Disability Programs: SSA Consultative Medical Examination Process Improved; Some Problems Remain

Highlights

In response to a congressional request, GAO reviewed the Social Security Administration's (SSA) management of consultative examinations (CE) in its disability programs. GAO evaluated: (1) SSA ability to ensure the quality and reliability of examinations and reports; (2) SSA controls to ensure the necessity and appropriateness of CE purchases; and (3) the operations of major volume providers nationwide.

Recommendations

Recommendations for Executive Action

Agency Affected	Recommendation	Status
Department of Health and Human Services	The Secretary of Health and Human Services should direct the Commissioner of Social Security to require states that use volume providers to establish standards for controlling CE appointment scheduling and/or examination duration, preferably before the resumption of continuing disability reviews.	Closed – Implemented Revised regulations have not been officially signed.
Department of Health and Human Services	The Secretary of Health and Human Services should direct the Commissioner of Social Security to clarify SSA intent and provide specific direction to states on structuring systems for ongoing review of CE reports and require larger DDS to establish independent report review systems.	Closed – Implemented Revised regulations have not been officially signed.
Department of Health and Human Services	The Secretary of Health and Human Services should direct the Commissioner of Social Security to issue specific direction to SSA regional offices on how to conduct reviews of states' CE management plans and require them to reevaluate the plans to ensure that they have effective procedures for implementing each critical area of the CE process.	Closed – Implemented The comprehensive medical evidence effectiveness plan includes a multifaceted review of state CE management plans to ensure a consistent nationwide system of reviews.
Department of Health and Human Services	The Secretary of Health and Human Services should direct the Commissioner of Social Security to issue a comprehensive review guide to SSA regional offices for use in conducting annual and uniform comprehensive reviews of states' CE management activities.	Closed – Implemented Revised regulations have not been officially signed.
Department of Health and Human Services	The Secretary of Health and Human Services should direct the Commissioner of Social Security to monitor DDS implementation of the new requirements to pursue treating-source evidence to determine if additional controls are needed to prevent premature and unnecessary CE purchasing.	Closed – Implemented SSA does not believe that it is appropriate to limit the ordering of CE to any predetermined waiting period. Instead, SSA required that all regional offices and the quality assurance branches conduct quarterly on-site reviews of DDS CE ordering, including case reviews, to prevent premature and unnecessary CE purchasing.
Department of Health and Human Services	The Secretary of Health and Human Services should direct the Commissioner of Social Security to conduct a study to determine the effect of physician review of CE requests on the appropriateness of CE purchases and, if warranted, require that such reviews be mandatory for all DDS.	Closed – Implemented Revised regulations have not been officially signed.

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