Pages

May 22, 2014

In Fantasyland We Can Do Away With The Medical Improvement Standard

     From a recently released report by Social Security's Office of Inspector General (OIG):
Our objectives were to (a) determine whether the Social Security Administration (SSA) would consider beneficiaries disabled using the Initial Disability Standard, rather than the Medical Improvement Review Standard (MIRS), during continuing disability reviews (CDR) and (b) evaluate data on the MIRS exceptions . ...
We estimated, after all appeals, SSA will pay about $269 million in benefits until the next CDR due date to about 4,000 adult beneficiaries who would not be disabled if SSA used the Initial Disability Standard , rather than MIRS , during a CDR.  Additionally, although the cessation determinations were correct, we found issues with the reason coded for cessation for some types of MIRS exceptions. ...
 Our review of 275 sample cases (with a CDR continuance because of no medical improvement) found that if SSA used the Initial Disability Standard instead of MIRS, 12 individuals would not be considered disabled ; 242 individuals would be disabled; and 21 individuals had insufficient evidence available to determine whether the individual would be disabled. ...
     I wonder who asked OIG to look at this question. Who thinks it would be possible to do away with the medical improvement standard? It would have to be someone unlike me who wasn't around in the early 1980s. I know it's not happening in any political environment I can imagine. If it did happen, from the looks of this study, it wouldn't even save much money.

7 comments:

  1. I see your point of view, Charles, but surely you can see the other side.

    There are countless shoddy initial FF/PF decisions where an ALJ (perhaps one of those high payers) paid someone whose disability was...questionable.

    Forcing the Agency on CDR review to have sufficient evidence to show improvement prevents the cessation of a claimant whose symptoms were not disabling at the time and haven't changed much since.

    Ahh, but what about the opposite situation, you may ask? All the wrongfully denied claimants! Well, they can appeal or file new claims. The medical improvement standard will FOREVER bar a cessation on the improper FF decisions described above.

    ReplyDelete

  2. Senator William Cohen referred to SSA employees as "overzealous bureaucrats" during a Congressional hearing on high cessation rates at the time.

    The outcome of those hearings eventually was the MIRS. This proposal is just the return of the pendulum.

    ReplyDelete
  3. @ 2:40

    could not have said it more perfectly

    ReplyDelete
  4. no medical improvement standard on age 18 redets. not needed on adult cdr's either. the med improvment standard simply complicates what ends up being essentially the same analysis.

    ReplyDelete
  5. Age 18 redeterminations are not done with the Medical Improvement Standard now -- but by the regular adult disability standard. There is already an exception for those who obtained disability by fraud (such as the allegations made against the New York first responders) -- so the MI standard isn't used for that. There are other exceptions for when medicine has advanced in that particular area -- and a whole list of other exceptions. The MI standard is needed for ordinary folks on dib, to protect against someone with a different view from cutting off the checks. Many hearing cases are a matter of judgment, which could be decided either way. MI is needed as a matter of due process.

    ReplyDelete
  6. Dear 2:40

    If the prior FF was indeed "shoddy", the Medical Improvement standard will not be a very high hurdle. Just cite a couple of medical findings different from the past; assert that they support a less restrictive rfc; and "bang" you have a defensible cessation decision.

    If you can't make such an argument, then maybe the prior decision wasn't so shoddy.

    ReplyDelete
  7. 9:58

    I should have been more specific--the medical evidence from the prior records for these CDRs contains the same types of findings/symptoms/etc. (i.e., not seemingly disabling) that are present in the current medical evidence.

    That's the problem. The symptoms/findings/etc. were not disabling then and haven't really changed (really improved--even for mild symptoms, they tend to stay stable or worsen, not improve), and thus a medical improvement finding is impossible.

    ReplyDelete