Social Security:

New Continuing Disability Review Process Could Be Enhanced

HEHS-94-118: Published: Jun 27, 1994. Publicly Released: Jun 27, 1994.

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Pursuant to a congressional request, GAO reviewed the Social Security Administration's (SSA) new continuing disability review (CDR) process, focusing on: (1) the reliability of beneficiary self-reported data; (2) SSA procedures for determining when to do full medical CDR; (3) the cost of the new mailer process compared with the cost of the historical CDR process; and (4) SSA plans to further evaluate its continuing disability determinations.

GAO found that: (1) the previous CDR process was labor-intensive but cost-effective, despite a 94-percent continuing eligibility rate; (2) in recent years, SSA has reduced the number of CDR because of a large increase in new applicants and budget constraints; (3) SSA experience with the new CDR process has shown that beneficiary self-reported data are reliable when used with other key SSA information; (4) SSA has established reasonable procedures for determining when to do full medical examinations; (5) SSA is taking further steps to assess the reliability of self-reported data and will continue to refine its use of computerized beneficiary data to predict medical improvement and benefit terminations; (6) the mailer process costs $23.50 per case versus the average $1,000 cost of full medical CDR; (7) SSA continues to fall short of the number of CDR required by law; and (8) SSA could save the disability trust fund millions of dollars annually and preserve the program's integrity by removing ineligible beneficiaries.

Status Legend:

More Info
  • Review Pending-GAO has not yet assessed implementation status.
  • Open-Actions to satisfy the intent of the recommendation have not been taken or are being planned, or actions that partially satisfy the intent of the recommendation have been taken.
  • Closed-implemented-Actions that satisfy the intent of the recommendation have been taken.
  • Closed-not implemented-While the intent of the recommendation has not been satisfied, time or circumstances have rendered the recommendation invalid.
    • Review Pending
    • Open
    • Closed - implemented
    • Closed - not implemented

    Matter for Congressional Consideration

    Matter: Congress should develop an alternative means to provide SSA more funds for CDR activities because the funding of these activities results in substantial program cost savings.

    Status: Closed - Implemented

    Comments: The 104th Congress established a new funding mechanism for CDRs and authorized up to an additional $2.7 billion for CDRs through FY 2002 over regular administrative funding. The new mechanism makes funds available for 7 years for CDRs from the Old-Age and Survivors Insurance Trust Fund and the Federal Disability Insurance Trust Fund.

    Recommendations for Executive Action

    Recommendation: The Commissioner of Social Security should continue to examine ways to refine the CDR process to optimize SSA resources, eliminate the CDR backlog as soon as possible, and do CDR on beneficiaries when scheduled.

    Agency Affected: Social Security Administration

    Status: Closed - Implemented

    Comments: SSA has improved the process for identifying which beneficiaries should undergo full CDRs and has planned improvements over the next 2 years that will further increase its ability to identify beneficiaries who should undergo a full CDR. Also, SSA has plans to conduct over 8 million CDRs between FY 1996 and FY 2002, which is twice as many CDRs as the agency has conducted over the past 20 years combined.

    Recommendation: The Commissioner of Social Security should increase the number of full medical CDR on both disability insurance and supplemental security income beneficiaries.

    Agency Affected: Social Security Administration

    Status: Closed - Implemented

    Comments: The 103rd Congress mandated that SSA conduct at least 100,000 CDRs in the SSI Program, and the 104th Congress increased the amounts authorized for CDRs in both the SSI and DI Programs through FY 2002. In response to the congressional mandate, SSA dramatically increased the number of full SSI CDRs in FY 1996; the number done in FY 1996 exceeds the total of all SSI CDRs done in FY 1991 through FY 1995. The number of DI CDRs has also increased. Further, SSA has plans to conduct over 8 million CDRs between FY 1996 and 2002, which is twice as many CDRs as the agency has conducted over the past 20 years combined.

    Recommendation: The Commissioner of Social Security should focus full medical CDR primarily on those beneficiaries determined to have the highest potential for showing medical improvement.

    Agency Affected: Social Security Administration

    Status: Closed - Implemented

    Comments: SSA has developed and refined a profiling system to determine which recipients have the highest probability of recovery. As a result, it only selects those recipients for full medical reviews that are most likely to be taken off the rolls.

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