The first ripple in calm waters was a few days before the conference, when Susan Daniel’s, Ph.D., now Deputy Commissioner for Programs and Policy (congratulations!!), had to cancel her appearance due to pressing business elsewhere. For awhile we weren’t sure if anyone form SSA would be able to make it. We were expecting Ken Nibali, but he also could not attend. However, in the end we were very fortunate to have four representative from SSA speak before us regarding various issues! . The next disaster was the problems with the hotel rooms!! New Orleans is a highly sought after conference and convention site and is generally booked up everywhere. The Radisson, in Kenner, had our reservations blocked out, BUT, they also had the Small-fry basketball tournament!! This was a contingency of pee wees (about 8 to 12 years old or so) who were in town to compete in a tournament featuring children from all over the country. The group at the Radisson apparently lacked confidence, because they only booked through Monday night and then a miracle happened—They Advanced! Well, naturally the two or three hundred kids (perhaps a slight exaggeration) could not give up their rooms to those of arriving Tuesday night for the conference. Not to worry, negotiations were carried out and some of the early arrivals were placed in another property a couple of miles down the road, with free shuttle service back and forth. But there were only two shuttles for the entire hotel, so getting back and forth was an adventure of sorts. The lucky folks who got rooms at the Radisson, also got a jackhammer digging up the front parking lot until nine P.M. at night. They also were treated to hundreds of small fry running up and down the corridors, bouncing basketballs off of the doors to the rooms, using the two elevators for races and constantly trying to invade the hospitality suite-all night long!! We were assured that the kids were departing the next morning and all would be accommodated by Wednesday noon, because of the definite departure of the tournament Wednesday morning. Alas, another miscalculation. Those of us arriving on Wednesday found no hotel rooms and beaucoup children!! But eventually we all were settled into rooms for another night of midnight basketball reveling.

After this welcome, the glitches in the equipment (slide projector missing, bulbs burning out, no screen for the projector, etc.) though irritating, were mere bagatelle. And the fact that the hotel insisted I was there only one night and charged me for two (only at my insistence), informed all those who called for me that I was not registered there at all and then a week after the event charged me for three nights, well hey—this was New Orleans! The most important part of this whole event was that the camaraderie that various misfortunes caused was tremendous and the content of the conference was excellent and the New Orleanians are really to be congratulated on rising above adversity to give us an informative and valuable conference and incredible memories as well!

We were treated to a presentation by Sue Roeker on the current status of various Redesign projects and projected dates for implementation, including the Single Decision Maker, AO, PDI, Full Process Model and recon elimination. She covered the historical reasons for the inception of Redesign and the many changes it has undergone. Jim Everett, stepping into the shoes of Mr. Horace Dickerson, Jr., Dallas Regional Commissioner, who was unable to attend, gave an excellent presentation regarding SSA priorities, in particular planning to assure future program solvency in the face of the current statistics which show the programs revenues will be depleted by 2029. Bill Anderson, Director of Office of Disability, Division of Medical and Vocational Policy, spoke at length, regarding needed changes for assuring that the program integrity was maintained through real world solutions and strengthened the idea that DDS input into policy and program changes was valued and necessary for meaningful change.

Dr. Crisann Schiro-Geist spoke regarding DATS, a revolutionary, sweeping training program, which if funded and implemented would go a long way towards conforming disability decisions at all levels, a la Process Unification, as well as providing program wide standards for all program professionals. This proposed program is one of the most exciting ideas yet to come out of Redesign.

In addition to the extremely interesting information imparted by the representatives of SSA, we were also treated to an excellent presentation by Mr. Doug Willman, Nebraska DDS Administrator and President of NCDDD. He was up to his usual standard, providing a slightly different viewpoint on many of the previously mentioned topics in his forthright, informative and entertaining manner. Mr. Willman has the advantage of seeing the challenges of the Program from the DDS perspective, as well as being exceptional astute and well informed regarding the many changes being proposed at SSA. This combined with his engaging wit and style makes him a highlight of any conference. Hopefully, he will continue to speak at NADE conferences long after his term as NCDDD President ends.

