National Association of of Disability Examiners
Senate Finance Committee Subcommittee on Social Security and Family Policy
by Debi Gardiner, NADE President
July 7, 1998
NADE is a professional association whose membership includes disability examiners, physicians, support staff and administrators who are employed in the state Disability Determination Service (DDS) agencies. The DDSs have responsibility for adjudicating Social Security and Supplemental Security Income (SSI) disability claims. Our membership also includes physicians, psychologists and other professionals not in the DDSs (including federal employees) who work with and are interested in the disability program. We believe the diversity of our membership and our experience in working directly with the disability program–and with the applicant — provides us with a unique understanding of this program. It is our members who are responsible for making the system work efficiently and effectively, serving both the claimant/beneficiary and the taxpaying public.
On several occasions, in previous testimonies and in correspondence with the Social Security Administration, NADE has expressed concern that the SSI program for children with disabilities may not necessarily be serving the best interest of these children. (Our January 1995 Position Paper on this subject is attached.) Children with disabilities represent some of the most vulnerable members of our society. They need, and deserve, assistance beyond that needed by the general public. NADE strongly supports actions taken by Congress in providing assistance to these children and their families. Any such assistance, however, must serve the best interests of the individuals involved. We are concerned that many children were being labeled “disabled” and were receiving checks who did not have a severe impairment. We have expressed concern that this practice may actually be harming the very population it was intended to help.
NADE strongly supported those provisions in the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (PRWORA) which established a new and stricter definition of disability for children and which required the representative payee to present evidence that the child is, and has been, receiving appropriate treatment. Many children were awarded benefits as a result of the less restrictive standard of eligibility created by the 1990 Zebley Supreme Court decision. Congress wisely tightened that standard in the 1996 legislation. As a result, approximately 288,000 children who were receiving benefits had their claims reviewed to determine if they continued to meet the new standard. We support the redetermination process as an effort to insure the integrity of the disability program.
The PRWORA was signed by the President on August 22, 1996 and the reviews were to be completed by August 22, 1997. Unfortunately, instructions for these redeterminations were delayed until February 1997. At that time DDSs throughout the country were hit with a tidal wave of childhood claims with only a six month window in which to complete the reviews. These cases were given top priority and the DDSs worked overtime to complete the reviews as quickly and as accurately as possible. Our efforts were hampered by the fact that training instructions and notices were often received in a piecemeal fashion. When it became clear that the DDSs could not complete the redeterminations within the mandated time frame, SSA requested a six month extension. This was granted and the DDSs were given until February 1998 to complete the redeterminations.
Advocates have been critical of the redetermination process. News articles and other public statements have often conveyed the impression that this workload was completed in a hasty manner with emphasis on meeting mandated time frames at the expense of accuracy, and that severely disabled children lost benefits without due process or appropriate evaluation. NADE disagrees. The efforts of the DDSs to process this workload in a timely and accurate manner, despite the challenges they faced in doing so, were recognized by Commissioner Apfel following his “top to bottom” review and by the General Accounting Office.
NADE is committed to the goal that disabled individuals, children and adults, should receive fair and timely decisions on their claims for disability benefits. At the same time, we will continue our efforts to insure the integrity of the disability program.
Anecdotal evidence suggests that many of the children whose claims were reviewed were not receiving appropriate treatment. In the absence of treating source evidence, we must rely on purchased consultative examinations. These appointments, scheduled by the DDS, were frequently not kept and often several appointments were missed. At the appeals level, Hearing Officers report similar experience with missed appointments and instances of lack of cooperation from parents and guardians.
While we do not believe there were widespread errors of significant problems with the initial redetermination process, we do agree with Commissioner Apfel that actions above and beyond those normally taken are appropriate to ensure that children with disabilities receive a fair and accurate decision. However, while we supported taking a second look at some of these claims we found the instructions for processing these to be unclear, sometimes contradictory and often unrealistic. Resources — including appropriate staff, clear and timely instructions, and a meaningful Quality Review process — are essential to the success not only of the redetermination process but of the disability program as a whole.
Children are our future. They should not be political pawns. Congress and the Social Security Administration must take what ever actions are necessary to insure that the SSI childhood program is administered fairly and appropriately. While NADE believes that severely disabled children should receive benefits, we are concerned that some children may not be encouraged to reach their full potential because they have been labeled “disabled”. Such disincentives serve neither society nor the individual.
Again, thank you for allowing us this opportunity to present testimony.