic process with all kinds of potential problems, from the application through the benefit delivery process.

Most of the fraud allegations seen are disability related. Due to resource limitations, only a few of those reported can be investigated. Of those investigated, only a few reach the point of trial and conviction. However, the IG sees that there isn’t much chance of getting money back after a conviction. OIG is more interested in figuring out how to stop others from defrauding the system, and of course stopping those currently receiving money fraudulently, than they are in putting people in jail.

What’s going on locally? Cooperative Disability Investigation Units (CDIU) are being established, involving the IG office, the State Police, DDS staff and local prosecutors. They have dealt with 1,100 allegations and have obtained restitution of $363,000 with another $20 million in program savings and $6 million in other agency savings. These units have been established in several areas across the country.

These units are good news for the program, but they are just pilots and will remain so until 2005. So far, they have not been funded effectively, with the money shunting through the DDS and they are trying to get them set up for line item funding. They are also trying to get additional changes that will allow the CDIU to pursue civil penalties for proof of fraudulent activity. Hot topics for their future? Jurisdiction. They have derived authority that is limited to local jurisdictions. They cannot deputize people and allow them to operate as a normal federal agent would, across local jurisdictions.

Social Security Advisory Board Margaret Malone, Staff Director

The Social Security Advisory Board currently engaged in reviewing implementation of Prototype. They have already visited Michigan, New York and Pennsylvania. In each site, they interviewed the Directors, people in training, QA staff, and line staff.

So far, most analysts really like the additional control afforded by the program. Medical Consultants, by and large, seem to fear the effect on their jobs and question the qualifications of analysts to supplant them.

Overall, people have not been negative. Most are looking at the Prototype as the job they have been doing or should have been doing. Everyone agrees that it takes a great deal more time to do each case.

There is some concern that the cases coming from the Field Offices are not adequately prepared. Of course, this is driven by workload pressure at the Field Office and the DDS.

The biggest issue seems to be with the Process Unification Rulings. To implement them takes additional time and, depending on the level of implementation, can really drag down production.

Both the administration and analysts are concerned about the drop in productivity, rise in processing time, increase in allowance rate and rising workloads in spite of diverting work to other states. (The allowance rate issue is in question because they cannot tell if it is where it should be - especially since we do not know what the effect will be at OHA.)

Clearly people need more training and better/more consistent feedback about their work. This feedback needs to come from in-house QA as well as DQB. It is too early to tell what will happen to administration and program costs.

What’s in store for the Advisory Board? They will continue to focus on the need for additional resources and the need for changes in the disability program. The areas they see needing change are training, quality assurance, computer systems, medical evidence and access thereto, and the single presentation of policy. They will consider getting into the structure of the program, including issue such as the state/federal relationship and whether SSA should get into dictating training, salaries, etc. (They have noted a big range of salaries and a very high attrition rate.)

The 'big picture' from their perspective is that the disability program needs strong leadership from SSA with changes thoroughly thought out prior to implementation. They urged NADE to keep all members informed and to be alert and responsive to the changes we see occurring in the disability program.

Listings and Certification Ken Nibali Associate Commissioner for Disability, and Bill Anderson Director of Division of Medical and Vocational Policy

The listings have needed revision for a long time but there was never enough pressure to actually make it happen... until now.

Recently, Bill Anderson hired 15 people specifically for the revision of listings, (four of them are from DDSs).

What direction to pursue? Would they go with a medical or a more functional direction? Answer: stick with the present form but eliminate some of the ambiguity. We will soon see more results of their work. We have seen some of their work in the form of the elimination of the obesity listing. The first listings that we see will appear expect to be more heavily weighted on function.

While they cannot get to DSM-IV for another four or five months, a final regulation can be done with what they have. The changes will include an option for the PRTF to be completed by an analyst. It will also require the PRTF to be in file at any hearing on the case.

Anderson assured us that they are committed to making the listings work for us. They will request our input on a draft when it is done. And what is on the hot plate? They will soon publish Notices of Proposed Rule Making (NPRM) in the Federal Register for these listings: Mental, Hemolymphatic and Neoplasm, Neurologic, and Skin. Respiratory, Cardiac, and Immune systems are not on the immediate horizon. Depending on political issues, there could be some changes in the timing and presentation of these NPRMs.

What about certification? Nibali described the Prototype and Process Unification as two issues that drive an expectation for more consistently qualified Disability Analysts. He also believes that certification can assist in the argument for higher salaries.

Consequently, he is proposing the expenditure of SSA funds for the purpose of hiring a contractor to come in and determine what is needed to create a certification process. It wasn’t clear whether the contractor would be expected to do more than just identify the need for testing to establish competence, or if follow-up testing is anticipated to evaluate continued competence. Nor was it clear whether the contractor would design the system to maintain records of certification, as well as establish and maintain records of the continuing education needed to maintain certification. There was quite a bit of discussion about the proposal and NADE’s current certification process. In fact, the Board was split on the issue with some feeling that we really need SSA’s assistance to get this off the ground while others felt equally strongly that, as a professional organization, we should not have our certification process tied to SSA.

Bottom line agreement existed in this though - if the DDS Directors would not be able to offer assurance that preference in hiring would be given the certified Disability Analyst, there really was no point in going to all the trouble. We can certainly strengthen the certification process we now have by adding continuing education requirements and recertification provisions.

Disability Process Redesign Team Sue Roecker

Sue’s alloted time was shortened somewhat by the discussion with Ken Nibali on Certification. However, she did have time to talk to us about the Disability Claims Manager (DCM) pilot. This pilot is in phase two testing where they are taking away some of the supports and requiring the DCMs to perform in situations that are closer to real life.

Now they are developing the assessment criteria to determine whether the pilot is successful. Several different approaches could be used but the two criteria most likely to be used would be either productivity or cost.

She expects to have data from phase 2 available in November. The plan is to have a final report developed and presented by January 1, 2001.

Other Board Meeting News

In a very busy meeting, lasting several days, the Board addressed many issues affecting the organization and the disability program. Among these issues discussed were those surrounding the prototype. Terri Spurgeon discussed her action voicing NADE's concern to Commissioner Apfel regarding a prototype poster that implied the initial DDS decision was inherently wrong. We continue to watch the outcomes from prototype states to see whether we should be bringing additional concerns to Commissioner Apfel’s attention.

We also discussed a new process which we believe might make for a more productive conference for our new attendees at National Conferences. CCP Chair Dean Crawford has developed a question and answer sheet that new attendees may use to map out their participation.

We elected to increase the membership grant from just a few each year to the point where every chapter could receive a $50 grant.

We also agreed to begin the process of revising the position descriptions in the chapter services handbook so everyone will have a better way of determining whether they want to hold any of these jobs for the organization.

There was a lot of discussion about what we are all hearing - that our agencies will not be very supportive of the national conference this year. The two primary issues are funding and the fact that Puerto Rico is perceived as a resort area and thus less suitable for professional meetings. An additional concern is the workload that all DDSs are facing this year.

We also discussed the issue of developing certification criteria for Medical Consultants.

Naturally, we discussed many more issues than this and exercised the democratic process so we avoided coming to blows on any subject, though it was clear from the discussions that many people are committed to this program and this organization. Our efforts to make both better result in disagreements and ultimately, better decisions for all. You should consider joining this kind of fun!