Medical training was not neglected at the conference either. Dr. John Neitsche, a expert in Internal Medicine, Rheumatology, Allergies and Immunology, presented instruction on disease processes with musculoskeletal consequences. He discussed at length the signs, symptoms and findings, as well as presenting slides which illustrated the full range of abnormalities and demonstrated objective findings and loss of function.

Robert MacFarland, Ph.D., presented information regarding violence in the workplace. Giving an overview of the types of violence which can be expected and effective long-term and immediate useful solutions to this growing problem This was particularly interesting as we routinely engage people who can be frustrated, angry and potentially violent. Both of these gentlemen are CE providers in the New Orleans area and it was a pleasure to note that their expertise extends not only to their specialties, but also to Program requirements and policies. Their presentations were not only instructive with regards to medicine, but also as to how to evaluate the objective evidence to reach a solid disability decision with Program regulation and policy.

We were also lucky to have a presentation by Paul Tassin, D.C., a chiropractor, who after a shy beginning had the entire audience groaning and laughing and rotating our necks and dropping our shoulders. His presentation was not only fun, but full of greatly needed tips and resources for stress reduction!

This conference had everything that could be desired and a few things more besides. We had the opportunity to learn and inform. The chance to interact, as well as exercise patience and negotiation skills. We were provided with a venue that had history and culture as well as bacchanalian delights. This was most definitely “Nawlins”!

Kudos to Lyndell Layerele, President of the New Orleans chapter, and her minions, y’all did GOOD!!

As a prelude to the conference, ESADE hosted an opening night buffet dinner reception, highlighted by a presentation of “A Historical Perspective of NADE,” given by Mary Blum, Susan LaMorte, Frank Giordano, and Debi Gardiner.

The meeting officially began on Wednesday, June 10th, with a traditional Thanksgiving blessing offered by Mr. Kellar George, and Mr. Brian Patterson of the Oneida Nation’s Men’s Council. The welcoming address was given by Brian J. Wing, Commissioner of the Office of Temporary and Disability Assistance, the parent agency of the NY DDD, who strongly encouraged the advancement of the professionalism of disability adjudicators through membership in NADE. Dr. Slowe then addressed the conference, stressing NY DDD’s leadership and innovation in continuing medical training for medical consultants and examiners via CME accredited medical lectures. Debi Gardiner, current President of NADE, provided an informative overview of testimony given to Congress on several issues, a general update on legislative items, and current concerns of NADE. Debi also encouraged the celebration of National Disability Professionals Week, as well as membership recruitment.

