Disability Determination Slowing Down Due To Government Shutdown

     I'm hearing from North Carolina Disability Determination Services (DDS) that they have no more funds to pay for consultative medical examinations and are having some trouble paying for those which have already been held. They also lack funds to obtain existing medical records on clients. These problems will progressively slow disability determinations in this state. I imagine that the circumstances are much the same in other states.

SSAB’s Last Day

      I thought that the Social Security Advisory Board (SSAB) was defunct, killed off by the Trump Administration, a few months ago but they’ve managed to hang on until the end of the federal fiscal year, today. While heading out the door they’ve issued a report on Improving Hiring Processes at State Disability Determination Services.

     Best wishes to the Board and staff.

Are You Suggesting That There’s A Relationship Between Staffing And Productivity? That’s Crazy Talk!

      From a press release issued by Social Security’s Office of Inspector General:

From FY 2019 to FY 2023, Disability Determinations Services (DDS) productivity, measured as Production Per Work Year, decreased by 21 percent, and average processing time increased by 81 percent from 121 to 219 days. The lower productivity and increase in processing times coincided with the loss of key technical staff, including disability examiners who evaluate disability claims and make disability determinations in accordance with laws, regulations, policies, and procedures governing Social Security Administration (SSA) disability programs.

Might Tell You Something About The Future

     From the Urban Institute:

Click on image to view full size

Disability Examiners Getting Authority To Issue Allowances Without Medical Consultant Input

      From Emergency Message EM-25009 issued last Friday:

This emergency message (EM) provides the Disability Determination Services (DDS) and federal disability adjudicating components with disability case processing guidance for Disability Examiner Decisional Authority (DEDA). DEDA will temporarily allow qualifying disability examiners to make fully favorable disability determinations in adult cases based on physical impairments alone without medical review by medical consultants (MC), but with the flexibility to consult with an MC at the disability examiner’s discretion. 

These temporary instructions apply to initial level claims, including initial-level claims pending at the DDS and federal disability case processing sites (DPB, DPU, etc.).

The Social Security Administration (SSA) faces unprecedented initial disability claims backlogs surpassing the 1.12 million case mark, resulting in high average processing times and claimant wait times. A contributing factor to the increase in average processing time is the general requirement that qualified physicians, psychiatrists, and psychologists (referred to in our policy as medical consultants (MC) and psychological consultants (PC)) complete the medical review of all initial level disability determinations combined with an insufficient number of MCs and PCs. See Section 221(h).…. 

     If this issue comes up in your confirmation hearing, Frank Bisignano, what say you?

FY 2024 DDS Allowance Rate

     From a recent release from Social Security:

Why It Takes Longer To Get A Disability Determination

     From a recently released report. Click on image to view full size. The full report breaks it down by state and region.

It Keeps Getting Worse

     From a recently released report:

From Social Security's Freedom of Information website

Disability Examiner Losses

 

From a report by Social Security's Office of Inspector General

NADE Newsletter

     The National Association of Disability Examiners (NADE), whose members work at state agencies making disability determinations at the initial and reconsideration levels for Social Security, has released its most current newsletter, concerning its National Training Conference in Oklahoma City in August. Presentations by John Owen, Associate Commissioner of the Office of Disability Determinations, Hope Grunberg, Associate Commissioner of the Office of Disability Policy (ODP), Ben Gurga, Deputy Associate Commissioner of ODP, Kasey Torres, Director of the Division of Disability Quality and Kevin Huse, Deputy Assistant Inspector General For Cooperative Disability Investigations are summarized.

Some Pics

     The Commissioner of Social Security, Martin O'Malley, visited Raleigh yesterday for an event at the Governor's Mansion to celebrate the 70th anniversary of North Carolina's Disability Determination Service (DDS). My partner and I received an invitation to the event. Here are a few pictures. 

    First, me with Commissioner O'Malley:

    Second, a picture of my partner, Crystal Rouse, with the Commissioner:

    Next, a picture of Rose Mary Buehler, the Regional Commissioner for the Atlanta Region, myself, Joseph Lytle, the Deputy Commissioner for Hearings Operations and Crystal.

    Finally, a picture of the NC DDS employees in attendance.

    The venue was not large enough to accommodate the entire workforce at NC DDS.

State Disability Determination Services Processing Times

 

SSA Stops CDRs For The Remainder Of The Fiscal Year

     From Emergency Message EM-24021:

With the enactment of our full-year appropriation for this fiscal year, we are lowering our Full Medical CDR t[Continuing Disability Review] arget from 575,000 to 375,000.

This reduction will allow DDSs [Disability Determination Services] to focus on processing Initial Disability Claims and Reconsideration cases. The field offices will not send additional Full Medical CDRs to the DDS for the remainder of FY 2024. ...

Do not assign unassigned CDRs pending in your receipt or staging queue. DDS should take no action on the unassigned Full Medical CDRs. ...

Age 18 Redeterminations:

If you have sufficient evidence in file at the publication date of this emergency message, make the Age 18 Redetermination.
If the evidence in file at the publication date of this emergency message is insufficient to make the Age 18 Redetermination:
a. Do not initiate additional development, such as requesting medical evidence of record (MER) or school records;
b. Do not schedule for consultative examinations (CE); and,
c. Do not assign to medical or psychological consultant(s) for review. ...

