Concerns Over Proposed Mental Illness Listings Changes

From the Chicago Tribune:

Deep inside a 34-page proposed federal regulation are a few sentences that are causing nightmares for mental health advocacy groups.

The regulation, from the Social Security Administration, could change how people with mental illnesses are evaluated for disability payments.

The angst is over whether standardized testing will be required to determine such payments. The proposed regulation is not clear on that controversial subject. At one point is says standardized tests will not be required but then goes into detail on how the exams would be used to determine a person's fitness for work.

The confusion over the wording — and fears that it will be interpreted to require testing — has advocates by the hundreds calling in comments to the Social Security Administration, which will accept them until Wednesday....

"We don't have good tests for this, and the way they are describing how the tests would be used suggests the goal and likely effect is to dramatically reduce the number of people who are eligible for disability," said Mark Heyrman of the Mental Health Summit, a Chicago-based advocacy group. ...

Tom Yates, an attorney with Chicago's Health and Disability Advocates, has a benign interpretation of the proposed rules. He thinks Social Security wants only to clarify its expectations for the few times a standardized test might be used in a mental illness disability claim.

For the record, I have only mild concerns about this aspect of the proposal. In my mind there is a more serious problem that has to do with substituting the word "and" for the word "or." I will write more about this in the near future.

CBO Study On Social Security Disability

From a Congressional Budget Office (CBO) Study(footnotes omitted):

Between 1970 and 2009, the number of people receiving DI benefits more than tripled, from 2.7 million to 9.7 million. That jump, which significantly outpaced the increase in the working-age population during that period, is attributable to several changes—in characteristics of that population, in federal policy, and in opportunities for employment. In addition, during those years, the average inflation-adjusted cost per person receiving DI benefits rose from about $6,900 to about $12,800 (in 2010 dollars). As a result, inflation-adjusted expenditures for the DI program, including administrative costs, increased nearly sevenfold between 1970 and 2009, climbing from $18 billion to $124 billion (in 2010 dollars). Most DI beneficiaries, after a two-year waiting period, are also eligible for Medicare; the cost of those benefits in fiscal year 2009 totaled about $70 billion.

Under current law, the DI program is not financially sustainable. ... Without legislative action to reduce the DI program’s outlays, increase its dedicated federal revenues, or transfer other federal funds to it, the Social Security Administration (SSA) will not have the legal authority to pay full DI benefits beyond [2018].

NOSSCR Comments On Mental Impairments Listings Changes

The National Organization of Social Security Claimants Representatives (NOSSCR) has posted its comments on the proposed changes to Social Security's Mental Impairment Listings. Here are a few excerpts:

II. “B” Criteria Issues ...
[W]e have a significant concern about the language change in paragraph B3, which also applies to the newly proposed paragraph B1. As discussed below, SSA should use the word “or,” rather than “and.”

The NPRM [Notice of Proposed Rule-Making] proposes to change paragraph B to read as follows:

B. Marked limitations of two or extreme limitation of one of the following mental abilities:”
1. “Ability to understand, remember, and apply information”;
2. “Ability to interact with others”;
3. “Ability to concentrate, persist, and maintain pace”; and
4. “Ability to manage oneself.”

In the preamble to the NPRM, SSA explains the change from “or” to “and,” stating that it is not a substantive change from current policy, “but only a clarification of the overall requirement” ...

We are concerned that changing “or” to “and” in the actual listing could be misinterpreted as a change in policy that would set a higher standard so that a claimant would be required to demonstrate limitation in each of the three components of the proposed B1 or B3 criteria. We do not believe that this is what SSA intends by the proposed change in light of the statement above in the preamble ...

C. Use of standardized test scores and “standard deviations”

SSA proposes to incorporate provisions from the childhood SSI functional equivalence regulation, 20 C.F.R. § 416.926a(e), regarding the definition of “marked” and “extreme.” See 75 Fed. Reg. at 51342. This results in SSA defining “marked” and “extreme” in terms of standardized testing and standard deviations below the mean. Under this change, an individual could be found to have a “marked limitation” in one of the paragraph B criteria with a score that is at least two, but less than three, standard deviations below the mean on an individually administered standardized test designed to measure that ability. The individual could be found to have an “extreme limitation” with a score that is three standard deviations below the mean. ...

This is a flawed approach which should not be used in the listings for either adults or children with mental health disorders because, to date, no standardized instruments have been developed which measure the specific functions in the B criteria and are widely accepted by professionals in the field of assessment. ...

V. Listing 12.05: Intellectual Disability/Mental Retardation (ID/MR) ...
Claimants’ representatives know first-hand that some adjudicators will ignore or give less weight to IQ test scores if the adjudicators subjectively believe that the claimant’s functioning is inconsistent with the test score, even if there is no basis for rejecting the validity of the test score. We question this practice. The proposed criteria could support the practice of some state agencies and ALJs who deny cases because the claimant can cook, take care of personal needs, care for children, or shows some other skill or strength.

Comments on the NPRM must be filed by November 17.

