Medicare Waiting Period Draws Attention

The Associated Press is running a story on the terrible human costs of the two year waiting period for Medicare after someone becomes eligible for Title II Social Security disability benefits. The story does not even mention that the waiting period is actually almost two and a half years for most disabled people, since the two year waiting period is on top of a five month waiting period for the cash disability benefits and those must be five full months. Here are a couple of excerpts from the story:

An estimated 1.8 million disabled workers are languishing in Medicare limbo at any given time. And about one out of eight dies waiting.

As many as one-third of those waiting are uninsured. ...

"The current law is really indefensible," said Sen. Jeff Bingaman, D-N.M. "There is no logic behind requiring people who are determined to be disabled to wait two years before they become eligible for Medicare." Bingaman introduced a bill to phase out the waiting period, and as a senator Obama co-sponsored it. ...

"When it comes to people dying of cancer, you can't help but be sympathetic," said Sen. Charles Grassley, R-Iowa. "But at a time when we have a big downturn in the economy, it may be questionable what can be done in a lot of these areas." Grassley, the senior Republican on the Senate committee that oversees Medicare, said he hasn't made up his mind about a repeal of the waiting period.

A possible compromise that could save taxpayers money would be to subsidize a continuation of employer coverage for disabled workers during the 24-month wait. Many can keep their benefits now, provided they pay the full premium, which not all can afford.

I do not recall Senator Grassley holding a hearing on repealing the Medicare waiting period when he was Chairman of the Senate Finance Committee and the economy was booming.

California Considers Cutting SSI Supplement

The federal government pays Supplemental Security Income (SSI) benefits to indigent people who are aged, blind or disabled. SSI was adopted in the 1970s and replaced earlier state programs. The federal SSI rate was lower than the benefits already available at that time in some states. Most, if not all, of those states chose to supplement the SSI benefits so that their indigent people who were aged, blind or disabled would not lose money because of the adoption of SSI. The state supplements are combined into one check or direct deposit sent by the U.S. Treasury.

California is one of those states that supplements SSI. The Sacramento Bee is reporting that because of its disastrous state budget situation the state of California is considering reducing its state supplement for SSI. If this happens, I am pretty sure that it will be the first time such a thing has been done. I have a feeling that this will not be the last time this issue comes up.

Occupational Information Development Advisory Panel

From today's Federal Register:

We are establishing the Occupational Information Development Advisory Panel (Panel) under the provisions of the Federal Advisory Committee Act (FACA). ...

Panel members will analyze the occupational information used by SSA in our disability programs and provide expert guidance as we develop an occupational information system (OIS) tailored for these programs. We plan to design the OIS to improve our disability policies and processes and to ensure up-to-date vocational evidence in our disability programs. We will select Panel members based primarily on their occupational expertise. This Panel will provide guidance on our plans and actions to replace the Dictionary of Occupational Titles and its companion volume, The Selected Characteristics of Occupations. We expect to tailor the OIS specifically for our disability programs. ...

The Panel will be composed of not more than 12 members, including: (a) Members of academia recognized as experts in relevant subject areas, such as occupational analysis, vocational assessment, and physical and occupational rehabilitation; (b) professional experts in relevant subject areas, such as vocational rehabilitation, forensic vocational assessment, and disability insurance programs; (c) medical professionals with experience in relevant subject areas such as occupational or physical rehabilitation medicine, psychiatry or psychology, and physical or occupational therapy; (d) professional experts who represent or advocate on behalf of the disabled claimants; and (e) an agency employee who has expertise in our disability program policies, processes, and systems. The Panel is continuing in nature. In accordance with the FACA, we will publish a notice of the first Panel meeting in the Federal Register.

This kicks any real decisions a few years down the road, which seems to be Social Security's strategy for dealing with its dirty little secret. The agency is basing decisions to deny claimants upon data that is decades old, data that everyone knows is unreliable and misleading. Newer data would almost certainly show that unskilled sedentary jobs have disappeared. My opinion is that the only way of forcing the agency to face up to its problem is through litigation.

Social Security Seeks Legislation To Allow Electronic Medical Release

From Social Security Update, an online newsletter from the Social Security Administration:

Each year Social Security makes more than 15 million medical record requests for disability applicants and beneficiaries. Social Security has been working diligently on ways to make the disability determination process go faster and smoother for applicants and all parties involved. Now, Social Security is working in collaboration with advocates and the Disability Determination Services (DDS) to get legislation passed that will streamline the medical release piece of the disability process.

Currently, when a person applies for Social Security or Supplemental Security Income, part of the application process is to have the applicant complete several medical release forms (SSA-827) which Social Security and DDS use to send to medical providers. Each time we need a piece of evidence from another source, we must send out another medical release form. Sometimes, it is required that we go back to the applicant to have additional releases signed which delays the process.

Expedited Records Request would make the process go much faster. Applicants will still be advised of the need to obtain medical records, but they will be asked to grant Social Security permission electronically instead of on a signed paper form. No additional evidence of authorization would be required for the provider to release the information to Social Security. The provision would also relieve providers of existing liability for disclosure of medical records to Social Security when they respond to a request.

