2013 Annual Report of the SSI Program

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D. HISTORICAL REDETERMINATION AND CONTINUING DISABILITY REVIEW DATA
1. Redeterminations
Redeterminations are reviews of all of the nonmedical factors of eligibility to determine whether a recipient is still eligible for Supplemental Security Income (SSI) and still receiving the correct payment amount. There are two types of redeterminations: scheduled and unscheduled. All recipients are subject to periodic scheduling for a redetermination. Every year the Social Security Administration (SSA) schedules redeterminations for the cases most likely to have payment error, but the agency can also schedule reviews for cases unlikely to have payment error. SSA completes unscheduled redeterminations on an as-needed basis when recipients report, or we discover, certain changes in circumstances that could affect the continuing SSI payment amount. The numbers of redeterminations completed fluctuate from year to year due to variation in: (1) the numbers of unscheduled redeterminations completed; and (2) the numbers of scheduled redeterminations that we are able to complete during the fiscal year because of limitations on administrative resources and the impact of other workload requirements on the field offices. Redeterminations that we cannot complete in the scheduled fiscal year carry over into the next fiscal year.
Between scheduled redeterminations, SSA uses the limited issue process to detect situations that have the potential to affect the continuing eligibility of SSI recipients and SSI payment amounts. SSA conducts periodic computer matches between its own systems and the systems of other Federal and State agencies to determine if the income and resources information on SSI recipients’ records conflicts with data that we obtain from the other systems. We post an indicator to the individual’s Supplemental Security Record when a match detects conflicting information. We select these limited issue cases for field office review of the issues for which we posted indicators. Beginning in fiscal year 2007, SSA included limited issue completions with redetermination completions.
Table V.D1 provides historical data on numbers of redeterminations and limited issues by fiscal year.
 
Table V.D1.—SSI Redeterminationsa and Limited Issues Completed, Fiscal Years 1986‑2012
c  1,900
d 1,597
e 1,725
e 1,071
e 692
e 900
e 1,390
f 2,223
f 234
f 2,457

a
Effective fiscal year 2007, total redeterminations reported by SSA include limited issues.

b
Data not available.

c
Decrease in number of redeterminations completed in fiscal year 1994 due to low-error profile redeterminations not being completed from January through September 1994.

d
Effective fiscal year 1995, we selected approximately 200,000 fewer redeterminations annually due to a change from a 3-year to a 6-year redetermination cycle for low-error profile cases.

e
We selected fewer redeterminations in fiscal years 2005-09 due to limitations on administrative funding.

f
Includes redeterminations completed during the 53 operating weeks in fiscal year 2011.