Study On Accelerated Medicare Benefits For The Disabled

Social Security has released a new issue of the Social Security Bulletin, the agency's scholarly publication. One article is of particular interest for the long term. Social Security has been doing a demonstration project which has allowed a few people approved for Disability Insurance Benefits by Social Security to go on Medicare immediately without the brutal two year and five month waiting period. This is the first report on that project. Not surprisingly, those few who received early Medicare reported better health care.

Virginia Attorney Accused Of Misappropriating $450,000 In Social Security Fees

From the Richmond Times-Dispatch:

A Richmond attorney who was fired for theft this year from the law firm of Marks & Harrison has surrendered her law license after admitting to the Virginia State Bar that she misappropriated at least $450,000 from her former employer.

The case involving Kyle Cornelia Leftwich is now in the hands of Hopewell Commonwealth's Attorney Richard K. Newman, who said yesterday that he intends to seek criminal charges against Leftwich after the matter was referred to his office by the Virginia State Bar. Leftwich worked at Marks & Harrison as a disability-law specialist from September 1994 until her termination in June. ...

According to a disciplinary board affidavit, Leftwich's practice included representing disability claimants before the Social Security Administration. When she successfully concluded a claim, the government would issue a check for legal fees payable to her as the claimant's attorney.

Although the checks were made payable to her, they were the property of Marks & Harrison, in accordance with her employment agreement. Beginning in 2003, however, Leftwich began diverting some of these checks for her own use rather than delivering them to the law firm, the affidavit says. ...

Chamberlain, Edmonds Sold

I missed this story from the Atlanta Business Chronicle from September:

Emdeon will acquire Atlanta-based Chamberlin Edmonds & Associates for $260 million.

Nashville-based Emdeon, a health care information technology company, announced Monday it will buy Chamberlin Edmonds, whose software helps hospitals determine Medicaid eligibility. Chamberlin Edmonds' customers include more than 200 acute care facilities in 30 states.

As many readers know, Chamberlin, Edmonds provides representation on Medicaid disability cases that are closely related to Social Security disability claims.

Hypocritical?

The co-chair of the President's budget deficit commission, Erskine Bowles, is from my state, North Carolina. Bowles has a day job. Although he will be retiring shortly, he is President of the Consolidated University of North Carolina, meaning that he is in charge of 16 state colleges and universities which have about 200,000. students. North Carolina, like other states, has been hit hard by the ongoing recession. This has reduced tax revenues and created massive budgeting problems for all NC state agencies, including state colleges and universities. Given that Bowles seems largely unconcerned by the possibility of massive cuts in Social Security and Medicare, you would think that he would be hard at work cutting deeply into the budgets of the colleges and universities he controls, making the politically unpalatable decisions that must be made. You might think that but you would be wrong. Despite the fact that the state constitution requires that the legislature "shall provide that the benefits of The University of North Carolina and other public institutions of higher education, as far as practicable, be extended to the people of the State free of expense," Bowles has embarked upon massive tuition hikes at state colleges and universities.

By the way, I wish I could link to the "Erskine bowls" ad that Bowles ran during his race for the Senate in 2002, but alas, it is not available on youtube. The ad showed Erskine Bowles bowling. It was a feeble attempt to show that he had the common touch. It failed as did his Senate campaign.

The Real Problem

From Kevin Drum's blog:

I've been trying to figure out whether I have anything to say about the "chairman's mark" of the deficit commission report that was released today. In a sense, I don't. This is not a piece of legislation, after all. Or a proposed piece of legislation. Or even a report from the deficit commission itself. It's just a draft presentation put together by two guys. Do you know how many deficit reduction proposals are out there that have the backing of two guys? Thousands. Another one just doesn't matter.

But the iron law of the news business is that if people are talking about it, then it matters. So this report matters, even though it's really nothing more than the opinion of Alan Simpson and Erskine Bowles. So here's what I think of it, all contained in one handy chart from the Congressional Budget Office:

Here's what the chart means:

• Discretionary spending (the light blue bottom chunk) isn't a long-term deficit problem. It takes up about 10% of GDP forever. What's more, pretending that it can be capped is just game playing: anything one Congress can do, another can undo. So if you want to recommend a few discretionary cuts, that's fine. Beyond that, though, the discretionary budget should be left to Congress since it can be cut or expanded easily via the ordinary political process. That's why it's called "discretionary."
• Social Security (the dark blue middle chunk) isn't a long-term deficit problem. It goes up very slightly between now and 2030 and then flattens out forever. If Republicans were willing to get serious and knock off their puerile anti-tax jihad, it could be fixed easily with a combination of tiny tax increases and tiny benefit cuts phased in over 20 years that the public would barely notice. It deserves about a week of deliberation.
• Medicare, and healthcare in general, is a huge problem. It is, in fact, our only real long-term spending problem.

To put this more succinctly: any serious long-term deficit plan will spend about 1% of its time on the discretionary budget, 1% on Social Security, and 98% on healthcare. Any proposal that doesn't maintain approximately that ratio shouldn't be considered serious. The Simpson-Bowles plan, conversely, goes into loving detail about cuts to the discretionary budget and Social Security but turns suddenly vague and cramped when it gets to Medicare. That's not serious.