Other highlights of the first day included a presentation by Joe Markovic, Director of Policy and Procedure, SSA OD, presenting SSA Associate Commissioner Ken Nibali’s message, explaining the growth of the SSDI and SSI disability program, and the requirement by Congress of management of the disability rolls via CDRs. The number of CDRs done by the DDS is expected to rise from 443,000 in FY 97 to 759,000 by FY 1999. Mr. Markovic noted that SSA exceeded it’s target of 655,000 total CDR’s by DDS & SSA components, completing 713,000 during FY 97. The emphasis on this aspect of the program is in keeping with Commissioner Apfel’s first priority re the solvency of Social Security in general. A number of other items were addressed during this session, including PUT, FPM, rationales, lost folders for CDRs. He also listened to the concerns of conference attendees regarding the DC Redetermination process and the implementation of the complete rationale process. Pamela Gardiner, Assistant Inspector General, Audit discussed the anti-fraud initiatives being piloted in 10 states, including New York, in a cooperative effort by the DDS, the SSA office of Inspector General and state law enforcement departments, stressing the rate of recovery from successful prosecution for fraud. Other featured SSA speakers were Beatrice Disman, SSA Regional Commissioner, and Susan Roecker, Deputy Director, DPRT. Ms. Disman stated that while solvency of Social Security was the first priority of the Commissioner, the management of the SSI program was priority #2. Ms. Disman is the leader of the SSA Regional Commissioner’s workgroup on this project. GAO has identified SSI as a “High Risk” program, with special concerns regarding accuracy of payments, which stood at 94.5 percent nationally. She discussed proposals of administrative sanctions against claimants who knowingly conceal information to continue to receive benefits. Ms. Disman praised all components in their handling of the DC redetermination process, under very trying circumstances, as an example of what can be accomplished when we all work together as a team. In response to a question, she reassured us that SSA remains committed to the Federal/State partnership, with the decision as to which component will do which parts of the program yet to be resolved. Ms. Roecker spoke on the Disability Redesign project. She stated that the FPM (Full Process Model) pilot was a fantastic test of over 30,000 cases nationally, that the controls were handled very well, and that the test has yielded valid results; especially noted was a lower appeal rate, and an increase in initial allowances. A complete assessment of the first phase of FPM is scheduled to be completed by Sept. 1998. The Single Decision Maker (SDM) process was also noted to be a success, with accuracy of adjudication higher than for other claims, slightly shorter MPT, and somewhat higher initial allowance rate. SSA has found that the testing of the SDM has been sufficient, the Regulations to implement SDM are in the works to go to the Commissioner for signature, and the roll out process is being considered. Planning for 1999 includes the beginning of implementation of the Personalized Decision Interview (PDI), and elimination of the Recon step by June or July of 1999. Ms. Roecker addressed the Adjudication Officer project as requiring further evaluation, as it had not yet shown saving in terms of cost effectiveness or productivity. Examiners expressed their concern regarding the elimination of AO as a replacement. Ms. Roecker emphasized that we need to do a better job on initial claims, but that SSA needs to provide the DDSs with procedures, funding, and authority to do this.

Dr. Grover Evans, Director, Arkansas DDS, the Awards Luncheon keynote speaker, took us all on a three day journey to Arkansas, emphasizing the concepts of integrity, motivation, and trust, on which to build a solid foundation. Dr. Evans’ motivational speech was received with great enthusiasm. ESADE was presented the NE NADE Chapter award; Conference Chairperson Debi Chowdhury was awarded Professional of the Year for the region, and the Director of the Puerto Rico DDS was cited for the Administrator’s Award. A special presentation was made by Debi Gardiner to Jim Coseo, the former Associate Commissioner for the NY DDS, for his support of NADE. We wished him well on his new career in the private sector.

Featured at the conference were three panel discussion; a panel discussion on quality, and how to avoid DQB returns, which was preceded by a role playing skit, using signs which spelled out the words “explain it” - re the need to clearly state the reasons for decisions. Taking part on the panel were ROQA (DQB) Directors, Ira Callis, NY; Gail Davis, Philadelphia, and Eugene Jerry of OQA (OPIR), moderated by Thomas Malvey, Chief, Quality Control, NY DDS. The second panel of DDS Administrators addressed the NY & PA DDS experience with the Full Process Model, and the roll out to complete rationales in Arkansas. Dr. Evans, Arkansas DDS Director, highlighted his presentation with information regarding the use of voice recognition software to dictate rationales. Jim Coseo moderated the panel, and spoke on the success of FPM in NY, while Howard Thorklson, PA DDS Director, voiced some concerns and reservations in relation to the FPM pilot in his state. Al Cannistraro, DHU Supervisor, Albany, NY DDS led a panel discussion of DHO’s regarding issues involved in the DHU process.

