DISABILITY REDESIGN--OVERVIEW AND STATUS

Goals of the New Process

The redesigned process replaces an existing process that is slow, labor-intensive and paper reliant with a seamless claims process that makes better use of technology, eliminates fragmentation and duplication, promotes more flexible use of resources and results in significant improvements to public service. The redesign objectives are:

providing a user-friendly process for claimants and those who assist them;
allowing claims that should be allowed at the earliest possible level;
making and effectuating decisions quickly;
developing an efficient process; and
providing a satisfying work environment for employees.

Redesign Assessment (Narrowing the Issues/Sharpening the Focus)

The original redesign vision was created at a "50,000 foot level" and set forth an ideal process. Following release of the original plan, implementation efforts and development began. After two years, a great deal was accomplished in terms of planning and identifying what is really necessary to implement the redesign vision. During that time, several redesign tests began--a significant process unification training effort was completed, and preliminary work began in research and systems development.

However, dramatic changes had not occurred which would significantly impact on disability case processing. Reasons included:

more rigorous testing than initially anticipated to ensure that new process features would accomplish the objectives; and

other major initiatives, including systems development and the supporting methodology, would not be expected to produce significant improvements for several years.

In light of these circumstances, an assessment was conducted to examine the status of redesign and determine how best to proceed as the redesigned disability continues to be an Agency Priority. As an outcome of the assessment, SSA made a decision to focus on eight major areas of the redesign--four testing efforts (Single Decisionmaker, Adjudication Officer, Full Process Model and Disability Claim Manager) and the development of four critical enablers (Systems, Process Unification, Simplified Methodology and Quality Assurance). Click here for Map for states participating in various redesign tests). Other redesign features were moved (transferred process features) as "good business practices" to individual components for implementation or deferred ( deferred process features) pending the development of supporting enablers.

Redesign Vision

SSA’s vision of the new disability process starts with the use of more options. Options for claimants to use in filing-- including more third party options, options for using electronic access in obtaining application forms, and options for claimants to decide how involved they want to be in the process. SSA’s current 4-step administrative process will be streamlined to a redesigned 2-level process.

The vision also includes increasing responsibility and accountability in claims processing at every level of the process.

Redesigned Disability Claims Process

At the initial level:

--a person called a Disability Claim Manager becomes responsible for the claim from first point of contact through initial decision and/or payment;

--the claim manager maintains responsibility for both medical and non-medical determinations on the claim, using technical and medical resources for assistance/advice as needed.

--the role of the medical consultant becomes that of a true consultant and the expertise is focused on the most difficult cases.

--the claim manager provides the claimant with an opportunity to talk with him/her as decision-maker before any less-than-favorable initial decision is made. This pre-decisional interview is used to help ensure that all evidence has been considered and that the claimant fully understands the disability decisional process.

At the appeals level:

--two appeals steps are eliminated as part of the streamlined process (the reconsideration step and the appeals council review step). The hearing process becomes the only level of administrative appeal;

--when a request for hearing is filed a new position, called the Adjudication Officer, steps into the process to:

- fully develop the record, obtaining additional evidence if needed;

- hold informal conferences with the claimant and/or the claimant’s representative;

- allow the case if supported by the evidence;

- or, certify the case to the ALJ for a hearing if not wholly favorable.

--the ALJ concentrates his/her time and expertise on hearing and deciding the more difficult cases.