Articles from prior issues of The Advocate

May/June 2000

Prototypes - Here to Stay?
by Lisa Martin, Texas DDS

PHIL LANDIS, SSA’S DIRECTOR OF the Disability Process Redesign staff, addressed a packed room of disability professionals at the Southwest Association of Disability Examiner’s annual training conference held in Austin, Texas in April. Mr. Landis began by stating that it is very difficult to transition from one process to another. Mr. Landis identified Process Unification as a key part of the prototype change. The prototype plan puts emphasis on Process Unification and rationales and is one of the most difficult hurdles for examiners to overcome in learning the new process. Process Unification was designed to achieve similar results on similar cases at all adjudication levels through the correct application of law, regulations, and rules. Two of the goals of the prototype are to make the disability claims process easier for claimants and those who assist claimants and to make the right decision as early as possible in the process.

In the spring of 1999 Commissioner Apfel made a decision to prototype the successful elements of the Full Process Model of Redesign in ten states. This would include a focus on case development at the initial level. It also revised the roles for disability examiners and state agency medical consultants. It would provide a predecision interview with the claimant prior to the denial of disability and would also eliminate the reconsideration step of the appeal process.

Mr. Landis indicated that the early prototype experience indicates a general positive reaction from the DDSs. Most feel that the prototype design is the right way to handle cases. The disability examiners like the enhanced authority given by the Single Decision Maker Model. Disability examiners in the prototype states prepare their own RFCs and make their own medical decisions on cases with the exception of childhood and mental cases. Disability examiners have the option of consulting with a state agency medical consultant, but the case does not need the signature or review of a medical consultant if the disability examiner is comfortable in making the decision.

The prototype experience is, however, a major cultural change to the way the DDSs do business. There is anxiety by all in the DDSs over anticipated problems, especially with the claimant conference. The prototype states began the new procedures effective October 1, 1999. Since then disability examiners have become more comfortable with the claimant conference, but the conference does take a lot of time. Preparing the RFC has been a burden for some. There is also concern regarding the Process Unification development, documentation, and DQB feedback.

There is also an impact on productivity as the new process does require more case handling. Mr. Landis stated that it is still too early in the process for solid data. There is a transition period where the DDSs have been handling pipeline reconsideration cases. The learning curve has also been longer than initially anticipated. This may be a training issue. There have been multiple changes going on simultaneously; RFC completion, claimant conferences, and more development and explanations.

The early lesson learned is to focus on local training. The quality of the Field Office product is also critical for the process to work. There is some benefit to the disability examiner making a first day call to the claimant to identify medical sources, allegations, and other adjudicative information. Also it may be beneficial for states to start phasing in changes earlier. SSA will work with the states on training needs. Some alternatives need to be designed to handle pipeline cases. There are still a lot of reconsideration claims pending in the prototype states.

In March 2000 monitoring visits took place in the prototype states. These visits confirmed SSAs earlier impressions. The baseline of the DDS environment directly affects progress in transitioning to the prototype mode. The tone set by management is also critical to the success of the transition. It is important that procedures are followed. There have also been inconsistencies in the way the claimant conferences are being conducted. There are some issues that have arisen from the claimant conference. The notice of the conference confuses the claimants. They no longer think the notice is a denial notice. However, the claimant is unsure what they are expected to do. SSA will be looking at simplifying the notice. There are several messages that should be delivered during the claimant conference. The disability examiner is expected to explain eligibility criteria, i.e. the definition of disability as established by SSA. The disability examiner also is expected to explain what evidence the DDS has and how this evidence relates to the eligibility criteria. Lastly the disability examiner offers the claimant a chance to submit more evidence.

The next steps that need to be taken by SSA in implementing the prototype model is to clarify the goals of the claimant conference. There is also a need to process refinements where appropriate. These include the decisional documentation sheets used by the DDSs and the claimant conference notices. Training is needed on analysis and writing. The McGeorge School of Law has been contacted and McGeorge will be providing IVT training on analytical thinking. It is hoped this training will be available in early June, 2000. A survey of non-prototype baselines is needed. Finally, a rollout strategy will be devised.

Rollout to other DDS states, ten to fifteen states at a time, is to be implemented effective October 2001. (I thought that was when all the disability examiners from throughout the nation would be attending the NADE training conference in Austin!) Three major issues of rollout are: preparation (incremental training and survey of DDS procedures), phased rollout, and pipeline cases (should they be grandfathered into the new system?). A NPRM (notice of proposed rule making) is to be issued in early fiscal year 2001. The rollout to the first group of states is proposed for early fiscal year 2002.

The following are preliminary statistics for prototype states.

Year to Date

Accuracy 94% 95%

Allowance Rate 34% 39%

Prototype States

Claimant Conference Participation (through 4/7/00)

Total Eligible Cases Processed 43,976

Conference by Phone 27,055 (99.2%)

Conference Face-To-Face 210 total