Chairman Shaw, Chairwoman Johnson and members of the Subcommittees, on behalf of the members of the National Association of Disability Examiners (NADE), thank you for this opportunity to comment on current and future service delivery challenges that the Social Security Administration is facing in the 21st Century.
NADE is a professional association with a diverse membership and a strong commitment to the viability of the Social Security and Supplemental Security Income disability programs.. Although the majority of our members are disability examiners, quality assurance and public relations personnel, hearing officers, physicians, administrators and support staff employed in the state Disability Determination Service (DDS) agencies, our membership also includes Social Security claims representatives, physicians, psychologists, attorneys, advocates, representatives from private insurance companies, and other professionals not in the DDSs who work with, and are interested in, the evaluation of disability claims. Many of our members have been, or are currently, involved in testing the process changes envisioned in SSA’s Disability Redesign initiative. It is the diversity of our membership, as well as our experience working directly with the Social Security and SSI disability programs, which provides us with a unique perspective and understanding of those programs and the public they serve. We understand the importance of the Social Security Administration’s service to the public and the issues which must be addressed in order to maintain and improve that service.
Those of us who have worked with the Social Security and Supplemental Security Income programs for even a short time have seen enormous increases in the complexity of the issues involved in administering these programs. We do not expect that to change. In fact, many of the Disability Redesign initiatives, while simplifying the process for the claimant, have increased the responsibilities of the adjudicator and the complexity of the decision making process. The redefined role of the disability adjudicator now encompasses responsibilities and tasks previously performed by the medical consultant and have significantly increased the scope of their duties. Legislative initiatives, court decisions and an aging, and increasingly diverse, population will further increase the complexities of these programs. It is imperative that Congress act now to ensure that resources are available to meet the challenges ahead.
The Social Security Advisory Board, in their September 1999 Report noted, “The responsibilities of the Social Security Administration in serving the public are numerous and complex.” These responsibilities include:
· Issuing Social Security numbers · Maintaining wage records · Determining eligibility for OASDI benefits · Determining eligibility for SSI · Keeping up with changes in beneficiary circumstances (postentitlement changes) · Delivery of related beneficiary service · Providing public information · Developing program policy · Resolving disputes
Despite the continued increase in the number and complexity of the programs administered by SSA, the Advisory Board’s September 1999 report documents the dramatic decline in SSA staff. The impact of this “downsizing” on service delivery cannot be overemphasized. Continued budget reductions will only serve to further erode public service and public confidence in the Social Security program.
Robert J Myers, former Chief Actuary and Deputy Commissioner of Social Security, in his March 5, 1992 testimony before the Subcommittee on Social Security stated:
“Unfortunately, in recent years, the various services provided by the Social Security Administration have deteriorated somewhat. This, in my opinion, has been due to inadequate funds being made available for administrative expenses – and not to the lack of zeal or ability on the part of the administrators. …. Proper administration of an insurance system – whether social insurance or private insurance — requires that administrative expenses should be neither too low nor too high. In the latter case, the funds available for benefits would be eroded. In the former case, inadequate service would be provided. In fact, in some instances weak administration could mean improperly excessive benefit payments due to fraud and abuse. ”
The need for appropriate -and adequate-funding for administrative expenses described in Mr. Myers’ 1992 testimony remains true today and provides a framework for the proper administration of Social Security’s insurance programs. The programs administered by the Social Security Administration touch the lives of every American. It is irresponsible to have an Agency this important be underfunded and understaffed. We echo the Advisory Board’s belief that, “It is entirely appropriate that spending for administration be set at a level that fits the needs of Social Security’s taxpayers and beneficiaries rather than at an arbitrary level that fits within the government’s overall discretionary spending cap.” The State DDSs have historically met the challenges posed by limited resources and increased program demands. But there is a cost to that achievement and a limit to how long it can be sustained. NADE has consistently expressed the need for adequate resources, including funding, staffing, training and clear and timely operating instructions. While we recognize that funds for government programs are limited we believe that if spending for administrative costs is not sufficient to ensure accurate decisions and maintain program integrity, to obtain quality medical evidence to document disability claims and to combat fraud and abuse, then program costs will increase. It is far better to invest in an adequate and well trained staff that will ensure that those who deserve benefit payments receive them, and receive them in a timely manner, and that those who do not deserve benefit payments do not get them. It is far better to invest in the quality of service delivery and to see that quality of service reflected in how SSA is able to meet the expectations of its constituents, than to acknowledge that quality public service comes at too high a cost, and contribute to further erosion of the public’s confidence in the service they receive from their government. We concur with the recommendation in the September 1999 Advisory Board report that improvements in the disability process should remain a priority of the agency and we strongly support the five priority measures described in their August 1998 report:
· Development and implementation of an ongoing joint training program for all adjudicators; · Development of a single presentation of disability policy that is binding on all decision makers, including the updating of medical listings and vocational standards; · Development and implementation of a quality assurance system to unify the application of policy throughout the disability determination system; · Improvement in the quality of medical evidence that is used in determining disability claims; and · Development and implementation of a computer system that will provide adequate support to all elements of the disability claims process.
All of these require adequate resources, including funding and staffing.
