Appropriations Situation

I hate to yank your chain, but this is from The Hill:

Senate Majority Leader Harry Reid (D-Nev.) cautioned Republicans Monday against forcing a government shutdown over expanded oil drilling ...

With no appropriations bills signed by President Bush, lawmakers’ chief task this month is to pass a stopgap measure to fund the federal government in the fiscal year beginning Oct. 1.

Republicans are mulling whether to press the offshore oil drilling fight by blocking the funding resolution, which contains the congressional moratorium on such drilling.

Reid reminded the GOP that its government shutdown led by former House Speaker Newt Gingrich (R-Ga.) during the Clinton administration was met with widespread public disapproval.

Hearing On Social Security Hearing Office Performance

An announcement from the House Social Security Subcommittee:

Congressman Michael R. McNulty (D-NY), Chairman, Subcommittee on Social Security of the Committee on Ways and Means, today announced that the Subcommittee will hold a hearing on the performance of the Social Security Administration’s (SSA’s) appeals hearing offices. The hearing will take place on Tuesday, September 16, 2008, in room B-318 Rayburn House Office Building, beginning at 10:00 a.m.

In view of the limited time available to hear witnesses, oral testimony at this hearing will be from invited witnesses only. However, any individual or organization not scheduled for an oral appearance may submit a written statement for consideration by the Subcommittee and for inclusion in the printed record of the hearing.

BACKGROUND

Over the past several years, SSA’s disability claims backlogs have grown to unprecedented levels, with more than 1.3 million Americans currently awaiting a decision regarding their claim. Backlogs are particularly severe for the more than 765,000 Americans who have had their cases denied at an earlier stage of the process and have requested a hearing before an Administrative Law Judge (ALJ). These individuals now wait an average of 532 days for a decision on their appeal. Recognizing the central role that prolonged underfunding and staffing shortfalls have played in the development of these backlogs, in combination with rising workloads, last year Congress provided SSA with $150 million more in administrative funding than the President had requested – the first such increase in ten years.

The Subcommittee has examined the backlog crisis from a number of perspectives, including the need for more administrative funding and adequate staffing, the agency’s ability to hire more ALJs to hear disability appeals, proposals to improve the disability determination process, and initiatives that SSA has undertaken to reduce the backlog. This hearing will focus on the performance of SSA’s hearing offices and SSA’s overall management of these offices.

SSA’s hearing process is an important one for claimants, as new medical and other available evidence is added to their claim and they have the opportunity to meet face-to-face with the judge who is deciding their claim. Approximately two-thirds of those who appeal to the ALJ level are awarded benefits. However, the process is very labor intensive for SSA, typically requiring clerical staff to prepare the case file, obtain evidence and schedule the hearing with all necessary experts and other participants; ALJs to review the case, conduct the hearing, and make a decision; and attorneys or paralegals to draft the decision and accompanying legal rationale for it, based on the judge’s instructions.

According to a recent report from SSA’s Inspector General (IG), the productivity of SSA’s hearing process has improved in recent years. In 2005, SSA produced 421 dispositions per ALJ. By 2007, productivity had increased by 13 percent, to 474 dispositions per ALJ. However, hearing office performance varies significantly between offices. The IG found that productivity was often hindered by a lack of hearing office support staff, a conclusion the IG had also reached in a March 2005 report. Interviews with ALJs and hearing office staff also identified other factors that could affect productivity, including the use of a number of techniques to promote speedier processing (such as spending less time reviewing the case and conducting the hearing). Finally, the IG found that a small number of ALJs – approximately 1 percent – processed fewer than 200 cases per year even though they were employed as full-time adjudicators. At the same time, the IG reported that some judges – about 2 percent – issued more than 1,000 decisions in a year. This could raise concerns about the quality of these decisions.

As concern about the backlog has grown, SSA has undertaken a number of initiatives to improve the productivity of its hearing offices, including hiring more ALJs and support staff; reinstituting the Senior Attorney adjudication program to allow judges to focus on more difficult cases; developing automation improvements; and asking judges to issue 500-700 decisions per year. However, concerns have been expressed that the agency’s plans for hiring support staff are not sufficient to address the large hearings backlog, that planned automation improvements will not meet expectations, and that an overemphasis on speed could degrade quality or compromise program integrity.

