Social Security Disability:

Improvements Needed to Continuing Disability Review Process

HEHS-97-1: Published: Oct 16, 1996. Publicly Released: Oct 29, 1996.

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Pursuant to a congressional request, GAO provided information on how to improve the Social Security Administration's (SSA) continuing disability reviews (CDR) process for Disability Insurance (DI) and Supplemental Security Income (SSI) beneficiaries, focusing on: (1) the number and characteristics of individuals who are due for CDR; (2) how SSA selects individuals for and conducts CDR; (3) whether available resources are adequate for conducting required CDR; and (4) potential options for improving the CDR process.

GAO found that: (1) about 4.3 million DI and SSI beneficiaries are due or overdue for CDR in fiscal year 1996; (2) SSA selects beneficiaries for CDR on the basis of the likelihood that their benefits will be terminated; (3) SSA plans to improve its CDR selection process by obtaining Medicare and Medicaid data and mailing questionnaires to beneficiaries' physicians; (4) funding for CDR could exceed $4 billion by 2002; (5) SSA must incorporate additional CDR required by legislation into the agency's workload and conduct CDR for beneficiaries whose CDR were previously done at the agency's discretion; (6) SSA should conduct CDR on a random sample of beneficiaries normally excluded from the selection process to improve program integrity; (7) SSA proposal for time-limited benefits may increase the agency's workload when beneficiaries who are terminated from the program reapply for benefits; (8) the formula used by SSA to select beneficiaries for CDR excludes approximately half of those who are due or overdue for CDR; and (9) SSA could utilize CDR to strengthen its return-to-work initiatives.

Recommendations for Executive Action

  1. Status: Closed - Not Implemented

    Comments: SSA disagreed with the recommendation regarding specific changes to the CDR process. SSA believes that its redesigned CDR strategy will result in reliable, cost-effective monitoring of all disabled beneficiaries. SSA said its use of profiles is effective in identifying cases with the most potential for program savings. SSA officials told GAO at the time of the review that SSA does not know which type of CDR--full medical or mailer--is more appropriate for beneficiaries in the middle group; thus, GAO believed random samples should be done. SSA officials told GAO that the agency is committed to eliminating the backlog over a 7-year period for all beneficiaries. If the agency cannot develop a profile to identify which type of CDR should be done for the middle group, it will conduct a full medical on all such beneficiaries. SSA officials said the agency has other higher priority workloads and does not have the resources to conduct mass mailings and recontacts in case of nonresponse.

    Recommendation: To the extent SSA is authorized to act, the Commissioner of Social Security should replace the routine scheduling for CDR of all who receive DI and SSI program benefits with a more cost-effective process that would: (1) select for review beneficiaries with the greatest potential for medical improvement and subsequent benefit termination; (2) correct a weakness in SSA CDR process by conducting CDR on a random sample from all other beneficiaries; and (3) help ensure program integrity by instituting contact with beneficiaries not selected for CDR.

    Agency Affected: Social Security Administration

  2. Status: Closed - Not Implemented

    Comments: SSA agrees with GAO that it should continually seek ways to maintain stewardship of the disability programs in the most cost-effective manner. To that end, SSA intends to begin considering which legislative changes, if any, will produce such a result. However, because SSA disagreed with the recommendation regarding changes to the CDR process, any legislation it proposes will not address the recommendation.

    Recommendation: The Commissioner of Social Security should develop a legislative package to obtain the authority the agency needs to enact the new process for those portions of the DI and SSI populations that are subject to required CDR.

    Agency Affected: Social Security Administration

  3. Status: Closed - Not Implemented

    Comments: SSA evaluated the recommended action using FY 1996 vocational rehabilitation (VR) cases to determine its utility. The results of SSA's evaluation were inconclusive. Beneficiaries can enter VR in many ways before a CDR occurs. This decreases the number of cases for which a VR referral made during a CDR is the 1st referral which is material to a successful employment outcome. Also, in 1998 SSA proposed the Ticket to Independence Program as an alternative to SSA VR programs. In March 1998, Representatives Bunning and Kennelly introduced H.R.3433, the "Ticket to Work and Self-Sufficiency Act of 1998," and Senators Jeffords and Kennedy introduced S. 1858, the "Work Incentives Improvement Act of 1998." SSA expects to have legislation by the end of the current congressional session that will enhance beneficiaries' ability to gain from rehabilitation and employment opportunities. As a result, SSA plans no further actions on the recommendation.

    Recommendation: To enable as many disabled individuals as possible to become self-sufficient, SSA should test the use of CDR contacts with beneficiaries to determine individuals' rehabilitation service needs and help them obtain the services and employment assistance they need to enter or reenter the workforce.

    Agency Affected: Social Security Administration

 

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