From WTVQ:
A new report issued Tuesday shows an increase of staggering proportions in the number of Kentucky adults and children receiving disability benefits. The report was prepared by Kentucky’s Disability Determination Services (DDS) ...
The groundbreaking study of outcomes covers a 35-year timeframe between 1980-2015. During that time, Kentucky's population grew by 21 percent while its combined disability enrollment grew exponentially by 249 percent. Childhood enrollment growth was an astounding 449 percent.
In 2015, 11.2 percent of Kentuckians were receiving some form of disability benefit payment, which is the second highest percentage in the country. ...
As the rolls have increased, so has the rate of controlled substance prescriptions. Per capita opioid prescriptions for SSI/Medicaid adult recipients have increased from 47.58 doses in 2000 to 147.29 doses in 2015, a 210 percent increase. Per capita psychotropic prescriptions SSI/Medicaid children have increased from 272.61 doses in 2000 to 456.87 doses in 2015, an increase of 168 percent. ...
The report states Social Security disability benefit dependence should be created by genuinely disabling conditions which permanently preclude individuals from ever performing remunerative work. For people so afflicted, the integrity and solvency of the system must be preserved. Tragically, some individuals in Kentucky have never experienced life without public assistance. The culture within the Social Security Administration (SSA) is described as a bureaucratic institution, the SSA is motivated to protect and, if possible, expand the scope of its activities across the full horizon of its operational domain. For the SSA, claims and beneficiaries equal budget. This simple equation drives the SSAs internal culture thereby making it a significant obstacle to long-term change.An outline for SSA reforms is laid out in the report and includes a recommendation for an overhaul of the SSA Program Operations Manual System (POMS) to include:1) Mandate the use of objective medical evidence using best practices in forensic evaluation to determine benefit eligibility. Objective evidence of injury or illness must be paired with objective functional capacity evaluations that include cross-validation and intra-test reliability protocols which measure the legitimacy of demonstrated physical effort and limitation.2) Mandate the use of best practices in forensic psychological evaluation to include symptom and performance validity tests such as the Miller Forensic Assessment of Symptoms Test (M-FAST), the Structured Inventory of Malingered Symptomatology (SIMS), the Test of Memory and Malingering (TOMM), and the Rey 15 Item Memory Test. These tests should be accompanied with the application of clinical thresholds of benefit eligibility.3) Remove all subjective non-severe conditions from the listing of eligible conditions and require mandatory termination reviews for all recoupable conditions based on clinically accepted recovery timelines.4) Eliminate the SSAs Medical Improvement evidentiary standard of continuing disability review in favor of an Objective Functionality review founded upon objective forensic evaluation standards.5) Cease payment of benefits upon CDR termination pending the outcome of an appeal to an ALJ.6) Eliminate the SSAs Lost Folder policy which restricts the re-evaluation of a beneficiary whose file has been lost. This policy is referred to as the Golden Ticket because the individual whose file is lost will likely receive benefits for the rest of his/her life without any prospect of termination. ...
22 comments:
Link to report, please?
"5) Cease payment of benefits upon CDR termination pending the outcome of an appeal to an ALJ."
Due process is a foreign concept.
Kentucky was one of the last bastions of wild west pain pill prescription until just a few months ago. Docs could prescribe freely without any real checking or registration. You would see folks from Cincinnati cross the river to get oxycodone (both oxycontin and Percocet), morphine, dilaudid, etc. Those drugs were prescribed for such conditions of Crohn's, fibromyalgia, restless leg syndrome, migraines, etc. in the absence of clinically indicated medications or even a valid diagnosis.
#5 is interesting. I understand why benefits are continued and the basis for it, but when you've seen numerous ceased claimants request postponement after postponement, submit address changes after they don't appear at a scheduled hearing multiple times, etc., it would certainly cure those that are simply running from potential finality on their benefits.
Permanent disability is not required, only 12 months or likely to result in death. Additionally, disability is not meant to address an inability to perform remunerative work, even volunteer work can be found inconsistent with a claim of disability. In regard to the points raised in the report:
Point 1, Effort and limitations must be objectively measured. (Effort is subjective, as are limitations in general.)
Point 2, Use more tests in psych exams. (Using anything beyond the MMSE will result in more awards).
Point 3, Eliminate non-severe conditions from the listings. (Impairments are neither severe nor non-severe inherently. I think they mean the compassionate allowances.).
Point 4, Ignore the presumption of disability created by a prior award and look at the CDR file de novo (ALJs already do this).
Point 5, Eliminate interim benefits in CDR claims. (Award will result in underpayment, while termination will result in overpayment. If the person is truly no longer disabled, the overpayment will be paid. If they are not, the underpayment will be an administrative burden.)
Point 6, Stop terminating CDRs based on SSA losing the prior file. (I've never seen this happen. The ALJ just approaches it de novo, assuming the prior claim decision does not exist.)
Of all the opioid pain medications used in the world, 80% are used in the United States, more people in the US use an opioid than cigarettes. If you add it up it comes to about 110 TONS of addictive opioid pain killers consumed a year. Oh and we take the most non opioid pain killers as well. By a staggering margin.
"As the rolls have increased, so has the rate of controlled substance prescriptions. Per capita opioid prescriptions for SSI/Medicaid adult recipients have increased from 47.58 doses in 2000 to 147.29 doses in 2015, a 210 percent increase."
Either the rest of the world got tougher or we have gotten weaker.
Wait.
DDS is funded by the Social Security Administration even though it is a state agency.
The agency is now paying state DDS agencies to make policy suggestions?
Let's look at the suggestions.