In announcing the hearing, Chairman McNulty said, “Earlier hearings have demonstrated that prolonged underfunding has resulted in the loss of staff needed to process disability cases at the Social Security Administration. This has led to an unprecedented backlog of unprocessed claims and untold suffering. The agency must have the resources it needs to eliminate this unconscionable backlog. At the same time, we must ensure that SSA uses these resources as effectively as possible. This hearing will examine SSA’s management of its hearing offices, and explore measures that can be taken to improve productivity without compromising the right of claimants to a fair and impartial decision on their case.”

FOCUS OF THE HEARING

The hearing will focus on the performance of SSA’s hearing offices, factors that affect productivity, initiatives SSA is taking to increase efficiency and productivity, and other approaches to improving productivity without compromising the quality and impartiality of decision-making or the due process rights of claimants.

Raleigh Field Office Evacuated

The Raleigh, NC Social Security field office was evacuated this morning due to a powdery white substance found enclosed in an envelope. Probably nothing to it, but they have to be careful.

Average Patient On Liver Transplant List Doesn't Come Close To Meeting Listing

The Social Security Administration adopted new digestive system listings last October. The liver is part of the digestive system and is covered in the new listings. One of the ways to meet the liver listings is something labeled as the "SSA CLD" (Social Security Administration Chronic Liver Disease) score. This is computed using a complicated formula. The SSA CLD formula is the same as what is generally known in medicine as the MELD (Model for End-Stage Liver Disease) score.

I have wondered why Social Security wanted to avoid using the term MELD. My guess is that they did not want people thinking that one had to be in "End-Stage Liver Disease" to meet the listing. That just sounds so extreme.

The listing requires a SSA CLD (or MELD) score of 22 or higher to meet the listing. A recent issue of the New England Journal of Medicine has an article on liver disease. You can only read the abstract online, but the whole article includes a table showing that the median MELD score for those on the waiting list for a liver transplant is 15. One short quote from the article: "On average, the risk of death increased by 21% ... per unit increase in the MELD score." Not only must one be in end-stage liver disease to meet the listing on the MELD score; one must be well into end-stage liver disease and at great risk of death.

Where did the listing requirement of a MELD score of 22 come from? Why not 20 or 18 or 15? Did someone try to figure out how many more people would qualify if the MELD score requirement were lower and how much that would cost? Did someone try to figure out how many more expensive liver transplants Medicare would have to pay for if a lower MELD score was used? As it is now, people in end stage liver disease under age 65 are unlikely to live long enough to qualify for Medicare. Was the Office of Management and Budget involved in setting the MELD score requirement? Was someone thinking "Oh, the hell with them. Most of them are alcoholics anyway." You have to wonder how comfortable the physicans involved in creating this listing are with the requirement of a MELD score of 22.

Poll

Free Web poll for your Web site - freepolls.com

New Edition Of My Book Available

West Publishing has released the 2008 edition of my book, Social Security Disability Practice. You can take a look at the table of contents online.

Debit Cards

In case you were wondering what the new debit cards through which Social Security beneficiaries can receive their benefits look like, here you go.

Updated Fee Payment Stats

The Social Security Administration has posted updated data on payments of fees to attorneys and others for representing Social Security claimants. Since the attorney and client are paid at about the same time, this is a useful analog for speedups and slowdowns in benefit payments to claimants. You can certainly see evidence in these numbers that these payments are far from steady.

Payment delays are tough for claimants. The ups and downs also make for a stomach churning ride for those who represent claimants. If you work at Social Security and have ever thought about leaving to represent Social Security claimants, take a close look at these numbers before giving up that regular paycheck. This is one of the reasons that very few Social Security Administration employees leave the agency to represent claimants.

Fee Payments
Month/Year	Volume	Amount
Jan-08	20,559	$75,368,163.45
Feb-08	26,570	$95,228,284.32
Mar-08	23,088	$83,166,027.02
Apr-08	27,296	$98,616,579.78
May-08	29,305	$104,283,373.35
June-08	25,243	$89,786,459.83
July-08	22,238	$77,346,266.77
Aug-08	33,834	$120,819,791.05