Articles from prior issues of The Advocate

November/December, 1997

Susan Daniels Addresses NADE Conference
by Susan Neitzert, Great Plains Regional Director

Susan Daniels, Social Security Administration’s Associate Commissioner For Office of Disability, addressed the NADE Conference regarding the current status of the Disability Program. She reported that Social Security Disability applications have been declining since 1993 and the rate will probably hover where it is now. The major reasons for terminations are that most are turning 65 or that they die. A small number or recipients recover and are taken off by CDRs (Continuing Disability Reviews). The disability recipients are younger and healthier but they have more mental illness and there are more women. The number of CDRs is growing and that has increased termination. The other reasons for termination of benefits have been stable. Program costs continue rise in the DI program and are stable in the SSI program . We will probably come close to 100 billion dollars in payments by the year 2000. Program costs will continue to rise because the baby boomers are aging. Growth is caused by complex interactions of programmatic, economic, demographic and social factors. The biggest reasons for increased program costs are program changes, regulatory changes, policy changes, and court decisions. Other cost factors are SSA Outreach Programs, CDRs and the "adjudicative climate”. We now have emphasis on constraining the scope of the programs. These trends contributed to the need for SSA to move in three directions, constraining the scope of payments with DAA and children redeterminations. The redetermination of children’s cases had been estimated at reducing the rolls by 135,000 after all levels of appeal. New awards are estimated to go down by 160,000. Benefit savings are expected to be 4.7 billion dollars and Medicaid savings are expected to be 590 million dollars. We have continued 93,000 children's cases which is a 40 per cent allowance rate. Approximately 50 per cent have been allowed at an appeal level. Of the 320,000 new applications, 39 per cent have been allowed. Kenneth Apfel, Social Security Commissioner, promised a top to bottom review of the Disabled Children’s Program. Some areas under scrutiny are the rights to appeal and continuation since there were some allegations that people were not appealing at rates expected. Other issues being reviewed involve Failure to Cooperate, variances of allowance rate, quality, case development, policy application, new initial claims and redeterminations at age 18. SSA is conducting a centralized implementation review and improved training. High/low continuance rates of reviewed cases have been analyzed as well as modified determinations. The Office of Program Integrity Review looked at several areas such as failure, early information, quality assurance, special review, school records, regression analysis and review of 150 cessations. SSA has learned a lot about the dynamics of the program. Looking at the big picture the quality has been competent. Across the board expectations are where they were predicted. The work was done remarkably fast. There are some problems in targeted areas but they are specific problems in specific areas. Failure to cooperate ranged from 0 to 12 per cent in various states. Four states took very direct action to try to get the people in. SSA's review found that there were different case characteristics, state variances, and that there are a few are quality problems in this area. Commissioner Apfel will be releasing a plan for failure to cooperate shortly. Susan Daniels stated she has two concerns about the childhood decisions. First, children are being removed from the rolls that are still coded with a diagnosis of Mental Retardation. Some are being removed with using a new code such as learning disabled. The second problem is that children put on by another code and are now be taken off with the mental retardation. This has involved about 30,000 children. There continues to be a problem with application of the policy of this area across the country. Speech/Language Deficits are very hard to handle and we do need more experts in this area to help us with these cases. Case problems involving maladaptive behaviors have shown only a very small problem and it has not been wide spread problem. DDSs were supposed to do 603,000 Continuing Disability Review and we did over that amount. We have saved nearly 4.5 billion dollars in lifetime benefits with the cases ceased this past year. In 1998, SSA is targeted to do 1.2 million CDRs and DDS is to do 511 million, which is 82,900 over original budget. SSA is targeting SSI CDRs on children and want to develop child mailers. The ones most likely to have improved will be the focus, in order to avoid spending resources on those not likely to be removed from the rolls. DDS Productivity and Allowance rate charts showed that as productivity goes up, allowance rates go down to a certain point. SSA plans to look at what the costs of productivity are. Process Unification is getting all levels back together. SSA is also looking at single presentation of policy, documentation of evidence of DDS denials, remanding cases to DDS and looking at Quality Assurance for OHA. SSA is proceeding with the Adjudication Institute. Also under analysis is the knowledge needed for all levels to do the program and the training needed. Up to now, our training has been fragmented, hap-hazard and unresponsive to our changing needs. Daniels indicated we need a circle of competence, to include core knowledge, SSA requirements, and role specific components. Also needed is a system of training that promotes professional competency. The Adjudication Institute Workgroup is developing a vision, map for the future and what action needs to be done. You may receive copies of this slide presentation/information by e-mail to: ruth.roberts@ssa.gov and ask for updateNADE. You may also call 410-965-3424 or fax 410-965-6503.