Status Of FY 2017 Appropriations

     Social Security and all other agencies are operating on continuing funding resolutions. This is likely to be the case until March. With news that the incoming Trump administration probably won't even submit a Fiscal Year (FY) 2018 budget much less a FY 2017 budget, the pending House and Senate appropriations bills become even more important than usual. Below is a summary of what the two bills provide. In each case, the bill has only passed at the committee level. There will be new bills in the next Congress which will be at the least similar but which may not be exactly the same as these bills. Each bill will have to pass at the committee level before going to the House and Senate floors. The two bills must then be reconciled. Note that the money differences between the two houses are small in the context of a total agency appropriation of more than $12 billion.
     I have bolded what I regard as the most important riders, that is provisions in appropriations bills  or at least in committee reports that affect not how much money the agency has to spend but try to affect what the Social Security Administration does with that money. Note that what I have bolded is only in the bill that one of the two appropriations committees passed, not both. The committees may become in some ways more cautious and in other ways less cautious in their demands of the agency with a President who is at least nominally Republican. Do they really want to see changes that would deny far more disability claims if a Republican is in the White House to catch the blame? We'll have to see.

House appropriations bill: $75 million less than FY 2016 

House Riders:

• The Committee is aware that some locations average twice the processing time of others and that it can take up to two years to process. This degree of differential processing times is a concern to the Committee. The Social Security Administration is directed to include in the fiscal year 2018 budget request steps taken to reduce the processing times at offices that average over 600 days.
• The Social Security Administration is requested to submit to the Committee an information technology (IT) modernization plan in the fiscal year 2018 budget request. The plan shall include: a complete list of any new systems and significant improvements of existing systems proposed for development; the projected cost of each development project each year to completion including the total estimated cost of development; the estimated annual operations and maintenance costs for each system once development is complete; and a timeline and estimated maintenance cost savings of any legacy systems that will no longer be necessary and are proposed to be eliminated. The plan should also include an assessment of SSA's IT management controls, including how the systems integrate into SSA's enterprise architecture; an analysis of SSA's project management capabilities; and a review of SSA's IT investment and human capital management practices. The requested plan shall address IT funding provided in this Act and any other spending authority planned for or proposed to be used for such purposes.
• The Committee is aware that SSA was added to the Muscular Dystrophy Coordinating Committee through the Muscular Dystrophy CARE Act Amendments enacted in September 2014. The Committee requests that the agency provide relevant data within the fiscal year 2018 budget request on the rate at which persons with Duchenne and Becker Muscular Dystrophy utilize SSA programs, particularly those focused on promoting employment and community independence such as the Ticket to Work program.
• SSA's National Hearing Centers (NHCs) provide the SSA with invaluable flexibility and support to address the hearings backlog. Understanding the value of this flexibility and support, the Committee directs SSA to ensure that its upcoming Administrative Law Judge (ALJ) hiring allocates no less than 25 percent of those newly hired ALJs to NHCs.
• The SSA has committed significant resources to fighting fraud in the Disability Insurance program. To understand if these efforts are effective, the Committee directs the SSA Commissioner to work with the Office of Inspector General to establish a disability fraud rate baseline no later than September 30, 2017.

Senate bill: $32 million more than FY 2016 

Senate Riders:

