Commissioner Barnhart's Testimony at the Joint Hearing of the House Ways and Means Committee's Subcommittees on Social Security and Human Resources
Regarding Her Proposal to Improve the Disability Determination Process
September 30, 2004
Mr. Chairman and Members of the Subcommittees:
It is a real pleasure to appear before these two subcommittees today to discuss my approach to improving the Social Security disability determination process. I always welcome the opportunity to appear before you because I so greatly appreciate your ideas and insights as well as your consistent support for our agency. And I am doubly pleased to be here today because it was before you that I first described my vision for an improved disability system.
Today I would like to update you on how we are proceeding to convert my approach into a detailed plan and, ultimately, into an effective process to make the right decision as early in the process as possible.
I know that these subcommittees are painfully aware of the length of time claimants have to wait for an initial determination or an appeal. And delays in the current system occur in spite of the best efforts of the dedicated public servants in SSA and in the state Disability Determination Services (DDS), who are such a vital part of the agency's work. In fact, when I talk about SSA employees, I also refer to those who work in the Disability Determination Services, or DDSs.
Where We Are Now
We have moved forward in several areas:
- We are implementing the electronic disability process, which provides the infrastructure needed to support the new approach.
- We have conducted a massive outreach effort to obtain comments on the current system and the new approach and are giving thoughtful consideration to all of them.
- We are conducting an exhaustive study of all the issues. The Disability Service Improvement staff, or DSI, located organizationally in my immediate office, is coordinating this effort, making sure that we have all the information we need to make decisions.
Before I go any further, let me emphasize that the new approach is just that-an approach or an outline. I have made no final decisions on how to implement it. Everyone I speak with understands the urgency of the need to improve the disability process. But because this is such an important program, and because it is so complex, I needed to take the time to listen to people involved at all stages of the process, both outside of and within SSA.
I have made an active personal role in this process one of my highest priorities. For example, I have personally participated in more than 40 meetings with more than 30 organizations involved in the disability process-within SSA and outside the agency. Among the hundreds and hundreds of comments we received were more than 500 comments on our website from individuals, many of them disability claimants or recipients.
Elements of the New Approach
As I said a moment ago, the new approach is designed to make the right decision as early in the process as possible. Another major purpose is to encourage return to work at all stages of the system. I made a decision early on, to focus on those steps that we can implement through regulation rather than legislation.
The approach preserves some of the significant features of the current system. Initial disability claims will continue to be handled by SSA's field offices; DDSs will continue to adjudicate claims for benefits; and Administrative Law Judges (ALJs) will continue to conduct de novo hearings and issue decisions.
But there also are a number of important changes to the current system:
- A "Quick Decision" step at the earliest stages of the claims process for people who are obviously disabled would allow their claims to be decided within 20 days.
- Medical expertise within Expert Review Units would be available for decision makers at all levels of the process, including DDSs and the Office of Hearings and Appeals (OHA).
- The DDS reconsideration step would be eliminated.
- A Reviewing Official (RO) position would be created within SSA to evaluate claims appealed from the DDS. The RO could allow a claim or agree with the DDS decision.
- The Appeals Council step would be eliminated. The ALJ decision would be the agency's final action, unless the case was selected for review by an Oversight Panel of ALJs and an AAJ.
The lynchpin of quality assurance under the new approach is accountability and feedback at each level of the process. At all levels, the quality process would focus on denials as well as allowances, and concentrate on ensuring that cases are fully documented at each stage. This last point is crucial because I believe that better documentation will allow cases to move through the system more quickly and will produce better decisions.
The new approach would be workable only when SSA's electronic disability system-which we call e-Dib-is fully functional so that a claimant's file could be accessed by those working on the case anywhere in the nation. I'll discuss that in more detail a little later.
We also are working on several demonstration projects to encourage voluntary return to work. I believe these projects will let us learn a great deal about how to expand beyond the incentives in the Ticket to Work program that your Committee was so instrumental in creating.
Reaction to the New Approach
I began my presentation by describing our outreach to hear the full spectrum of views and concerns from those who are involved at every step of the process. Generally, the approach has been well received.
Certainly, there are issues on which there is not consensus. For example, the two most common comments we have received on the Reviewing Official step are that the reviewing official does not need to be an attorney and that the reviewing official absolutely should be an attorney. But every group I've talked to agrees that the current system needs to be changed.
I want to thank everyone who is giving us the benefit of their views and sharing their concerns. The comments we received have been extremely valuable and have definitely shaped my thinking. Many of the decisions will not be easy because there are multiple considerations for each issue.
For example, when I developed the new approach, I envisioned Regional Expert Review Units to provide specialized medical and vocational expertise for each step of the process. A number of organizations and individuals have raised excellent questions about how these units would work-questions such as:
- How to ensure that DDSs can access the medical expertise they need;
- How these units should be staffed;
- How to use specialized experts in cases of multiple disabling conditions; and
- How experts in these units will relate organizationally to the DDSs and OHA.
Similarly, there is a wide range of views as to where responsibilities for Quick Decisions should reside. The new approach calls for field offices to send them to the Expert Review Units immediately after taking the application. Virtually everyone we've talked to thinks the idea of a quick decision process for the obviously disabled is a good idea. My idea was to allow DDSs to concentrate more on difficult cases by removing the obvious cases from their workload. But we've heard from a number of parties who think the DDSs should handle the Quick Decision process.
Eliminating the Appeals Council is another element of the new approach that has generated a large number of comments. Advocacy groups have expressed concern about the effects of such a step-especially because it means closing the record after the ALJ decision. These groups have suggested that there should be a provision for good cause exceptions.
On the other hand, others fear that eliminating the Appeals Council could lead to significantly more cases being appealed to Federal court, and, thus, overwhelming the court system.
I cannot tell you how I will resolve these issues because I have not made decisions. My task is to put together a cohesive package in which every element of the process contributes to its effectiveness and removes obstacles to our goal to make the right decision as early in the process as possible.
I expect to make decisions relatively soon on the major issues so that we can put together a proposed rule on the new approach by early in calendar 2005.
Of course, the draft proposed rule will be available for public comment. I expect that we will receive many comments that will be very helpful. And I will look forward to the opportunity to hear your views.
Advancements in Systems Technology
When I first described my new approach to you, I said that it would require having the Electronic Disability System that we call eDIB fully implemented and in operation long enough for us to identify and address any startup problems. The new approach to disability claims processing can work efficiently only when all components involved in disability claims adjudication and review move to an electronic business process through the use of an electronic disability folder.
I am pleased to say that eDIB is right on schedule.
As you know, SSA field offices throughout the agency are now using the Electronic Disability Collect System (EDCS) that provides DDSs an electronic folder. In the DDSs, we rolled out eDIB in January 2004 starting in Jackson, Mississippi, and implementation has begun in 14 states. We expect this process to be complete by June 2005.
The Office of Hearings and Appeals (OHA) has begun using the new Case Processing and Management System. CPMS is a new software system for processing cases and managing office workloads in the OHA. CPMS is a replacement system and will provide OHA with the ability to work with the electronic file.
When these electronic processes are fully implemented, each component will be able to work claims by electronically accessing and retrieving information that is collected, produced and stored as part of the electronic disability folder. This will reduce delays that result from mailing, locating, and organizing paper folders.
I know that moving to eDIB poses significant challenges for the employees at SSA who are involved at all levels. And I want to publicly thank them for their dedication and hard work that is making eDIB a success.
I'd like once again to thank Chairman Shaw, Chairman Herger and the members of these subcommittees for their support and guidance. I look forward to working with you and your staffs as we continue our mutual efforts to improve the service provided to disabled individuals and their families.