Ssi We May Set Aside Review of Medical Condition
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What GAO Constitute
The Social Security Assistants (SSA) selects cases for continuing disability reviews (CDR) using several inputs, but it does not do then in a manner that maximizes potential savings. SSA first prioritizes CDRs required by police force or agency policy such equally those for children under i year old who are receiving benefits due in function to low nascence weight. Then SSA uses statistical models to identify the remaining CDRs to be conducted each year. The models besides determine which cases will receive an in-depth review of medical records by the Disability Determination Services—the land agencies that deport CDRs—versus a lower-cost questionnaire sent directly to the beneficiary. As shown in the figure below, a growing number of cases take been set aside for time to come review (backlogged) over the final ten years. Although SSA somewhat considers potential cost savings when selecting cases for in-depth reviews, its approach does not maximize potential savings for the authorities. For instance, estimated average savings from conducting CDRs are college for some groups of Disability Insurance (DI) beneficiaries than others, simply SSA's option process does not differentiate among these groups. As a upshot, it may exist missing opportunities to efficiently and effectively use federal resources.
CDRs Completed and Backlogged by SSA, Fiscal Years 2003-2013
SSA reviews a sample of CDRs for quality, just its analysis and reporting of errors is not comprehensive. Specifically, SSA randomly selects CDR decisions to bank check for a variety of potential errors. For example, SSA regularly monitors and reports on the frequency of errors that affect whether benefits are connected or ceased. However, reverse to federal internal control standards, SSA does non systematically clarify errors to find and address root causes. Consequently, SSA lacks information that could assistance improve the quality of the reviews conducted by the Inability Determination Services. Further, in determining CDR accuracy rates, SSA does not count appointment errors, including incorrect cessation dates, which can affect disability benefit payments. As a consequence, decision makers practise not have a complete movie of the CDR errors that touch on disability payments.
Why GAO Did This Written report
To aid ensure that only eligible individuals receive disability benefits, SSA conducts periodic CDRs to assess beneficiaries' medical status. CDRs accept historically saved the government money. However, in contempo years, SSA has had difficulty conducting timely CDRs resulting in a backlog of over 900,000 CDRs in fiscal year 2014. With this backdrop, GAO was asked to report SSA's power to conduct and manage timely, high-quality CDRs.
This written report evaluates, amidst other things, how SSA selects which CDRs to carry and the extent to which SSA reviews the quality of CDR decisions.
GAO analyzed CDR data for fiscal years 2003 through 2013 (the almost contempo year for which consummate data were bachelor); assessed SSA's models used to prioritize CDRs; reviewed relevant federal laws, regulations, and SSA documentation about CDR prioritization and accuracy review procedures; and interviewed SSA and state Disability Decision Services officials.
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Recommendations
GAO recommends SSA, among other things, further consider toll savings as office of its prioritization of CDRs, analyze the root causes of CDRs with errors, and track date errors. SSA agreed with most of GAO's recommendations, but disagreed that there is a demand to track date errors and to adjust its approach to sampling CDRs for quality review. GAO maintains actions are warranted and feasible as discussed in the written report.
