Articles from prior issues of The Advocate

January/February, 1996

NADE’s Position on the Accelerated Disability Claims Manager Pilot
December, 1995

The National Association of Disability Examiners (NADE) has had serious concerns about the efficiency, effectiveness and fiscal integrity of the Social Security Administration’s plan to redesign the Disability Program since early planning documents were released in March, 1994. We do not believe the plan adequately addresses the very real problem of the differences between the state Disability Determination Services (DDS) decisions and those of Administrative Law Judges. We believe that the current redesign process focusing on the Initial and Reconsideration decisions will only provide a bandaid approach to correct minor problems in the disability process. We believe the concept of the Disability Claims Manager (DCM), a single decision-maker handling both the medical and non-medical aspects of a disability claim, seriously underestimates the complexity if both the examiners’ and claims representatives’ jobs. And prior experience with the pre-decision interview has not demonstrated its effectiveness. We have expressed these concerns to SSA and in our testimony before Congress.

Certainly the current process is not perfect. There are some significant and serious flaws in the Disability Program which need to be addressed in order to ensure uniform, equitable decisions. As a nation we cannot afford to deny benefit to those who are truly disabled nor can we afford to allow benefits to those who are not. For that reason any solution to the current problems facing the Disability Program, any “redesign” efforts, must be carried out in a logical, systematic, objective manner. It does not make economic sense to rush the process.

The new process, as outlined by SSA in “Plan For A New Disability Claim Process” and “Disability Process Redesign: Next Steps in Implementation “ differs dramatically from the current process. Despite our reservations NADE has participated, when asked, in Task Teams and Workgroups to develop the procedures necessary to implement the new process. However, while we have been part of the input process, neither we nor the state DDSs have been part of the decision making group. Despite assurances to the contrary, SSA has not given the DDSs (who have extensive training and experience in disability evaluation) full partnership in developing the “new disability claim process.” All decisions relative to implementation of the new process are referred to the National Partnership Council (NPC). There are no DDS representatives on the NPC.

Recently SSA and the NPC reached an agreement with the federal employees union to accelerate implementation of several aspects of the Redesign Plan. This decision was made despite the fact that none of the enablers, which SSA stated were prerequisites for successful implementation, are in place. Further, the agreement includes at least a one step higher classification for those employees included in the accelerated Disability Claims Manager (DCM) Pilot. We do not believe accelerating the redesign initiative is in the best interest of either the Disability Program or the tax paying public. Although SSA has stated on numerous occasions that the new disability process will be “faster, better and cheaper,” implementation at this time--without the necessary enablers in place--can be expected to raise both administrative and program costs. Even though this is labeled as a pilot, SSA has informed us that they intend to proceed with full implementation of DCM in the future and the pilot is only to “work the bugs out” in advance.

Currently many Field Offices have no development clerks. The claims representative (CR) is classified at a GS-11 level, earning a base of $36,263 per year. The accelerated DCM pilot proposes a new position, a DCM, classified at a GS-12 level (base salary of $43,426 per year) with additional staff assistance of “appropriate technical/clerical personnel.” One proposal was for two assistants at a GS-6/7/8 level. The assistants would go from a GS-6 to a GS-8 level non-competitively. The two GS-8s each would be making $27,112 per year for a total of $54,224 in administrative costs. The current disability evaluation process is handled by a team, consisting of a CR and a Disability Examiner (DE) and costs roughly $60,000 (depending in which state the DE is employed). The proposed position will involve three to five positions and at a minimum will cost $97,650. Ultimately over 5,000 federal DCM positions are anticipated. At that staffing level the costs would be $488,250,000, an increase of $188,250,000 per year over current staffing costs. More significantly, however, are the potential increases in program costs as the integrity and consistency of the decision-making processes are compromised.

In “Disability Process Redesign: Next Steps in Implementation” (SSAs blueprint for the new Disability Program) a “correct” decision is defined as “one that appropriately considers whether an individual does or does not meet the factors of entitlement for disability as defined by SSA’s statute, regulations, ruling and policies. Correct decisions in the new process depend on: a simplified decision methodology that provides a common frame of reference for deciding disability at all levels of the process; consistent direction and training to all adjudicators; enhanced and targeted collection and development of medical evidence; and automated and integrated claim processing system that will assist adjudicators in evidence gathering, analysis and decision-making; and a single, comprehensive quality review process across all levels”. The new accelerated DCM agreement between the NPC and the federal employees union cavalierly dismisses the need for these enablers to be in place prior to implementing this pilot. Yet without them it is not reasonable to expect DCMs, who have minimal training in disability evaluation, to make “correct” decisions.

The Social Security Administration recently obtained Regulatory authority to test four disability process models: single decision-maker; pre-denial interview; elimination of the reconsideration; and adjudication officer. These process models have direct applicability to the redesign plan. SSA now proposes to accelerate implementation of the DCM to “test and evaluate” the benefits of the DCM on 1) service to the public, 2) employees who would be affected, 3) program and administrative costs, 4) program accuracy and timeliness, and 5) the efficiency of the disability process. However, these individuals will not perform the full scope of duties ultimately envisioned for the DCM. How then can valid conclusions be drawn regarding service to the public and program and administrative costs? We believe the disability process models should be completed and the results analyzed before accelerating, or piloting, implementation of the Disability Claims Manager position.

Any changes to the process that affects such a significant number of the nation’s most disadvantaged people, the disabled, needs to be thoroughly and carefully studied, analyzed, and evaluated in terms of quality and administrative and program costs. Accelerating the DCM position pilot does not allow for such an analysis to occur. NADE is very concerned about the impact of accelerating this process on the disabled population of the country.

Michael T. Blair Assistant Director U.S. General Accounting Office Atlanta Regional Office 2635 Century Parkway, Ste. 700