Articles from prior issues of The Advocate

November/December 1998

Associate Commissioner Nibali Addresses NADE
by Lisa Martin, Texas DDS

President Debi Gardiner presented Associate Commissioner Nibali with a plaque with his favorite quip..."I can only please one person today. Today is Not your day, and tomorrow is not looking good either."

Ken Nibali, SSA's Associate Commissioner of Disability, started his presentation at the NADE conference by thanking those in the audience for doing such a great job in their work at the DDSs. In a most sincere speech, Mr. Nibali came across as an understanding, interested individual that understood the problems that DDSs face each day. He gave an overview of the big picture of the Social Security Administration (SSA) by focusing on solvency, the SSI Program, disability, workloads/budget, and the year 2000 problems.

Solvency

Solvency is the Social Security Administrations first priority. It is also a major White House priority. Although the Social Security Administration is still many years from bankruptcy, in the next ten to fifteen years the trust fund will begin to see a downhill slide. One of the messages that SSA is trying to get out to the public: Social Security is much more than retirement. It is retirement, survivors, and disability benefits along with many other programs.

SSI Program

Mr. Nibali touched on a few of the concerns that SSA currently has with the SSI program. This included: SSI High Risk, Anti-Fraud, Overpayment Prevention, and Debt Collection. The General Accounting Office (GAO) recently released a very critical report of how SSA was handling the SSI Program. One of the concerns brought out in the GAO report was the lack of leadership in SSA on policy issues. It will be interesting to see how SSA reacts to this report.

Disability

In relation to disability, the major issues covered by Mr. Nibali included the following: Timeframes, DA& A, Childhood Cases, CDRs, Alien Cases, Non-English Speaking Issues, Return to Work, and Redesign.

Timeframes

The cumulative processing time of SSA/DDS for initial cases is currently 100 days. This increases to 180 days for reconsideration cases and to 564 days for ALJ cases. Applicants are currently being allowed at the initial level at a 60 percent rate. Ten percent are allowed at the reconsideration level and 30 percent are allowed at the ALJ level. Considering DDS time only, initial mean processing time is between 60 and 70 days. OHA pendings have shown a continual decline. It was estimated that by the end of the year OHA pendings should be around the 400,000 mark.

DA&A Cases

SSA mailed 209,000 notices on DA&A cases. Half of those sent notices did not respond and were ceased.

Childhood Cases

It was estimated that 288,000 children could have been potentially affected. There were 150,000 initial cessation determinations. SSA is now estimating that after all appeals and reviews that 100,000 recipients may lose eligibility.

CDRs

For fiscal year 1998, it was estimated that 660,000 medical CDRs and 734,000 CDR mailers would be processed. Of these mailers, 110,000 were estimated to be initial cessations. The net cessations after all appeals were estimated to be 55,000.

Alien Cases

Any qualified alien, age 65 or older, in the country on or before August 22, 1996 may qualify for SSI benefits. Of those that have applied, one third were denied. It was initially thought by SSA that most of these cases would be allowances. For this reason, some Regions are being asked to take a closer look at the cases that were denied on a non-severe basis, failure to cooperate, and based on medical vocational factors. Service to the Non-English speaking public.

SSA is studying when to involve an interpreter if additional evidence is needed. The most predominate other languages in the USA from the 1990 census were: Spanish, French, German, and Italian.

Return-To-Work

There are approximately seven million adult beneficiaries. Out of this seven million less than one percent return to work. This a big concern of Susan Daniels, SSA's Deputy Commissioner. Some of the major initiatives being looked at are: VR Program Enhancements, Return-To-Work Legislation, State Partnership Initiatives, and Work Incentives and Service Delivery. Two major return-to-work pieces of legislation are now before Congress. Both deal with these issues. If this legislation passes it could have an effect on the DDS caseloads.

Redesign

SSA has now lowered their expectations as far as Redesign is concerned. The tests have not have been as successful as they would have liked. However, the results from all pilot studies have not yet been received.