Interview With The Commissioner

    From things said by Social Security Commissioner Martin O'Malley during an interview conducted by reporter Lisa Rein of the Washington Post:

... I wasn’t asked to come here because everything was going great, right? We’re in a customer service crisis; that cannot be denied. ...

There is a theme running through this stuff [I've done]: It’s small.

[W]e executed on a bunch of little short-term, quick wins. Our new general counsel has probably said yes in 60 days more than any [Office of General Counsel] leader has said in 10 years. ...

I have been unpleasantly surprised by how dire the staffing situation is. ...

[W]e’ll be rolling out an action plan for the remainder of the year that will better organize over 150 actions under 21 initiatives, all of which are intended to take a bite out of these processing times [at Disability Determination Services]. ...

Clearly we need a more modern assessment of the widely available occupations out there [used in disability determination]. And we are taking a fresh look at this project [to create a new occupational data system], and at what we forecasted we might have to spend. ... Many members of Congress expressed their concern about the amount of money that we have put into this and the amount of time that it has taken. There’s still a systems component, and that also has a price tag. I would say it’s a big policy issue. There will be some winners, some losers. ...

Deep Red In More Than One Way

 

From a Social Security fact sheet

You Get What You Pay For

     Social Security has decided to post a Freedom of Information Act response they've given showing the rates at which the Alabama Disability Determination Section (DDS) paid for medical examinations and some other things they ordered. This is from 2020 so it's a bit out of date but take a look. I'm only posting the first page here. The whole thing which runs to 20 pages is linked above. The last page may surprise you a bit.

    Don't these rates seem a little low -- or maybe a lot low?

Click on image to view full size

Perfect Timing?

    Wouldn't now be the time to end the reconsideration step in Social Security disability determination? Over the years the objection to doing that has been that that it would throw too many cases to the hearing level but at the moment the backlogs are enormous at the initial and reconsideration steps and quite low at OHO. Doing it now would kill two birds with one stone. You'd dramatically reduce the backlogs at DDS and you'd give OHO something to do at a time when they're rapidly running out of work. It would create the "drinking from a fire hose" problem at OHO but I'd rather see that than have OHO lacking work while DDS struggles. 

    By the way, I have a vested interest in seeing this come to pass since I have a vested interest in seeing Social Security disability claims resolved expeditiously. Is that a bad thing?

 

This Is What's Going On At Ground Level

    Here's a note made recently by an employee at my firm about a pending disability claim that may give you some idea of the state of service at Social Security :

TC [telephone call to] ____ DO [District Office] and she said there is an initial claim that has been sitting there since 7/14/2023. She is sending it to the CR [claims representative] Mr. ____ but he is off.

    In case you don't understand the context, the DO only takes the claims. They don't make medical determinations. Those are made at Disability Determination Services (DDS). Under normal circumstances -- which don't currently exist -- new claims are forwarded from the DO to DDS in a week or two. Even if there is some technical problem, the claim isn't supposed to be sitting at a DO for six months! 

    For this to happen there has to be no effective tickler system at the DO. I'm sure there's supposed to be one but it's broken down entirely under the enormous pressure of overwhelming workloads.

    I'm not even mad at the personnel involved because I have an idea of just how overwhelmed they are.  If a case happens to fall by the wayside now, we're just about at what I've described before as the "Not now. Not later. Not ever" stage of service. Problems aren't being straightened out.

    And please don't blame my firm. We've been trying for three months to find out what happened to the case. It's almost impossible to get anyone on the phone. There's no smart trick that solves cases like this. There's far too many of them. We're not supposed to be Social Security's tickler system anyway.

Initial Processing Backlogs

     Social Security has released numbers showing the backlogs at the initial level on disability claims. This is from more than six months ago but I don't think there's been significant improvement since. The situation may be worse. The processing time is expressed in days. You can click on the images to view them full size.

OIG Report On Pandemic Effect On DDS Processing Of Disability Claims

     From a report by Social Security's Office of Inspector General (OIG) on the effects of the pandemic on processing of Social Security disability claims:

While SSA received fewer initial claims during the pandemic, it took the DDSs [Disability Determination Services] longer to process them than the year before. Before the pandemic, DDS’ average processing time for an initial claim was 95.5 days. This increased to 139.4 days and 135.5 days, respectively, during the first and second years of the pandemic. Numerous factors contributed to this:

• CEs - The number of CEs [Consultative Examinations] performed during the pandemic decreased, as SSA suspended in-person CEs for a period of time. Once DDSs resumed in-person CEs, they still had issues scheduling CEs because for example, (1) not all CE providers returned to conducting CEs and (2) claimants refused to attend in-person CEs because of fear of exposure to COVID-19.
• DDS Staffing and Training – About 4,000 DDS employees resigned or retired during the pandemic, but DDSs hired 4,305 employees during this same time. However, it takes a newly hired disability examiner an average of 2 years to become proficient at processing most initial claim workloads.
• Telework and Communication with Claimants – During the pandemic, most DDS employees teleworked, so the DDSs needed to adjust to how they processed certain workloads. SSA provided the DDSs with basic cellular telephones to communicate with claimants, but claimants were wary of answering the calls as the telephones’ caller identification did not show the incoming call was from a state agency.
• Policies and Procedures – During the pandemic, SSA updated policies and procedures on how the DDS should operate. The updates included combined instructions with the field office, which confused some DDS employees about what pertained specifically to DDS processes.