Nurse Case Manager Job Duties

The number of people being hired in the Disability Service Improvement (DSI) experiment as nurse case managers just for Region I -- 90 -- plus the job title, which is the term used in workers compensation and long term disability cases for personnel who often have an adversarial relationship with claimants leads to some concern about what Social Security is up to with Nurse Case Managers. Social Security has published a job announcement for more personnel to be hired for this position. The announcement gives the following job description:

Provides expert medical policy, procedural, and technical advice and guidance to DDSs, ROs, ALJs, the DRB, OQP and the national network of experts affiliated with the OMVE on the most complex issues encountered in making the determination or decision in a disability claim. This technical advice and guidance includes confirming what medical, psychological and vocational expertise is needed as well as verifying the need for additional medical or lay evidence, tests, or a consultative examination. Verifies that the request is in accordance with disability law, regulations, and policy.

Serves as a medical program expert and technical authority by providing technical advice on medical disability program issues, concerns, initiatives and requirements. Provides oral and written reports and conducts briefings on behalf of the Director to other SSA central office and regional components.

Provides expert medical advice and guidance for cases with multiple impairments to the DDSs, ROs, ALJs, DRB, OQP and the national network of medical and vocational experts.

This job description does not suggest that the Nurse Case Managers will have any direct contact with claimants, but it does suggest that the Nurse Case Managers may play something of an advocate's role in the process. They could be present at ALJ hearings, by video, to explain why the prior decision denying the claim was right. Still, the job description raises as many questions as it answers.

There is a worrisome history behind the idea of "case management" in the Social Security disability programs. The first recommendation that Social Security ought to have case managers that I can find came from Patricia Owens, formerly head of the Office of Disability Operations at Social Security and more recently an advisor to UNUM, the nation's largest Long Term Disability (LTD) insurer. She was pushing "case management" in 1999 in testimony to the House Social Security Subcommittee and she clearly had in mind people who would find a way to get claimants back to work, or at least off Social Security disability benefits.

The General Accounting Office, now the Government Accountability Office (GAO), picked up on this. The GAO testified, approvingly, in 2000 to the House Social Security Subcommittee about the practices of private long term disability insurance companies who were using nurse claim managers, among other personnel, to "encourage" recipients of long term disability (LTD) benefits under employee pension plans or under private insurance plans to return to work. GAO rehashed much the same subject in an early 2001 report. In 2002, in a report on disability determination at both Social Security and VA, GAO again urged "case management." None of the GAO reports acknowledged that the return to work "encouragement" was often perceived by the LTD recipients as harrassment aimed at lowering resistance to termination of benefits or that, in general, the insurance companies' handling of LTD claims has been extremely controversial in recent years.

July Fee Payments Down Sharply

Social Security has released monthly statistics on fees paid to attorneys and others for representing claimants before the agency. The fees come out of the back benefits of the claimants. Fee payments fell by 24% in July, 2006 as compared to June, 2006 and fell by 14% as compared to July 2005.

Fee Payments
Month/Year	Volume	Amount
Jan-06	18,752	$64,848,326.02
Feb-06	20,426	$70,312.586.15
Mar-06	26,227	$91,045,934.83
Apr-06	23,042	$79,714,961.76
May-06	23,581	$82,015,869.29
June-06	27,771	$97,085,724.60
July-06	21,432	$74,648,883.83

Bush Keeps Talking About Privatizing Social Security

It is hardly news anymore that President Bush speaks every chance he gets about privatizing Social Security. This is from a statement by the President at a bill signing on Thursday:

To ensure more secure retirement for all Americans we've got more work to do. We must also prepare for the impact of the baby boomer generation's retirement, and what that impact will have on federal entitlement programs like Social Security and Medicare. As more baby boomers stop contributing payroll taxes and start collecting benefits -- people like me -- it will create an enormous strain on our programs. Entitlement programs are projected to grow faster than the economy, faster than the population and faster than the rate of inflation. If we fail to act, spending on Social Security and Medicare and Medicaid will be almost 60 percent of the entire federal budget in the year 2030. And that's going to leave future generations with impossible choices: staggering tax increases, immense deficits or deep cuts in benefits.

We have an obligation to confront this problem now. The Secretary of Treasury understands what I'm telling the Congress: Now is the time to move; now is the time to do our duty. I'm going to continue to work with the Congress and call on the Congress to work with the administration to reform these programs so we can ensure a secure retirement for all Americans.

State Bar Of Michigan Social Security Newsletter

The Social Security Section of the State Bar of Michigan has issued its Summer 2006 newsletter. What may come as a surprise to attorneys in other states is that the Grand Rapids Hearing Office still copies Social Security files for attorneys who have hearings with that office.

An Interesting Old Story About Jo Anne Barnhart

Even with Jo Anne Barnhart's term as Social Security Commissioner ending in about four months, there is still interest in what sort of person she is, especially since she may be nominated for a second six year term as Commissioner. Here is an excerpt from an interesting old story from the Baltimore Sun about her, which came out at the time she was first nominated for the position:

Much of her career appears to have been shaped by her service to [former Republican Senator from Delaware] Roth, a former Senate Finance Committee chairman, for whom she worked off and on in several capacities since shortly after graduating from the University of Delaware in 1975.

Through the course of five Roth re-election campaigns and various stints on Roth's Senate staff, she developed into a fiercely protective senior adviser to the veteran lawmaker. She served him much as presidential counselor Karen Hughes serves President Bush, as chief spokesman and gatekeeper as well as a top tactician and alter-ego.

"She was intensely loyal to Roth and fiercely committed to [his] cause," said Brian Selander, press secretary to Delaware Democrat Thomas R. Carper, who defeated Roth last year in his bid for a sixth term at age 79.

Celia Cohen, a political writer who has covered Delaware politics for 20 years, called Barnhart "relentless."

The Roth campaign "was known as 'The Thrasher' because they just ground [rival candidates] up," said Cohen. "Jo Anne is very much a control person - nothing escaped her notice."

During the 1988 campaign, Cohen said, Barnhart was nine months pregnant with her son, Niles, and on the campaign trail full time. She left on a Friday, Cohen recalled, gave birth over the weekend and was in campaign headquarters directing traffic - with a days-old infant at her side - by Tuesday.

Public Citizen Lawsuit Dismissed

The lawsuit filed in the District of Columbia by Public Citizen claiming that the Deficit Reduction Act was unconstitutional because it was not passed in the same form by both houses of Congress has been dismissed. Among many other things, the Deficit Reduction Act made changes in the payment of back SSI benefits. The matter will now head to the Court of Appeals.

Filing Appeals By Telephone

Social Security has announced that appeals may now be filed by telephone. This is a significant step forward. In the past many claimants thought they had filed an appeal when they talked with Social Security on the telephone and were then shocked to discover that nothing happened on the appeal they thought they had filed -- because the telephone conversation was not an appeal, but merely a request for appeal forms that might or might not ever arrive, or which the claimant might or might not ever complete and return. This is effective immediately, although it is doubtful that many Social Security employees have been notified.

Debunking Social Security Myths

There are so many myths circulating on the internet concerning Social Security that the Social Security Administration has had to post information to try to set the record straight -- and the debunking has gone from one world wide web page to a second page. Snopes, a private service, also had one page and now a second page debunking these myths. All of these myths have a strongly anti-Social Security bias.