Articles from prior issues of The Advocate

November/December, 1995

Attempts to Quell Fears, Answer Questions
Enhanced Role Planned for DDS in Redesign
by Donna Hilton, Editor

CONFERENCE DELEGATES HAD AN OPPORTUNITY in Portland to voice their concerns and questions face-to-face with the Director of the Disability Redesign Team. Chuck Jones, a former Michigan DDS administrator who heads the Redesign Team, presented an update on Redesign progress and described role changes that are on the table for DDS and OHA levels. Jones cited concrete steps that SSA has taken. SSA has stated that there will be state and federal Disability Claims Managers (DCM) and Adjudicative Officers (AO). A letter is being prepared to affirm that the SSA Redesign intends to enhance the role of the state agency. Legislation is being drafted which will give the DDS authority to effectuate payments as soon as a favorable decision can be made. Jones also reassured delegates that DDS state jobs were secure. SSA is facing an FTE reduction of four to five thousand nationally. Given the current political climate of downsizing, there is no way the federal government will allow 13,000 DDS employees to be federalized. With regard to the place of DDS in the Redesign plans, Jones admonished delegates to “watch what we do, not just what we say.”

A major focus of redesign targets OHA because of the tremendous backlog of cases at that level. While the DDSs have steadily reduced pending caseloads by 140,000 over the last year, the OHAs have only seen a reduction within the last three months. OHA is 7,000 strong and due to be reorganized; SSA is seeking broad based feedback. SSA is exploring contracting of OHA work out to other federal Administrative Law Judges (ALJ), state ALJs, or DDS agencies. He noted that, "some DDSs are already involved in assisting OHAs with folder realignment and decisional writing." SSA has had a workgroup assigned to draft proposals and suggestions for the reorganization of OHA. Although no decisions have been made, Jones mentioned two suggestions being kicked around. One is to have the OHA staff (decision writers, adjudicative officers, and assistants) report to the Regional Commissioners. The other suggestion is to reorganize the various levels of OHA and change their work responsibilities.

Another area of redesign which will impact on DDS and OHA is Process Unification. As an example, Mr. Jones noted that DDS often goes to lengths to get around the Medical Source Statement (MSS) because funding is not always adequate to cover the cost of obtaining an MSS. Process Unification, as being considered, would require DDS to give the MSS as much weight as the ALJ does. He noted the POMS already addresses this (reference POMS DI 22505.006B.) Also, in Redesign both levels will move toward (1) face to face interview, (2) a DCM, and (3) a predenial/predecision interview. These changes of process unification will require both legislative and advocate approval.

Jones stated, "the AO is a radical change that will affect OHA tremendously." He felt that it will radically reduce the time it takes to get a hearing and increase productivity. However, judges are concerned that it will reduce their authority; it will be imposing another decision maker at OHA.

Associate Commissioner Daniels’ staff is looking at rulings regarding (1) pain, (2) treating source evidence, and (3) the Residual Functional Capacity Assessment (RFC). Redesign is likely to require changes in how the DDS assesses pain and the treating medical evidence of record. SSA is looking at giving the DDS more latitude; however, he noted that the program can’t financially afford to let the DDS adjudicate cases with the same latitudes as the ALJ or the SSA Trust Fund would be broke within a year. Jones indicated that it will be tricky balancing to loosen up adjudicative policies and maintain fiscal integrity. One possibility is to place medical consultants at the OHA level to assist in assessing medical evidence. To make some of these changes will require changes in the Administrative Procedures Act, because the ALJs have decisional independence. On the RFC issue, there are plans to provide more medical training to ALJs.

Finally, Redesign is looking at an entirely new quality review process, one which would be uniform throughout all levels of the organization. Jones joked that if redesign has accomplished nothing else, it has made all levels of SSA and DDS feel that Redesign is “out to get them.”

During the question period, he indicated that he was unaware of any concrete plans to change the Medical Improvement Standards. Another question provided information on changes being contemplated at OHA to make the Appeals Council a quality review unit for the ALJ allowances and denials.

He closed saying that “We want to listen to DDS, even if we don’t agree.”