2010 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 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 SSA schedules for redetermination the cases most likely to have payment error, but even cases unlikely to have payment error can also be scheduled for review. Unscheduled redeterminations are completed 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 are subject to some year-to-year fluctuation because of variation in the numbers of unscheduled redeterminations completed and in the numbers of scheduled redeterminations that were completed during the fiscal year due to administrative resource limitations and the impact of other workload requirements on the field offices. When redeterminations cannot be completed in the fiscal year scheduled, they are carried over into the next fiscal year .
During periods 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 is in conflict with data obtained from the other systems. Matches detecting conflicting information usually result in the posting of an indicator to the Supplemental Security Record of the SSI recipient. The limited issue case is then selected for a field office review of the issue for which the indicator was posted. 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 completed by fiscal year.
 
Table V.D1.—SSI Redeterminationsa and Limited Issues Completed, Fiscal Years 1986‑2009
c  1,900
d 1,597
1,773
e1,725
e1,071
e 692
 1,039
e  900
 1,221
e1,390
aEffective fiscal year 2007, total redeterminations reported by SSA include limited issues.
bData not available.
cDecrease in number of redeterminations completed in fiscal year 1994 due to low-error profile redeterminations not being completed
from January through September 1994.
dEffective fiscal year 1995, approximately 200,000 fewer redeterminations were selected annually due to a change from a 3‑year to a
6-year redetermination cycle for low-error profile cases.
eFewer redeterminations were selected in fiscal years 2005-09 due to limitations on administrative funding.
 
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 title II disabled beneficiaries at least every 3 years. A similar requirement was not put in place at that time for disabled title XVI recipients. Although the Committee on Finance of the Senate stated in its report on this legislation that the same continuing disability review (CDR) procedures should be applied with respect to both the title II and title XVI programs, title XVI was not amended 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 legislation was enacted adding some mandates for the performance of CDRs under the SSI program.
Public Law 103-296 specified that during each of fiscal years 1996, 1997, and 1998, SSA was required to conduct CDRs on a minimum of 100,000 SSI recipients. In addition, during the same period, SSA was required to redetermine the SSI eligibility of at least one-third of all SSI child recipients who reached age 18 after April 1995 during the 1-year period following attainment of age 18. Such redeterminations for persons turning age 18 could count toward the 100,000 CDR requirement.
Public Law 104-193 extended the requirement of redetermination of SSI eligibility to all SSI child recipients who reach age 18, with such redetermination being based on the adult eligibility criteria. This law also added the requirement that a CDR be performed:
Not later than 12 months after birth for recipients whose low birth weight is a contributing factor material to the determination of their disability unless the Commissioner determines that the impairment is not expected to improve within 12 months of the child’s birth.
Public Law 105-33 gave SSA some additional flexibility in the scheduling of these categories of CDRs.
In order to handle the large CDR workload mandated under these various provisions, SSA developed, beginning in 1993, a process by which certain title II cases scheduled for a CDR would be screened using the results of a profiling process which included a mailer questionnaire for some cases. In 1996 the profiling process was extended to title XVI adults who were scheduled for a CDR. In fiscal year 2009, the screening process resulted in the deferral of full medical reviews for 355,789 cases for which a scheduled CDR involving title XVI recipients was processed. 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. Subsequently SSA terminated their eligibility for disability benefits after 12 consecutive months of suspension for noncompliance. The streamlined FTC process resulted in the initial termination of 440 centrally-initiated medical CDRs involving title XVI recipients in fiscal year 2009.
For cases involving individuals who receive both title II and title XVI benefits, CDRs are initiated as title II CDRs with the results of the review affecting eligibility for benefits under both programs. Tables V.D2 and V.D3 present the latest available summary of results1 on CDRs of title XVI recipients performed under titles II and XVI since 1993. These tables include only cases for which a full medical review was conducted. In particular they do not include:
Miscellaneous other CDRs processed by the State 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 vocational rehabilitation reports).
In contrast with the allowance data presented in section V.C, the CDR data is tabulated on a cohort basis by the date of initial decision.
 
Table V.D2.—SSI Disabled Adult Reviews: Dispositiona  of Continuing Disability Medical Reviews by Fiscal Year of
Initial Decision and Level of Decision
Fiscal year of
initial DDS
decision
Total initial
DDS decisions  
 
Table V.D2.—SSI Disabled Adult Reviews: Dispositiona  of Continuing Disability Medical Reviews by Fiscal Year of
Initial Decision and Level of Decision (Cont.)
Fiscal year of
initial DDS
decision
Appeals  to  beyond 
reconsideration
 
Table V.D2.—SSI Disabled Adult Reviews: Dispositiona  of Continuing Disability Medical Reviews by Fiscal Year of
Initial Decision and Level of Decision (Cont.)
Fiscal year of
initial DDS
decision
Total initial
decisions
Cessations
pending an
appeal decision
Cessations
with no
appeal pending
Cessations
pending an
appeal decision
Cessations
with no
appeal pending
aData reflect results as of February 2010. The ultimate numbers of continuations and cessations are subject to change until all appeals are final.
bPercentage of decisions at this level.
cPercentage of cessations at this level appealed to next level.
dThe status and disposition of cases in the Federal courts are not reflected here. However, for cases remanded by the courts to SSA, the status and disposition at ODAR are included. The excluded experience in the Federal courts has a minimal impact on the number of cont­inuations.
eNumber of persons appealing beyond the reconsideration level.
fLess than 0.05 percent.
 
Table V.D3.—SSI Disabled Child Reviews: Dispositiona  of Continuing Disability Medical Reviews by Fiscal Year of
Initial Decision and Level of Decision
Fiscal year of
initial DDS
decision
Total initial
DDS decisions 
 
Table V.D3.—SSI Disabled Child Reviews: Dispositiona  of Continuing Disability Medical Reviews by Fiscal Year of
Initial Decision and Level of Decision (Cont.)
Fiscal year of initial DDS decision
Appeals  to  beyond 
reconsideration
 
Table V.D3.—SSI Disabled Child Reviews: Dispositiona  of Continuing Disability Medical Reviews by Fiscal Year of
Initial Decision and Level of Decision (Cont.)
Fiscal year of
initial DDS
decision
Total initial
decisions
Cessations
pending an
appeal decision
Cessations
with no
appeal pending
Cessations
pending an
appeal decision
Cessations
with no
appeal pending
aData reflect results as of February 2010. The ultimate numbers of continuations and cessations are subject to change until all appeals are final.
b Percentage of decisions at this level.
c Percentage of cessations at this level appealed to next level.
dThe status and disposition of cases in the Federal courts are not reflected here. However, for cases remanded by the courts to SSA, the status and disposition at ODAR are included. The excluded experience in the Federal courts has a minimal impact on the number of con­tinuations.
eNumber of persons appealing beyond the reconsideration level.
fLess than 0.05 percent.

1
The numbers of SSI recipients whose benefits are ceased as a result of CDRs are included in these tables. Estimates of Federal SSI program savings resulting from the cessation of benefits are reported to Congress in the Annual Report of Continuing Disability Reviews. The most recent such report was issued December 22, 2009, presenting estimates of the effects of CDRs conducted in fiscal year 2008.


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