The subject of the Disability Adjudication training System (DATS) was presented by Anne Graham, Policy Analyst, OD, and member of the DATS workgroup. Ms. Graham stressed the need for NADE to support this project, being advocated by Susan Daniels, SSA Deputy Commissioner, as a vehicle to promote the professionalism and uniform training of disability adjudicators within SSA, the DDSs and OHA in particular. Dr. Chris Ann Schiro-Geist, the Coordinator of the DATS workgroup, supplied numerous handouts, and made herself available to attendees to talk about this critical program. Susan LaMorte provided insights into the DCM pilot in NJ, for which she had the responsibility of training 25 Federal DCM’s & Project Supervisors on the medical aspect of the disability program. We thank both Anne and Susan for graciously agreeing to speak on very short notice; we appreciate the excellent presentations they made.

At the Northeast regional board meeting, Debi Thomas was reelected President; Debi Chowdhury, Vice-President, and Jane Osgatharp was again elected Secretary/Treasurer. The issue of NADE’s stand re giving CE’s equal weight to treating source evidence was discussed; Debi Gardiner agreed to revisit this issue.

The medical lectures were well attended and appreciated, especially the CME lecture on Evaluating Speech and Language Disorders in Children, presented by Dr. Kathleen Whitmire, Chair, Communication Disorders Dept., College of St. Rose, Albany. Another highlight was a presentation made by George Bousvaros, MD, NY DQB, on typical problem areas found by DQB in evaluation of cardiovascular disorders; other topics covered were Gulf War Syndrome; the effects of depression on ability to work; childhood mental impairments, and assessing remaining work capacity from a treating source’s point of view.

Many ESADE members contributed to the success of this conference, and we thank them all. All the speakers and panel members made the program special. We thank Brenda Kaselis, and the NADE Northeast Regional Board, as well as Eugene Jerry, NADE Mid-Atlantic Director, Debi Gardiner and the National Board of NADE for all their help and advice. We especially thank our fellow NY NADE members of the new Southern Tier (STADE) chapter, for their help with goody bags, and to the WNYADE (Buffalo) chapter for their assistance. This training meeting is a wonderful example of the investment NADE has in advancing the cause of professionalism for disability adjudicators connected to the SSA & SSI disability programs, building on the respect already given to NADE as an organization by SSA and the public. The planning and staging of this conference was a great experience, and will hopefully set the stage for our chapter to go onto a bigger and better future. Next year’s Bi-Regional conference will be held in Columbia, MD. We hope that everyone who came to this year’s conference in Albany benefitted by being here, and had a great time.

Opening Address: Martin Baer, SSA Region X Commissioner

Baer said he believes we are very close to implementation of some redesign pilots. While he was not specific about which ones, he did talk about several redesign steps. One was the pre-decision interview, which he is convinced will be successful because it is designed to get the decision made NOW!

He suggested that a one-book process (where all levels of adjudicative levels are required to use the same policies for determining disability) with shorter time frames and early interviews will ensure that only those with new information will be reversed at hearing.

Showing some signs of being a futurist, Martin described the fact that the world is changing and that the examiners’s job is changing as well. We all need to get on board because the train has left the station and we already have a new job which includes the need to offer the claimants an interview before denying their claim. He recommended that management work with people to make sure they have every opportunity to master new skills needed in this new job. He also said that examiners must accept this new role. At this point, Baer talked briefly about privatization. He suggested we not complacently assume that the nature of the program will prevent privatizing the disability program. In fact, he pointed out that the National Security Council has had its work load legislatively moved to the private sector. He said that if the security of the nation can be privatized then disability can as well. And, this sort of transfer is being supported by all political parties and is not necessarily disapproved by the administration.

Another major issue discussed was technology. While not the solution to all our problems, having the newest IWS/LAN (Intelligent Workstation/Local Area Network) infrastructure will allow the analyst to be poised to deal with increasing work loads and changing work requirements. This technology is seen as one means to improve efficiency. Region X will be very supportive of requests for improving and expanding the use of technology in getting the job done. He suggested that we not be afraid of technology but view it as our friend and begin to push the systems staff to provide the hardware and software tools we need to get the job done.

