OIG On Compassionate Allowances And Quick Disability Determinations

     The summary of a recent report by Social Security's Office of Inspector General:

Although 25 percent of allowed claimants in our sample [who were granted a Compassionate Allowance or Quick Disability Determination] died within 3 months of submitting their application, SSA’s CAL [Compassionate Allowance] and QDD [Quick Disability Determination] initiatives enabled the Agency to identify and expedite benefits to these disabled claimants before their death.

Based on our review, we estimated that SSA medically allowed about 76,000 and denied about 6,000 cases. As of June 2015, we estimated that, of the cases selected for CAL and QDD processing, about 

• 54,000 claimants were deceased; 
• 15,000 claimants allowed benefits were alive, were in current pay status, and had received approximately $214.1 million in benefits per year;
• 7,000 claimants allowed benefits were alive but did not meet Title XVI non - medical eligibility criteria. SSA stopped the ir Title XVI payments of approximately $34 million per year; 
• 3,000 claimants allowed had benefits ceased because of medical improvement, stopping payments of approximately $46.1 million per year; and 
• 3,000 claimants denied benefits, appealed or reapplied, and were subsequently approved. 

In addition, we estimated that, for about 13,000 claimants previously allowed benefits, SSA assessed approximately $43.9 million in overpayments and recovered approximately $15.9 million. Finally, we estimated that SSA reviewed approximately 22,000 allowance cases by conducting a CDR or redetermination and generally evaluated earnings for disabled individuals whose record contained work activity or income.

OIG On "Vision 2025"

     The Chairman of the House Social Security Subcommittee asked the agency's Office of Inspector General (OIG) to review Social Security's Vision 2025 plan. Here's a summary of the OIG report:

Vision 2025 does not include specific, measurable goals or outline the strategy needed to implement SSA's proposed vision. It presents three priorities: superior customer experience, exceptional employees, and innovative organization. Per SSA, these priorities will guide the development of clear goals, detailed plans, and performance measures, which will be outlined in the Agency’s strategic plans and annual performance reports. With this approach, SSA is using short-term strategic planning documents to support a broadly stated “aspirational vision.” We believe SSA’s long-term strategic vision should include specific, measurable goals that clearly outline the service delivery model SSA envisions in 2025 and beyond. This would allow SSA to use its shorter- term planning documents to outline the steps needed to achieve a larger and clearly defined objective.

Also, while Vision 2025 describes its future environmental drivers, it does not explain how the environmental factors will affect its ability to provide services in the future. Additionally, Vision 2025 addresses many of the issues outlined in NAPA’s [National Academy of Public Administration's] long-range strategic plan for SSA, but NAPA’s plan is more specific than Vision 2025. Most importantly, NAPA concluded that SSA needs to develop a more cost- effective service delivery system that is primarily virtual. Vision 2025 does not choose one service delivery method over another and promises a service delivery system that will meet each customer’s desire.

     Let me try to make this easier to understand. Republicans in Congress (and some Democrats) as well as NAPA are frustrated with Social Security. In their view, the current service delivery model, which includes field offices around the country, is inefficient, wasteful and delivers poor service. They don't understand why the agency doesn't move all of its operations online, eliminate its field offices and lay off most of its staff.  That's the "vision" they want from the agency. In Social Security's view, this criticism comes from people who have only the most simplistic idea of what the agency does. These critics envision Social Security as dealing mostly with simple retirement claims and mostly with capable people who can do business online. In reality, while retirement claims involve lots of money and lots of claims, they are only a small part of what the agency does. Most of what the agency does has to do with disability claims, Supplemental Security Income (SSI) claims and survivor claims. These cases are inherently complicated and the claimants are often seriously impaired. There's no realistic way to put this workload online. There's no realistic way to eliminate field offices.
     Let my give a simple example of the problems that Social Security must cope with. The daughter of an 85 year old woman who is drawing Social Security retirement benefits contacts the agency to say that she believes that her mother is no longer mentally capable of handling her money and needs a representative payee. Someone at the agency contacts the mother who says that she certainly is still capable of handling her money and that the daughter is a drug addict who just wants to steal the Social Security benefits. The person talking with the mother and daughter isn't sure what to do. The mother sounds a little addled but is her condition so bad that she can't handle money? Is the daughter a drug addict? Even if she isn't, is she the best representative payee since it's obvious that the mother and daughter aren't getting along? Is there someone else in the family who could be a representative payee? How is the agency going to deal with this situation only through an online process? Are you really comfortable with someone who is 3,000 miles away investigating this situation and making a decision about what to do? How would you feel about this if this situation was happening in your family?

But What About The Role Of Congress?

     From the summary of a report by the Government Accountability Office (GAO):

The Social Security Administration (SSA) selects cases for continuing disability reviews (CDR) using several inputs, but it does not do so in a manner that maximizes potential savings. SSA first prioritizes CDRs required by law or agency policy such as those for children under 1 year old who are receiving benefits due in part to low birth weight. Then SSA uses statistical models to identify the remaining CDRs to be conducted each year. The models also determine which cases will receive an in-depth review of medical records by the Disability Determination Services—the state agencies that conduct CDRs—versus a lower-cost questionnaire sent directly to the beneficiary. As shown in the figure below, a growing number of cases have been set aside for future review (backlogged) over the last 10 years. Although SSA somewhat considers potential cost savings when selecting cases for in-depth reviews, its approach does not maximize potential savings for the government. For example, estimated average savings from conducting CDRs are higher for some groups of Disability Insurance (DI) beneficiaries than others, but SSA's selection process does not differentiate among these groups. As a result, it may be missing opportunities to efficiently and effectively use federal resources.