DDS Goals

Initial receipts are down. However with CDRs, the DDSs continue to do more work than ever before. Currently, 410,000 claims are pending at the initial level. Due to 850,000 CDR cases pending the DDSs had the highest total pending rate ever in May, 1998. The message is that CDRs are here to stay and DDSs need to adjust to this intake. The CDRs should peak in the next two years. The CDR goal for fiscal year 1998 was 534,000. In actuality, the DDSs will process 660,000 CDRs this year. This is great! Processing time is also looking good at 100 days. However, the accuracy rate has been dropping and is currently at 95.7 percent. The net accuracy goal from SSA is 97 percent. This issue needs to be looked at carefully. Allowance accuracy runs higher than denial accuracy at the initial level. Reconsiderations and CDRs are following the same trends.

Office of Disability Focus

The Office of Disability currently has several focuses. They include: Quality, Timeliness/Efficiency, Up-to-date Instructions, Return-to-Work, and Program Understanding.

Process Unification

Several good things have resulted from Process Unification. These include: Training Instructions, Review of OHA Allowances, and Pre-effectuation review of ALJ allowance decisions numbering 10,000 a year. The enabling regulation went into effect in July, 1998. SSA began processing these cases in August, 1998. A dry run of these reviews has been running this last year. After review, the Appeals Council can remand the case back to the ALJs. ALJ allowance rates since Process Unification have dropped below 67 percent. DDSs are allowing approximately 30 percent. In the last three years since Process Unification, there has been a 15 percent drop in ALJ allowance rates. DDS allowance rates have gone up approximately five percent. We are getting closer in our allowance rates. If these trends continue, we should see less ALJ allowances and perhaps more DDS allowances.

DDS Rationales

Rationales are required by regulations and are reemphasized by the Social Security Rulings of 1996. The rationale should not just be a summary. The rationale should be an explanation of how a decision is made. It should promote good development and thought processes. It is believed that rationales affect the decisions made. The DDS impact of rationales include: Quality development and decisions, thus increased allowance rates. The OHA impact will be fewer cases and decreased ALJ allowance rates. Rationales are also the subject of litigation. One significant court case has been filed in Nebraska. The required explanations called for in the Social Security Rulings are not being implemented in a significant degree in making decisions. This reinforces the need to go back to rationales. The risk of not doing rationales is litigation. Other risks include the credibility of the process with DDS and OHA and increased costs. What is the cost to the DDSs? The cost to the DDSs is the decreased productivity per workyear (PPWY). The primary reason for the productivity increase over the last several years has been forced workloads. This was necessary at the time to enable movement of initial claims. In the last several years streamlining initiatives have been put into place to enable the development and documentation of decisions. In some DDSs, quality assurance personnel and others were used to process workloads.

Proposed Implementation of Rationales

Pilots are currently being conducted on the use of rationales. SSA has learned lessons from the pilots. DDSs have already made the point that DQBs cannot send back returns on rationales until the DDSs have clearer instructions. SSA is trying to clarify requirements by visiting the DDSs, providing desk guides, POMS instructions, samples, training, and simplifying the summary. Additional training sessions will be held in October, 1998 for the pilot sites. There will be a budgeting impact. Additional funds will be hard to come by. The Commissioner is aware of this. Redesign issues have not been included in SSAs current budget. However, Mr. Nibali has met with the Commissioner and he understands that funds need to be available for rationales. It will be essential to get ALJ feedback on the usefulness of rationales. With the ALJ review, SSA will be able to tell if the ALJs are using the rationales. This is one of the reasons the DDSs are going to do rationales and the ALJs need to utilize them. It was pointed out that now is a good time to initiate rationales since applications are down.

Disability Adjudication Training System

Another Office of Disability focus is the Disability Adjudication Training System (DATS). DATS is a comprehensive approach to training. It complements the current training process. The DATS workgroup has been meeting since mid-1997 under the leadership of Office of Disability and Office of Training. Representation for the DATS workgroup comes from the DDSs, OHA, and OQA. DATS direction is to provide consistent, quality training. Pre-employment education as well as on going education is being reviewed.

Challenges to NADE

Mr. Nibali expressed an interest in working with NADE. He asked for NADE's help in reaching new examiners. Nationwide, 40 percent of the disability examiners have less than two years experience. He also asked NADE to identify skills and training needed for Process Unification, quality, and DATS. He also asked for ideas to maintain timeliness and efficiency while improving quality. Lastly, he asked that NADE continue to work with the DDS administrators and to work in concert with NCDDD.