The WHO ICF And Social Security

     Social Security has published today in the Federal Register a request for comments from other government agencies on how it might incorporate the World Health Organization's (WHO's) International Classification of Functioning, Disability and Health (ICF).
     Social Security can't possibly have a specific intention in publishing this request since the current Commissioner of Social Security leaves office in less than three weeks and no one knows who will succeed him. So what might this portend? Australia has recently gone through a process to incorporate the ICF into its disability determination. Take a look at what the Aussies ended up with. It involves a lot of vague terms such as mild, moderate, severe and extreme that have proven to be be indefinable in U.S. disability determination. (U.S. Social Security defines "moderate" as more than "mild" and less than "severe" and "severe" as more than "moderate" and less than "extreme.") The Aussie system also involves a point system -- as in 5 points for mild, 10 points for moderate, 20 points for severe and 30 points for extreme. Apparently, there is some explicit consideration of work capacity as well as consideration of the labor market at some point. 

     What happened in Australia was probably far from inevitable once the decision was made to use the ICF. My very, very early impression is that ICF does not dictate any process for determining disability; it looks like an empty glass into which you can pour whatever you want.

     If Social Security wants to completely redo determination of disability, ICF would be a way of doing it. Whether the change would be for the better or worse would be determined as we go along. At least, we're likely to have a Democrat as Commissioner of Social Security for the next six years.

     The ICF would also be a great way of telling Congress that wonderful changes are on the way -- and, by the way, Congress, could you allow interfund borrowing so the Disability Trust Fund doesn't run out of money before we get these wonderful changes in effect? Those of you who remember former Commissioner Barnhart may recall how her wonderful "plan" kept Congress off her back about those awful hearing backlogs for six years. Introduction of her "plan" always seemed just around the corner. In the end, Barnhart introduced her "plan" as she was about to leave office. Barnhart's "plan" turned out to be worthless and was quickly abandoned by her successor. I doubt this came as a surprise or disappointment to Barnhart. Her "plan" was probably a success in her eyes since it had achieved its goal of keeping Congress off her back. My rule is to beware of any plan that a public official is just starting to implement as he or she is leaving office. If the public official really had a great idea, he or she would have implemented it long before leaving office. Still, the ICF could be a useful tool to help persuade Congress to allow interfund borrowing.

Happy New Year

Over The Cliff

     The House of Representatives is shutting down for the day without taking action on a fiscal cliff deal meaning we're going over the cliff at least for a day. There is no fiscal cliff deal at this point anyway. Will there be one before January 2? Stay tuned.

FICA Cut To End; No Sign Of Stimulus Funds

     Reportedly, the reduction in the F.I.C.A. will not be continued as a result of the fiscal cliff negotiations. Also, there is no sign that the agreement will include any stimulus funds although that could be in the details yet to be released. If there is any stimulus spending, Social Security could get some of it.

I Don't Know Where This Is Headed

     From a notice that Social Security is having published in the Federal Register on January 2:

We are seeking information and comments from other Federal agencies' regarding their intention to use the WHO ICF[World Health Organization International Classification of Functioning, Disability and Health] as a standard for coding functional capacity with broad potential for application to the business processes of other Federal agencies and researchers throughout the world. We invite other interested Federal agencies involved in disability monitoring to collaborate with us to evaluate an ICF-based standard for coding functional capacity in Federal disability programs. We also invite interested public and private parties to comment on appropriate Federal direction on capturing data on functioning. ...

The WHO ICF is a classification of health and health-related domains, including a list of body functions and a list of domains of activity and participation (see www.who.int/classification/icf/en/). The ICF for Children and Youth (ICF-CY) is a derived version of the ICF designed to record characteristics of the developing child and the influence of environments surrounding the child. The ICF and the ICF-CY reflect WHO’s framework for measuring health and disability at both individual and population levels. ...

We are studying several uses for ICF coding. We could use it, for example, to describe function in activities of daily living, to describe residual functional capacity (to satisfy a specific set of disability criteria), or to develop a compendium of job descriptions that includes mental and physical functional requirements.

     You can order your copy of the ICF for $50.

Cliffhanger

     The fiscal cliff negotiations drag on. At this point, preventing the sequester is on the table and the chained CPI change for Social Security's Cost Of Living Adjustment (COLA) is off the table. Republicans are even denying that they want chained CPI! 

     If this is not resolved, Social Security employees should soon expect to receive a furlough warning. As an example of what's coming, the Department of Defense is preparing to notify 800,000 civilian employees that they can expect several weeks of unpaid leave. However, the White House has not informed agencies of exactly how sequestration will be administered. According to the Wall Street Journal, the Office of Management and Budget (OMB) was not even returning phone calls on the subject last week!

No Surprise

     The user fee that attorneys pay for Social Security to withhold their fees from their clients' past due benefits will remain at 6.3% in 2013.

Sequestration Nearly Inevitable

     The Washington Post reports that sequestration seems all but certain to take effect on January 1. Most likely, it will last a couple of months. Social Security could avoid furloughs if sequestration were only to last a few days but it's hard to imagine such a huge cut in the agency's operating budget over a couple of months not resulting in furloughs.

     I was once a federal employee. I know many federal employees. I know that job security is an extraordinarily important consideration for most federal employees. I feel for the federal employees who may suffer partial or total furlough as a result of sequestration but I feel more for the members of the public who will suffer as a result of sequestration. This is a big deal.

     This shouldn't have happened.

No Chained CPI In Fiscal Cliff Deal But No Sequestration Fix Either

     In Social Security terms, the reports about the deal currently being worked out by Senate leaders to avoid the fiscal cliff are remarkable for what's not being discussed -- the chained CPI method of computing Social Security's cost of living adjustment (COLA) and any solution for the sequestration that will dramatically cut Social Security's operating budget on January. Also, the expected deal would do nothing about the debt ceiling problem.

Union Not A Big Fan Of Commissioner Astrue

     Council 220 of the American Federation of Government Employees (AFGE), the union that represents most Social Security employees is not a big fan of lame duck Commissioner Astrue. The Council's current newsletter includes a piece sharply criticizing Astrue. According to the union, Astrue promised during the confirmation process that he would have an "open door" for the AFGE but held only a couple of meetings with union representatives before breaking off all contacts. According to the union, Astrue seemed to be mad that the union had publicly criticized him. The union says that no only would Astrue not meet with its leaders, he would not respond to letters or acknowledge invitations to speak. The piece also criticizes Astrue for doing less than he could have to obtain an adequate budget for his agency:

Although the Commissioner testified before Congress regarding the impact of reduced resources on the ability of SSA to provide adequate services to the public, he has not aggressively addressed this issue with the public. The person in charge of SSA [Social Security Administration] should maintain a highly visible profile, demanding Congress provide the agency with sufficient dollars to provide the services the American public demands and deserves.

Since SSA is an Independent Agency, the Commissioner has a unique opportunity to communicate with the public the need for more resources to prevent office closings, to allow the public more face-to-face access to SSA employees and to provide assistance to the public for all their SSA/SSI issues.