Ongoing, joint training is needed, both to address the increased complexity of the issues involved in the development and adjudication of claims, and to improve the quality of the decision. NADE has consistently stressed, both to Congress and to the Social Security Administration, the need for ongoing training. In our October 1999 testimony prepared for thes Subcommittees we stated:
The Telecenters and Field Offices are the first point of contact for most disability applicants. While disability is a relatively small part of their workload the quality of the completed application at this level can have a significant impact on the efficiency with which the claim is processed at the DDS level. It is important, then, that these components work together to provide quality service to all applicants. To do this requires ongoing communication and an emphasis on teamwork. Unfortunately, communication between the Field Offices and the DDSs was severely curtailed with the workforce reductions in the 1980s. Efforts to increase communication between all components have recently been initiated and these efforts must be maintained. This, again, will require adequate staffing levels and coordinated training initiatives. SSA must invest in the training of its personnel to insure that those who take the applications for disability benefits, as well as those who adjudicate the claims, have the necessary skills and knowledge to do so. ….Ongoing training is important; joint training is essential.”
It is also essential that the initiatives to increase communication between components be continued. Again, this cannot happen without adequate resources.
In 1999 Congress passed the Ticket to Work and Work Incentives Improvement Act. This legislation assures that more Americans with disabilities will have an opportunity to participate in the workforce and lessen their dependence on public benefits. NADE supported this legislation and we applaud this Congressional initiative. However, while the actual impact of this legislation on Field Office and DDS staff and resources remains unknown, it is clear that additional resources, including staffing and training, will be needed. Other congressional initiatives, as well as Circuit Court and Supreme Court decisions, have had a significant impact on our workloads. As the complexity of the programs we administer increases so does the need for ongoing training. Unfortunately, staff reductions and budget cuts reduce SSA’s ability to conduct training at the very time that more is needed.
In addition to ongoing, joint training, NADE has long stressed the need for a single presentation of disability policy that is binding on all decision makers. This must be an agency priority if the Social Security Administration is to insure consistency in the decision making process and restore public confidence in the program. However, this cannot be accomplished without a strong, consistent and inclusive quality assurance system.
SSA’s quality review process has a significant ability to shape disability policy through subtle messages imparted by tighter or looser reviews, by the kinds of decisions that are selected for review or even by increasing or decreasing the size of the review sample. A strong, consistent and inclusive quality assurance system, with the review process applied in a similar manner to decisions made by the DDSs and by OHA, can be a major factor in assuring that program policy is implemented in a manner that is consistent, fair and nationally uniform.
A single presentation of disability policy and a strong, consistent and inclusive quality review process will promote uniformity in the decision making process. Quality decisions, however, require quality (complete, detailed and descriptive) medical evidence. Changes in the physician/ patient relationship and in the way medical records are maintained and stored have impacted on our ability to obtain the medical evidence which is the backbone of any disability decision. To address these issues, and to improve the quality of the medical evidence received, we must increase our outreach to the medical community and provide appropriate reimbursement for the information received. However, as the DDSs face severe budget cuts they are being asked to reduce expenditures for medical evidence. Quality decisions rely on quality medical evidence. If administrative funding is not available to obtain that evidence, program costs will undoubtedly increase.
NADE recognizes the value of technology and computer support and urges continued development in this area. However, we would echo the Advisory Board’s statement that the Disability Insurance and SSI workloads “….are highly labor intensive and do not lend themselves readily to significant savings though systems improvements.” Computers cannot replace people in these areas.
In an effort to improve efficiency and increase public service, in1994 the Social Security Administration issued its plan to redesign the disability claims process. This new process (prototype) is now being tested in 10 states. NADE supports the testing of this prototype although we continue to have reservations about some aspects of the new process. We have voiced these reservations to both Congress and the Social Security Administration. We are not convinced that the new process will improve efficiency, provide better service to our customers or increase public satisfaction. We hope that the prototype will produce sufficient data to clearly establish which aspects of this new process will work and which ones will not. We urge extreme caution, however, before full national implementation of this process, which eliminates the reconsideration level of appeal, until the necessary and well tested changes have been made at the OHA level of appeal that will produce some degree of assurance that OHA is equipped to handle the increase in the number of appeals. NADE believes that if SSA were to adopt the single presentation of policy, ongoing joint training and changes in the quality assurance process, the quality of service provided to its customers will be greatly enhanced and provide support for the new disability claims process.
Finally, we believe that any action taken by Congress to improve the Social Security Administration’s service to the public should include the elimination of the five month waiting period for Title II applicants. Currently Title II disability beneficiaries must wait five full calendar months from the onset of their disability before they can begin receiving cash benefits. Title XVI (SSI) beneficiaries, on the other hand, can begin receiving benefits immediately. This fosters a perception that the Title II program is unfair to the disabled worker who has actually paid into the system. This is particularly evident in cases involving claimants with terminal illnesses. Many of these claims are closed by the DDSs as “no decision” cases due to the fact that the claimant died during the waiting period. NADE’s Position Paper on this subject has been previously shared with the Social Security Administration and with members of this Subcommittee. We have been encouraged by recent actions by the Congress and by SSA to address many issues that deal with the public’s confidence in the disability program and the public’s perception of “fairness” between the two disability programs. NADE strongly urges Congress and SSA to work together to produce legislation that will eliminate, or significantly reduce, the waiting period. We offer the expertise of our membership to assist in this effort.
Again, thank you for allowing NADE this opportunity to comment.