     I would characterize Social Security's response as being "GAO, to the extent it's practical, we're already doing everything you're recommending."

     My response is "GAO, you're picking at nits. The real problem is that the agency has been so badly underfunded that it's unable to work down its backlogs."

Proposed Change To Unsuccessful Work Attempt Rules

     The Social Security Administration has asked the Office of Management and Budget (OMB) to approve a set of amendments to its regulations concerning unsuccessful work attempts and expedited reinstatement. Social Security does not have to release the proposal at this point. However, it does have to post a regulatory agenda in the Federal Register twice a year. Here's how the agency described this proposal last fall:

We propose to remove the additional requirements for evaluation of a Unsuccessful Work Attempt (UWA) in employment or self-employment that last between 3 and 6 months and use the current 3 month standards for all work attempts that are 6 months or less. We also propose to change the calculation for determining the amount adjusted for national wage growth for both employees and the self-employed from $530 to $700, the amount currently being used to calculate Substantial Gainful Activity (SGA). In order to avoid any unintended consequences for Ticket to Work (Ticket) holders as a result of our change to the calculation of the Trial Work Period (TWP) service month amount, we propose to change how we calculate timely progress toward self-supporting employment for the Ticket program to earnings equal to or greater than the amount representing 72 percent of SGA. Finally, we propose to allow beneficiaries to apply for Expedited Reinstatement (EXR) Eligibility in the same month they stop performing SGA. These changes would align our policies, make them easier for the public to understand, and simplify our processing procedures, thereby allowing for faster determinations.

     This proposal isn't going to be official for a long time. OMB must approve it. The proposal is then posted in the Federal Register for comments. Social Security must consider the comments. The agency may modify the proposal. If it still wants to go ahead with the proposal, it submits the final version to OMB again. If OMB approves the proposal, it is again published in the Federal Register and becomes official. The normal time frame for something like this is one to two years.

Will The Time Ever Come When Recon Is Eliminated?

     Professor Jon C. Dubin of Rutgers School of Law -- Newark Center for Law and Justice has written an article for the Georgetown Journal on Poverty Law and Policy on ending the reconsideration level of review for Social Security disability claims. That article itself isn't available online at this time but an earlier draft of the piece is available at the Committee for a Responsible Federal Budget website.

     There are excellent reasons why "recon" should be eliminated. The problems with doing away with reconsideration, in the view of Social Security and Congress, are:

• If reconsideration is eliminated, more claimants will request hearings. At this time, both Social Security and Congress view hearings as inherently a bad thing.
• If more hearings are to be held, more Administrative Law Judges would have to be hired. At this time, both Social Security and Congress view Administrative Law Judges as sources of error.
• If more hearings are to be held, more claimants will be approved. The goal of both Social Security and Congress is to hold down the number of disability claims approved.
• More Administrative Law Judges would cost more money, far more than would be saved by doing away with reconsideration.

     I first became involved with Social Security disability in 1978. Doing away with reconsideration wasn't a new idea at the time. It's never come close to happening since that time. I regard it as a nice idea that stands no chance of happening in the foreseeable future.

Florida Man Alkeged To Have Stolen $2.2 Milllion In Social Security Checks

     From the Tampa Tribune:

A Tampa postal employee has been charged in a scheme involving more than $2.2 million in stolen Social Security checks, the U.S. Attorney’s Office said today.  

If convicted on the charges of theft of government property and theft of mail. Stacy Darnell Mitchell, 48, faces up to 15 years in prison, the office said.

Appeals Council Slides Further Into Worthlessness

     David Paletta has put together an interesting chart showing what's been happening at Social Security's Appeals Council in recent years. What's mostly been happening is that the rate at which the Appeals Council is giving relief to the claimant, either by remand or reversal, has plummeted. Click on the chart below to view it at full size. Also, though not shown on the chart below, productivity has declined from 138,262 decisions in 2013 to 116,078 in 2015.

Waiver For SSI Overpayments Resulting From Legal Acceptance Of Same Sex Marriage

     Social Security has issued Emergency Message (EM) 16013 to give its staff instructions on overpayment issues resulting from legal acceptance of same sex marriage. Some readers are now thinking "Wait, what? I thought legal acceptance of same sex marriage would result in more money being paid." Overall, yes, somewhat more money will be paid. That's almost always the case for Title II benefits, those based upon someone's earnings record. (For sticklers, I said almost always. I know marriage could eliminate entitlement to widows benefits in some cases, for instance.) However, in Supplemental Security Income (SSI), which is a needs-based benefit, marriage usually causes reduction or elimination of entitlement to benefits. There are two ways that same sex marriage can hurt SSI recipients. The first and less common way is if both partners to a same sex marriage are on SSI. The rate for a married couple where both are eligible for SSI is less than the total of what the two would receive if they were not married. The second and more common way that same sex marriage can reduce SSI benefits is that if you're married the income and resources of the person you're married to are attributed to you for purposes of computing your SSI benefit. If, for instance, a disabled person is living with and being supported by a healthy person who is working and has a good income, if they're not married, the disabled person will suffer, at worst, a one-third reduction in his or her SSI benefits for "living in the household of another" whereas if they're married, the disabled person will lose his or her SSI benefits altogether.

     Now that I've explained the problem, what's Social Security going to do about the SSI overpayments resulting from legal acceptance of same sex marriage? Social Security will assume that the claimant is requesting waiver of the overpayment and will waive the overpayment. The claimant need not even file the form normally required to obtain consideration of waiver of an overpayment. The agency is saying it would be "against equity and good conscience" to try to collect these overpayments.