• The Committee supports SSA's efforts to reduce the backlog of disability claims hearings. Given the successful implementation of the Disability Hearing Pilot Program in Region 1, the Committee encourages SSA to implement the changes on a nationwide level. The changes should include providing advance notice of a hearing date, and requiring claimants to inform SSA or submit written evidence within a certain period in advance of the hearing, subject to the good cause exception. Furthermore, as recommended in the pilot, SSA should consider removing ``new and material evidence'' as a basis for reopening any decision made at the hearing of Appeals Council levels for benefits based on disability. The Committee requests a report on plans for implementation no later than 60 days after the enactment of this act.
• The Committee is dedicated to ensuring that the disabled have access to needed benefits, and strongly encourages SSA to work with us to achieve that goal. The Committee continues to be concerned that SSA uses outdated rules to determine whether or not a claimant meets SSA's definition of disability. The Committee is encouraged by SSA's indication that they are beginning the regulatory process, having already received input from the National Disability Forum, the National Institute of Medicine, as well as various aging and employment experts. These initial steps are well received by the Committee as we continue to work with the Administration to modernize the outdated vocational guidelines into a structure that reflects the 21st century labor market. As this is the first significant overhaul of the grid in nearly 40 years, the Committee requests SSA to submit, no later than 60 days after the enactment of this act, a report on its ongoing efforts to update the grid. In addition, the report shall include a study assessing the feasibility of maintaining a continuous update of the medical vocational guidelines every 10 years.
• The Committee is aware that the Social Security Administration is included in the Muscular Dystrophy Coordinating Committee under the Muscular Dystrophy CARE Act Amendments enacted in September 2014. The Committee expects the agency to make data available on the rate at which persons with Duchenne and Becker Muscular Dystrophy utilize SSA programs, particularly those focused on promoting employment and community independence such as the Ticket to Work Program.
•  While the Committee commends SSA on its continued Program Integrity efforts towards becoming current with regards to the Continuing Disability Review [CDR] backlog, a recent GAO report found that SSA's CDR prioritization models fail to maximize potential cost savings to the trust funds and the Treasury. Within 1 year, and every 3 years thereafter, the Committee directs SSA to review and update the models for prioritization of CDRs with the primary intent of efficiently and effectively maximizing lifetime cost savings to the Federal Government, both for the DI trust fund and Treasury. A detailed, cost-based explanation for the model's prioritization of different CDR types and justification for any updates made should be included in the annual CDR Report to Congress.
• The Committee commends SSA for its work to improve program integrity. However, the Committee is concerned, per previous GAO testimony and report findings from the SSA Office of the Inspector General, that confusion still exists about the Medical Improvement Standard (MIRS) and its exceptions. The Committee directs SSA to submit a report no later than 60 days after the enactment of this act on its progress in educating Disability Determinations Services in the proper application of the MIRS and its exceptions.
• The Committee expects that in resolving claims for disability insurance, SSA's consideration of medical evidence should reflect the degree of relevance and familiarity each medical source has with the effect of an individual's medically determinable impairment(s) on his or her ability to perform Substantial Gainful Activity [SGA]. Since the Treating Physician rule was first published in the Federal Register in 1991, healthcare delivery in the United States has changed significantly and the Treating Physician rule no longer reflects the present reality of the medical personnel with greatest knowledge of an individual's physical and/or mental condition. The Committee encourages SSA to consider revising the controlling weight doctrine in the Treating Physician rule and revising its Acceptable Medical Sources to reflect the new degree of familiarity with their patients, and rigorous training of, nurse practitioners, physician assistants, licensed clinical social workers, audiologists, and speech and language pathologists for the particular impairments that they are well-equipped to treat.
•  The Committee notes that the SSA's OIG has recommended that SSA periodically determine whether VE fees are appropriate to obtain the required level of VE service. The Committee understands that SSA plans to conduct such a review, including benchmark studies of VE fees paid in the national economy and those paid by other governmental and non-governmental organizations, during SSA's acquisition planning process for the contracts to be awarded in fiscal year 2018. The Committee looks forward to an update in the fiscal year 2018 CJ regarding these studies.

NHC ALJs To Travel

     I am hearing reports that National Hearing Center (NHC) Administrative Law Judges (ALJs) will now be forced to travel to remote locations when the claimant declines a video hearing. The obvious reason for this is that claimants are frequently declining to do a video hearing with an NHC ALJ because the identity of the ALJ is being kept a secret until the day of the hearing. The whole reason for the "secret ALJ" policy has been the NHCs. 

