Proposed Rule On "Compassionate Allowances"

The Social Security Administration has published an Advance Notice of Proposed Rule-Making (NPRM) on compassionate allowances. No specific amendment to Social Security's regulations proposed. Here is a key excerpt:

In addition to these methods of identifying compassionate allowances [that Social Security is already using], we are considering the creation of an extensive list of impairments that we can allow quickly with minimal objective medical evidence that is based on clinical signs or laboratory findings or a combination of both. We believe that we could use certain listed impairments, such as those described above, as a starting point for a much longer list of impairments that could be allowed based on established diagnoses alone (supported by objective medical evidence) or based on diagnoses that have reached certain points in their progression that would be considered disabling. We would not limit, however, the compilation of conditions to those already covered by our listing. We would incorporate any conditions that should be allowed quickly with minimal, but sufficient, objective medical evidence. As such, the list of qualifying conditions would be specific and extensive.

Additionally, although we already have some policies and procedures for identifying the most obviously disabled individuals quickly, we are investigating methods for identifying compassionate allowances by perhaps starting with a specific allegation or through the use of a computer system that is able to search key words included in an electronic disability folder. Because the health care industry is capturing more and more clinical information in structured electronic formats using standardized codesets, we also are interested in your ideas about whether and how we can use that information for identifying compassionate allowances.

Many, although by no means all, of the individuals who would qualify for a compassionate allowance will have impairments that are expected to result in death and need immediate decisions on their claims. It is our hope that compassionate allowances will not only bring faster benefits to individuals in need, but that they will also help to quicken the processing time of those claims that must be processed through our existing procedures. ...

Please provide us with any comments and suggestions you have about new standards and identification methods for compassionate allowances.

To believe that this is going to make a significant difference, one has to believe that disability examiners cannot now quickly identify the claims of those who are most seriously ill and get those cases adjudicated quickly. For the most part, I do not believe this to be accurate, nor can I imagine anything coming out of this process that will speed up anything. My opinion is that this comes from a naive view that disability examiners are not so bright and that simple checklists or keyword search programs can speed up their work. I think this greatly underestimates the disability examiners and the complexity of the problem. Social Security has been doing disability determination for 50 years. All the simple ideas were implemented a long time ago. I do not think this idea is coming up from the trenches. It is coming down from the top, from people who have never done disability determination work themselves.