AFL-CIO Calls For More Funding For Social Security

The Obama transition is posting documents and position papers it receives from organizations. The AFL-CIO has submitted a paper dealing with Social Security. They recommend a higher "replacement rate" for Social Security, that is higher Social Security benefits. That is unlikely to happen, but the AFL-CIO's justification is not without merit. Traditional pensions are disappearing. Most employer-based retirement plans now are defined contribution plans, such as 401Ks. Such plans do not guarantee retirement income in the way that traditional pensions do. Social Security benefits are more important than ever.

Of more immediate interest, AFL-CIO recommends higher funding for the Social Security Administration. It recommends achieving this by taking Social Security's administrative expenses "off-budget," so the agency's operating budget does not count against the unified federal budget. My guess, or perhaps hope, is that a number of other groups may recommend the same thing. AFL-CIO advises that Social Security's "focus on electronic filings and new requirements that claimants perform functions formerly provided by SSA staff should be reversed."

Somewhat embarrassingly, AFL-CIO told the transition team that "An immediate decision for the next President will be who should lead the Social Security Administration." Actually, no. While the new President can appoint a new Deputy Commissioner for Social Security, Michael Astrue can stay on as Commissioner of Social Security for another four years and, apparently, plans to do so.

SSAB Advice To Transition Team

The Social Security Advisory Board (SSAB) met recently with the Obama transition team for Social Security. The SSAB's written materials for this meeting are available on the SSAB website.

I hardly know how to describe the SSAB comments. They seem mostly to describe problems and issues at Social Security, but to provide few suggestions on what to do about them. Mostly, the comments suggest that Social Security needs to solve its problems by doing some sort of very smart reorganization. The SSAB has no idea what this very smart reorganization would look like, but Social Security has problems, so management at Social Security must come up with a very smart reorganization to solve the problems. There are vague hints at the possibility that SSAB thinks that the agency might just possibly need a few more warm bodies to get the work done, but these hints are submerged in a sea of this sort of thing:

SSA needs to develop a vision and focus on the integration of processes, investment in a modern technology platform, and development of a highly skilled and creative workforce. This is not merely tinkering around the edges—by addressing fundamental organizational change in these three areas—process, platform, and people, the agency has the potential to make the administration of the Social Security programs more effective in meeting the public’s demand for service.

This sort of drivel -- it sounds like something out of the comic strip Dilbert -- makes it hard to justify the continued existence of the SSAB.

Hearing Backlog Report

Social Security has posted its "Annual Report 2008 on The Plan to Eliminate the Backlog and Prevent Its Recurrence." Interestingly, the report is signed not by the Commissioner of Social Security, but by the outgoing Deputy Commissioner for the Office of Disability Adjudication and Review, Lisa de Soto. Should we ascribe any significance to this?

De Soto reports that "Fiscal Year 2008 was a tremendous year filled with impressive accomplishments" and, in a sense, it may have been since I am sure that everyone involved worked hard and some productivity gains were achieved, albeit usually at the expense of quality. However, the backlog still grew and that is the subject of this report, so it is hard to see how the last fiscal year could honestly be described as "tremendous."

The report predicts that the backlog will decline dramatically in coming years, but this prediction appears to be based upon an expectation of unprecedented increases in productivity.

Putting things in a positive light is one thing. Crowing about great successes when you have failed miserably is another. I do not know whether to call this spin or just fantasizing, but this report does not seem to be based upon reality -- a common complaint about the outgoing Bush Administration.

GAO Report On Medical Evidence Collection

From Collection of Medical Evidence Could Be Improved with Evaluations to Identify Promising Collection Practices, a report issued by the Government Accountability Office (GAO):

Obtaining timely and complete medical records is a challenge to DDSs [Disability Determination Services, state agencies who do disability determination for the Social Security Administration] in promptly deciding disability claims ... 14 of 51 DDSs reported the percentage of requests for which they did not receive records was 20 percent or more in fiscal year 2007. In response to this challenge, all DDSs conduct follow-up with providers and claimants to urge them to provide records. Over half of the DDSs (34 of 51) have also implemented more timely payments for records and six increased the amount they pay. ...

Recruiting and retaining qualified providers is a challenge to obtaining consultative exams needed to supplement insufficient medical records. For example, 41 of 51 DDSs reported routinely asking claimants' own providers to perform these exams; yet 34 reported providers never or almost never agree to do so. DDSs directors in our survey believe that current payment rates account for some of the difficulty recruiting and retaining consultative exam providers. In response to these challenges, 32 DDSs rely on medical providers who specialize in performing disability evaluations, and 20 pay providers for time spent preparing for appointments claimants fail to attend. SSA evaluates evidence from consultative exams, but these evaluations and the data they yield are too limited to identify and share promising DDS practices.

SSA has made progress moving to electronic collection of medical records, but faces challenges in fully implementing electronic retrieval and analysis of medical evidence. SSA now uses electronic images instead of paper copies of new claimants' records. Though SSA seeks to obtain all records electronically and provides options for online submission of records, only one large provider accounts for most of the records submitted online, and about half of all records received are on paper. To date, SSA has taken only limited action to identify and analyze the barriers providers face in using current electronic record submission options, and has not developed a strategy to address them. In the long run, SSA is participating in an advanced prototype to collect medical records in formats that can be searched and analyzed by electronically querying a hospital’s records database and directly retrieving the claimants’ records.