The last major issue covered was the solvency of the program For the past 65 years, SSA has been the most successful program for Americans taking care of other Americans. However, including both disability and retirement costs, it is a very expensive program. Baer compared it to having a $300,000 life insurance policy, based on the benefits provided to the retired, disabled and survivors. We are currently putting more money in the bank than we are paying out in benefits, but that will not always be true. One we start paying out more than we are putting in, the fund will begin to drop and we will not be able to meet the payment obligations.

Redesign: Sue Roecker. Assistant Director of the Disability Process Redesign Team (DPRT)

Sue reviewed the changing environment that led to the need for redesign. Processing time was rising and pending work loads were growing both in the DDSs and in OHA. While the DDSs were able to increase productivity to meet the demands, sometimes at the expense of quality, OHA was never able to rise to the occasion and continued to fall further behind.

By 1993, the costs of the disability program were taking up more than 50 percent of the entire SSA budget, even though the disability program represents less than 50 percent of the SSA work load. Program costs (the amount it costs to process the claims) were ballooning to almost twice what they were in 1985. Looking at current trends, we have a blossoming CDR (Continuing Disability Review) work load. This year alone, we are processing more than twice as many CDRs as any previous year. By the year 2000, we can expect this to be ten times as high. Dire predictions from actuaries and others studying our system continued and redesign was born.

DCM (Disability Claim Manager - state DDSs began taking cases 5/11/98; federal DCMs will start in 8/98.

SDM (Single Decision Maker) - marginal but positive results have led to a second round of testing. Examiners feel empowered; medical consultants are addressing issues of the claims instead of completing paper work.

AO (Adjudication Officer) - looks good on paper; hasn’t worked as well in practice. Quality is good; productivity is creeping up.

Full Process Model includes a pre-decision interview, a written rationale, the AO. eliminates the reconsideration step, and eliminates the Appeals Council review from the process. Initial allowance rates are higher and the appeal rate has shown a modest decrease. Takes more time at the initial step, expected to cut the maximum time from filing to final decision to about 275 days. Currently, this can exceed 400 days!

DC Redeterminations, Mental Retardation, Learning, Cognitive and Communicative Disorders by Robert Henry, Ph.D.

Medical consultants Adele Reese, M.D. and Terrilee Wingate, Ph.D. from the Olympia WA DDS presented a discussion on the assessment of Cognitive and Communicative Disorders and its application in childhood redetermination claims.

Some helpful ideas from this presentation include the following:

It is useful to think of interrelated, overlapping domains reflecting three broad areas of cognition and communication: 1) Performance abilities, 2) Verbal abilities, and 3) Language speech and hearing.

There are many different etiologies for disorders in communication, including family, genetic, and neuroanatomic.

There is evidence that some communication disorders may be linked to abnormalities found on specific chromosomes. It is estimated that 5 to 10 per cent (or higher) of children exhibit identifiable speech and language disorders.

There is a high (as much as 60 per cent) co-morbidity with other childhood disorders such as Attention Deficit Disorder, Oppositional Defiant Disorder, Conduct Disorder, Anxiety Disorder, and Adjustment Disorder. In other words, it is likely that a child with a Cognitive/Communicative Disorder also manifests another disorder. The evidence suggests that Speech/Language disorders do change over time and are responsive to intervention. For this reason, testing should be within the past six months to be considered “current”.

Assessment of language disorder often provide separate assessments of impairment in expressive and receptive language. For our determination purposes, we should focus on the impairment in “total” language, including both of these. The assessment of nature and severity of articulation disorders has become particularly important.

An initial step in assessing cognitive and learning disorders is to determine whether or not the diagnosis of Mental Retardation is appropriate. If it is, this establishes the presence of a marked impairment.

In the absence of Mental Retardation, a marked cognitive impairment may still exist if data (including IQ and academic test scores) reflect the presence of a learning disorder (achievement test scores significantly below age, IQ, and grade levels).