Recommendations for Executive Action
| Agency Affected | Recommendation | Condition |
|---|---|---|
| Social Security Administration | The Interim Commissioner of Social Security should straight the Deputy Commissioner of Operations to further consider cost savings as function of its prioritization of full medical reviews. Such options could include considering the feasibility of prioritizing different types of beneficiaries on the basis of their estimated average savings and, as advisable, integrating case-specific indicators of potential cost savings, such as beneficiary historic period and benefit amount, into its modeling or prioritization procedure. | As of Baronial 2020, SSA completed an evaluation of alternative methods that further consider cost savings every bit part of its prioritization of full medical reviews. It considered the expected net present value of lifetime savings from a cessation on an individual basis for Supplemental Security Income and Inability Insurance benefits recipients. SSA so combined these expected lifetime savings with models that predict the likelihood of a cessation given a full medical review to yield an expected savings score. SSA considered a variety of prioritization methods using the expected savings score and ended that no method produced an estimated increment in full federal savings that was significant enough to justify modifying its current procedure. |
| Social Security Assistants | The Acting Commissioner of Social Security should direct the Deputy Commissioner of Budget, Finance, Quality, and Direction to complete a re-interpretation of the statistical models that are used to prioritize CDRs and make up one's mind a plan for re-estimating these models on a regular footing to ensure that they reflect electric current conditions. | In July 2016, SSA re-estimated the statistical models that information technology uses to prioritize CDRs. In fiscal year 2019, SSA determined a programme for because re-estimating the models on a regular basis to ensure that they continually reverberate current conditions. |
| Social Security Administration | The Acting Commissioner of Social Security should directly the Deputy Commissioner of Budget, Finance, Quality, and Management to monitor the characteristics of CDR errors to identify potential root causes and study results to the Disability Determination Services. For instance, SSA could analyze CDRs with and without errors to identify trends by impairment, beneficiary type, or other characteristics. | SSA agreed with this recommendation and stated that information technology reports all errors to the relevant DDS for cosmetic action. SSA further stated that its identification of root causes is limited past the relatively few reviewed CDRs that take errors. Nonetheless, in financial year 2014 as an example, SSA identified over 600 CDRs with errors. Although these CDRs make upward a modest percent of the CDRs reviewed by SSA that twelvemonth, the agency could analyze the characteristics of CDRs with errors by comparing relevant percentages without modeling. In addition, SSA could combine data from multiple years if information technology determined that because more CDRs with errors would be helpful. In 2020, SSA stated that it does not plan to analyze CDR errors because of the depression volume. |
| Social Security Administration | The Acting Commissioner of Social Security should direct the Deputy Commissioner of Budget, Finance, Quality, and Direction to regularly track the number and rate of appointment errors, which can affect benefit payments (e.g., wrong cessation dates), and consider including those errors in its reported CDR accurateness rates. | SSA disagreed with this recommendation and stated that, per SSA regulation, the agency does not consider date errors when computing accuracy rates because date errors do not affect the determination to cease or go on benefits. SSA also stated its stewardship reviews examine the not-medical quality of benefit payment decisions. Even so, these reviews are non focused on CDRs, and SSA does not report results from them for CDRs specifically. SSA besides explained that it does not rails the number and rate of engagement errors considering they are exceptional. Still, SSA'south regulations do not prevent the agency from tracking date errors, and until information technology does, SSA cannot definitively determine the frequency of these errors. In improver, we found that considering date errors substantially reduced some states' estimated CDR accuracy rates. Without tracking these errors, SSA cannot appraise their effect and consider whether including them in its reported CDR accurateness rates has merit. In FY2020, the agency connected to disagree with this recommendation and does not program to implement information technology. |
| Social Security Administration | The Acting Commissioner of Social Security should directly the Deputy Commissioner of Upkeep, Finance, Quality, and Management to adjust its approach to sampling CDRs to efficiently produce reliable accuracy rate estimates for continuances and cessations separately in each state. | SSA disagreed with this recommendation and stated that some states do not generate enough CDR decisions, particularly cessations, to generate statistically valid samples. Even so, for states with CDR samples that are consistently also small to produce reliable results, SSA could, for case, pool decisions from more months than it currently does to generate statistically valid samples by state. Conversely, for states with CDR samples that are consistently larger than necessary to efficiently accomplish reliable results, SSA could, for example, reduce sample sizes. Because CDR accurateness rates vary by country and cessations are consistently less accurate than continuances, nosotros maintain that SSA should adjust its approach to sampling CDRs. In FY2020, the agency connected to disagree with this recommendation, noting that they would have to acquit a 100 percent review of the cases, which would be highly resource intensive and provide limited additional value to CDR QA accuracy reporting. |
| Social Security Assistants | The Acting Commissioner of Social Security should directly the Chief Actuary to conduct sensitivity analyses on SSI and DI's contributions to CDR cost savings estimates and written report the results reflecting a range of inputs (e.g., from optimistic to pessimistic). | SSA agreed with this recommendation and provided prove that it conducts sensitivity analyses on SSI and DI's contributions to CDR cost savings estimates and reports the results reflecting a range of inputs. |
| Social Security Administration | The Interim Commissioner of Social Security should directly the Chief Actuary to amend certificate the methods including data sources, assumptions, and limitations that cistron into its estimates of CDR cost savings. | SSA agreed with this recommendation. As of June 2020, SSA documented its interpretation methodology and assumptions for Social Security Disability Insurance CDR price savings. In July 2020, SSA documented its methods for corresponding Supplemental Security Income estimates. |
Full Written report
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Source: https://www.gao.gov/products/gao-16-250
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