2. Continuing Disability Reviews
Following enactment of the Social Security Disability Amendments of 1980, section 221(i) of the Social Security Act generally requires SSA to review the continuing eligibility of Old-Age, Survivors, and Disability Insurance (OASDI) disabled beneficiaries at least every 3 years. No legislation required the same review process for disabled SSI recipients at that time. Although the Committee on Finance of the Senate stated in its report on this legislation that the same continuing disability review (CDR) procedures should apply to both the OASDI and SSI programs, no new legislation amended Title XVI to accomplish this. Section 1614(a)(4) of the Act gives SSA discretionary authority to conduct periodic CDRs on SSI recipients. On September 28, 1994, SSA issued a Federal Register notice that periodic SSI CDRs would begin on October 1, 1994. In 1994 and again in 1996 Congress enacted new legislation adding some mandates for CDRs under the SSI program.
Public Law 103-296 required SSA to conduct CDRs on a minimum of 100,000 SSI recipients during each of fiscal years 1996, 1997, and 1998. In addition, during the same period, the law required SSA to redetermine the eligibility of at least one-third of all SSI child recipients who reached age 18 after April 1995 within one year of attainment of age 18. Such redeterminations for persons turning age 18 could count toward the 100,000 CDRs required by the law.
Public Law 104-193 required SSA to redetermine the eligibility of all SSI child recipients who attain age 18 based on the adult initial eligibility criteria. This law also required that SSA perform a CDR:
Public Law 105-33 provided SSA some additional flexibility in the scheduling of these categories of CDRs.
Beginning in 1993, SSA developed a screening process for OASDI cases scheduled for a CDR in order to handle the large CDR workload mandated by these various provisions. The screening process included a mailer questionnaire for selected cases. In 1996, SSA extended the profiling process to SSI adults who were scheduled for a CDR. In fiscal year 2012, we deferred full medical reviews for 392,960 adult SSI recipients scheduled for a CDR as a result of the screening process.
In 2007, SSA implemented a streamlined failure to cooperate (FTC) process for medical CDRs. Under this process, recipients who fail to comply with the field office requests for information necessary for processing their medical CDRs have their benefits suspended. After 12 consecutive months of suspension for noncompliance, SSA terminates their eligibility for disability benefits. SSA initially terminated 1,134 centrally-initiated medical CDRs involving SSI recipients in fiscal year 2012 as a result of the streamlined FTC process.
For individuals who receive both OASDI and SSI benefits on the basis of their own disability, SSA initiates CDRs as Title II CDRs, and the results of the review affect eligibility for benefits under both programs.1 Table V.D2 presents the numbers of centrally-initiated periodic medical CDRs of SSI recipients we performed under Titles II and XVI since 1993. Tables V.D3 and V.D4 present the latest available detailed results2 on CDRs of SSI recipients performed in the most recent 15 years.3 These tables include only cases for which we conducted a full medical review. In particular, they do not include:
Administrative closures — cases for which we curtail development for technical reasons;
Miscellaneous other CDRs processed by the State disability determination services (DDS) but not as part of the normal CDR scheduling process (such as voluntary and third-party reports of medical improvement, post-transplant end-stage renal disease cases, and rehabilitation reports).
In contrast with the allowance data presented in section V.C, we tabulate the CDR data on a cohort basis by the date of initial decision.
 
Fiscal year of
initial DDS
decision
Total full medical reviews
Reviews of concurrent Title II/XVI cases initiated under Title II
Title XVI initiated reviews
Reviews of low-birth-weight children
All other reviews of SSI disabled children
Total SSI children reviews
a

a
Fewer than 500.

 
Table V.D3.—SSI Disabled Adult Reviews: Dispositiona of Continuing Disability Medical Reviews by Year of
Initial Decision and Level of Decision, Fiscal Years 1998-2012
Fiscal year of
initial DDS
decisionb
Total initial
DDS decisions  
 
Table V.D3.—SSI Disabled Adult Reviews: Dispositiona of Continuing Disability Medical Reviews by Year of
Initial Decision and Level of Decision, Fiscal Years 1998-2012 (Cont.)
Fiscal year of
initial DDS
decisionb
Appeals  to  beyond 
reconsideration
Table V.D3.—SSI Disabled Adult Reviews: Dispositiona of Continuing Disability Medical Reviews by Year of
Initial Decision and Level of Decision, Fiscal Years 1998-2012 (Cont.)
Fiscal year of
initial DDS
decisionb
Total initial
decisions
Cessations
pending an
appeal decision
Cessations
with no
appeal pending
Cessations
pending an
appeal decision
Cessations
with no
appeal pending
a Data reflect results as of February 2013. The ultimate numbers of continuations and cessations are subject to change until all appeals are final.
b For years prior to 1998 see the most recent Annual Report of Continuing Disability Reviews.
c Percentage of decisions at this level.
d Percentage of cessations at this level appealed to next level.
e We do not reflect the status and disposition of cases in the Federal courts here. However, we have included information on the status and disposition at the Office of Disability Adjudication and Review (ODAR) for cases remanded to us by the courts. The excluded experience in the Federal courts has a minimal impact on the number of cont­inuations.
f Number of persons appealing beyond the reconsideration level.
g Less than 0.05 percent.
 
Table V.D4.—SSI Disabled Child Reviews: Dispositiona of Continuing Disability Medical Reviews by Year of
Initial Decision and Level of Decision, Fiscal Years 1998-2012
Fiscal year of
initial DDS
decisionb
Total initial
DDS decisions