     There are several problems with having the NHC ALJs travel like this:

• Social Security doesn't have the money for the travel expenses.
• The traveling will make the NHC ALJs much less efficient.
• None of the NHC ALJs signed on to any travel, much less extensive travel.
• It has been my impression that at least a few of the NHC ALJs wanted to be at a NHC because they wanted to avoid being in the same room as the claimant and the claimant's attorney. For them, the lack of face to face contact wasn't a bug. It was a feature.

     Defeat the NHCs and you probably defeat the "secret ALJ" policy. I think the NHCs are in trouble.

OIG Report On NHCs -- And Read To The End For News On Remands And Possibility Of NHC ALJs Traveling

     From a recent report by Social Security's Office of Inspector General (OIG) on the agency's National Hearing Centers (NHCs):

During FYs [Fiscal Years] 2010 and 2011, ODAR’s [Office of Disability Adjudication and Review] 5 NHCs processed more than 56,000 hearings to assist backlogged hearing offices with older cases. The Chicago Region transferred the highest number of cases during this period, about 50 percent of all cases the NHCs received. These transfers allowed the Chicago Region to address case backlogs while new hearing offices were being constructed to permanently address workload needs. We found the ALJs [Administrative Law Judges] working in the NHCs had a higher than average disposition rate that may have related to such factors as (1) a higher decision writer-to-ALJ ratio, (2) how attorneys are supervised, (3) the lack of travel to remote sites, (4) useful pre-hearing briefs, and (5) the processing of NHC remands at the hearing office level. However, the NHCs identified a number of challenges that may limit the effectiveness of the NHC model, including (1) availability of video capacity, (2) difficulties scheduling experts, and (3) claimants declining video hearings. The assisted hearing offices we contacted stated case transfers to the NHCs led to fewer pending cases and improved processing times. The hearing offices also had a few concerns, including their processing of NHC remands as well as the extra work related to declined video hearings.

     The OIG report does not try to evaluate the NHCs versus their alternative, which would have been adding ALJs to traditional hearing offices where office space was available and using the excess capacity to help out backlogged offices.

     Also of interest is a statement that Social Security is considering having NHC ALJs travel to hearing sites to hold hearings for claimants who decline video hearings. I suppose that Social Security may be re-evaluating this since they are no longer advising claimants of which ALJ will hold the hearing. There is also a statement that since January 3, 2012 remands from a NHC ALJ decision will be sent back to the NHC ALJ rather than being assigned to an ALJ at the ODAR office with jurisdiction over the area.

     By the way, Social Security doesn't even know how many claimants are declining video hearings with NHC ALJs. From what I hear from other attorneys, I think that number has gone up dramatically since Social Security started withholding the identity of the ALJ until the day of the hearing.

Withholding ALJ Assignment Information

     Let me give a brief comment on Social Security's plan to withhold the identity of the Administrative Law Judge (ALJ) to whom an appeal is assigned until the day of the hearing. As a general matter it does not matter much to me. I do not prepare cases any different depending upon which ALJ the case is assigned to. Any differences in the way I present a case are minor. I can easily adjust on the day of the hearing since I know all of the local ALJs. Many others who practice Social Security law feel different.

     The idea that this will prevent "judge shopping" is, for the most part, ridiculous. The only way that an attorney can "judge shop" at Social Security is to decline to do a video hearing with a particular ALJ if it is known that the ALJ will not schedule an in person hearing. That is only a small percentage of cases. 

     What I am hearing from my colleagues is that many will refuse to do any video hearings with out of area ALJs under this policy since they would have no way of knowing anything about the ALJ in advance of the hearing. I may do this myself since the danger with having to deal with an out of town ALJ with serious peculiarities with no advance warning is all too real.

     My guess is that attorneys refusing to do hearings with the national hearing offices will become an even greater problem for Social Security under the new policy. Instead of trying to do one thing after another to keep the national hearing offices going, perhaps Social Security should revisit the entire idea of the national hearing offices. Was it really a good idea to create them?