Item 1. Basically asking for functional capacity testing. That runs about $600 a pop in smaller markets and right now privately scheduling one can be a challenge because there is not a huge supply of qualified people doing them and most are making their money from worker's comp evaluations. Congress is looking to cut Social Security administrative costs, routinely performing an expensive test seems unlikely.
Item 2. Seeking the magic bullet that the medical community says does not exist. Quality neurocognitive testing is more reliable and more expensive than functional capacity testing. Insurance will pay in some limited circumstances but first you need insurance and second you need to have a condition that fits. Like item 2, this seeks to increase spending in the face of a Congress not disposed to spend more.
Item 3. Eliminates most mental health impairments, reduces the number of people who will meet the listings for most neurological disorders and immune system disorders. Eliminates the skin disorders that are not scientifically described in size and number of lesions or percent on body impacted.
Item 4. Sneaky work around to "fix" decisions DDS does not like. If an ALJ finds a person is disabled and DDS disagrees, requiring a showing of medical improvement from the first decision means disability continues even if DDS does not agree with the ALJ. With the medical improvement rule, DDS may not like the decision but unless the person has gotten better in a measurable way, they remain disabled. It also means DDS can move on to another file by screening quickly for improvement. Eliminating it means the prior decision never happened.
Item 5. Yes it is frustrating knowing that there is going to be significant overpayment but unless there is some sort of fast track where hearings are held in a short time like 90 days you impose a significant hardship those who are found to remain disabled and if there is a fast track then the dollars involved are much lower.
Item 6. Lost folder is becoming rare. The inspector general reviewed 100 continuing disability reviews where DDS found the individual not disabled and an ALJ reversed the DDS decision. Lost folder was the cause in 7 of those cases. That's just out of the cases where DDS was overturned. https://oig.ssa.gov/sites/default/files/audit/full/pdf/A-07-13-23019.pdf
There appears to be the continuing confusion of state SSI and federal SSDI here. Someone who has never worked who gets SSDI money has to be a child/dependent of a SSDI recipient, yes? SSI can go to one who has never worked, I thought.
If any of this opinion is true, Kentucky is clearly operating in a totally different atmosphere from where I live. Maybe if people want to get approved, they should move to a friendlier state.
Item #5 Overpayments caused in these situation are universally waived. If the 3 installment, 6 months worth of benefits requirement for SSI were eliminated, paying these retroactive benefits would be relatively easy.
So what is it about Kentucky that lead to a 11% disability rate? I was trying to find a state by state breakdown on disability percentages without success. Anyone know whether such a table/ graph exists?
4) Eliminate the SSAs Medical Improvement evidentiary standard of continuing disability review in favor of an Objective Functionality review founded upon objective forensic evaluation standards.
Absent clear error on the face of the initial allowance,it seems logic dictates if the medical conditions are the same or materially the same then benefits should continue.
Utter nonsense.
True places like Kentucky and West Virginia have seen abuses. But also those states seem to have more physically demanding labor requirements (e.g. coal in West Virginia). So of course there will be more SSD claims. Maybe not a rise by 249 percent. But also people are more knowledgeable about filing for SSD so that could explain a rise. Numbers can be used for any bogus confirmation bias. The DDS report researchers should be ashamed.
And they rank in the top 10 consistently for neck and back pain cases.
http://247wallst.com/special-report/2013/05/20/states-with-the-most-americans-on-disability/2/
I need Richard Thaler to write a paper on the fact that this state is represented by rand Paul and Mitch McConnell, its the ultimate manifestation of people acting irrationally in the field of behavior economics
In regards to item 6, you may not have seen a lost or destroyed folder case because 99 percent of such cases are continued at the initial DDS CD review except when there is failure to cooperate. It is declining due to electronic folders but is still a big problem. After being continued, they are agai continued the next time the case is reviewed because there was nothing much wrong with them the previous time. The same problem exists with expedited reinstatements. The folder was destroyed because person was gainfully employed for several years after the TWP, EPE expired
N
They did imply that the five full month waiting period for DIB cases should be eliminated
http://1.bp.blogspot.com/-mnrolhd1O9Y/VbpwnSt7NqI/AAAAAAAACM8/YxLOcYYsUSs/s1600/adult%2Bobesity%2Brate%2Bin%2BKentucky.JPG
A correlation that will likely not be made by politicians.
Why Kentucky and W VA? Anyone heard of Eric Conn and Huntington?
BTW did they ever catch Conn? or is he still on the lamb?
a nice response from KY: http://kypolicy.org/social-security-disability-insurance-works-vulnerable-kentuckians/
I tracked down this report. The report contains factual errors that always seem to be in favor of more forcefully making the author's point that Social Security benefits should be cut to make people less dependent. One I particularly noticed was that the author decried de novo review by ALJs stating that "This power allows SSA ALJs to completely disregard .... the entire evidentiary record on which those prior decisions [initial and reconsideration] were based." Not so, medical exhibits and witness statements submitted below are (and by regulation, must be) considered by ALJs.
The author, who is listed as W. Bryan Hubbard, demonstrates concerning gaps in his knowledge of SSA programs and rules in the report. Mr. Hubbard has a right to express his personal political views about wanting to cut Social Security benefits. However, Mr. Hubbard and the co-authors listed in the report deserve criticism for disseminating misinformation about SSA programs while doing so.
To all the "Mr. Hubbards" out there: show us FIRST that you mean this, by eliminating all government payouts, kickbacks and tax breaks to wealthy businesses. Eliminate all money from corporations, unions, etc. to political campaigns. Outlaw lobbying. Do this FIRST, then maybe I will find you credible. However, it is not government payments that make the disabled dependent on those payments. It's the disability, stupid! Oh, and the I in SSDI is Insurance.
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