SSA & President Lyndon B. Johnson
History of SSA During the Johnson Administration 1963-1968
On April 12, 1937 Franklin Roosevelt completed a rough architectural sketch of what would become the nation's first Presidential Library. An amateur architect and historian, as well as a world-class maker of history itself, FDR was keenly aware of the need to preserve the records of the highest office in the land. This had never before been done in any systematic way. Raising private donations, FDR directed the design, construction and operation of his library. By the summer of 1940 the library was complete and FDR turned it over to the National Archives. Thus began the tradition of Presidential Libraries. Generations of scholars, students, and the broad American public, have benefited from President Roosevelt's visionary actions. Subsequent Presidents have followed in FDR's footsteps and created their own Presidential Libraries, after the manner of the first one. Today the National Archives manages 10 Presidential Libraries-key centers of American political history. New Deal officials also started another important tradition, the assembly of narrative histories. Various administration figures turned over their personal diaries, oral histories, and other narratives to the FDR Library. These diaries and narratives provide key insights into the history of the New Deal era. This custom of collecting narrative histories was systematized in a formal way at the end of the administration of Lyndon Johnson. President Johnson directed each federal agency to prepare a formal administrative history of its operations. These Johnson Administrative Histories have come to be prized by historians as one of the most accessible sources of documentation regarding this period. SSA's contribution to the Johnson administrative histories, entitled "U.S. Social Security Administration: History of the SSA During the Johnson Administration, 1963-1968," was 381 typed pages and was written expressly for this purpose. The original of this document is in the Johnson Presidential Library in Austin, Texas, and several additional bound copies were placed in SSA's Main Library in Baltimore. Outside of these two sources, the document was not accessible. We are therefore publishing here for the first time the full text of SSA's Administration History during the Johnson Administration.
Table of Contents
Introductory Material
Medicare
THE DEVELOPMENT OF MEDICARE
Legislation--The Product of Many
Enactment of the 1965 Amendments
Hospital Insurance Plan
Supplementary Medical Insurance (SMI) Plan
Preparation for Administration
ORGANIZATION FOR ADMINISTRATION
Role of the Social Security Administration
Role of the Public Health Service
Role of the Social and Rehabilitation Service
Health Insurance Benefits Advisory Council
Other Consultation
Role of the State Agencies
Role of the Intermediaries
Role of the Carriers
Supervision of Intermediary and Carrier Performance
Contract Reporting and Monitoring System
Audits of Intermediaries and Carriers
Contract Performance Review
Establishing the Claims Process
Statistical Data
Coordination of Medicare and State Medical Assistance Programs
ESTABLISHING BENEFICIARY ENTITLEMENT
Initial Enrollment Activities
Ongoing Enrollment Activities
Medical Insurance Premium Payments
Enrollment and Premium Payment Under State Agreements
Enrollment Withdrawals
PROVIDERS OF SERVICES
Conditions of Participation
Certification as Providers
Certification of Hospitals
Certification of Extended Care Facilities
Certification of Home Health Agencies
Certification of Independent Laboratories
Utilization Review of Hospital and Extended Care Services
Applicability of Title VI of the Civil Rights Act
HOSPITAL INSURANCE OPERATIONS
Principles of Reimbursement
Provider Payment
Claims Experience
Hospital Insurance Benefits Paid
Inpatient Hospital Services
Outpatient Hospital Diagnostic Services
Extended Care Services
Home Health Services
Fiscal-Intermediary Performance in Processing Hospital Insurance Bills
Hospital Insurance Intermediary Workloads
Performance Indicators for Hospital Insurance Intermediaries
Administrative Costs of Intermediary Operations
Providers Dealing with the Social Security Administration
Reimbursement for Emergency Services
MEDICAL INSURANCE OPERATIONS
Outpatient Services
Physicians' Services Rendered in a Teaching Setting
Billing Procedures
Determination of Coverage and Appropriate Utilization of Services
Reimbursement of Group Practice Prepayment Plans
Experience under the Medical Insurance Program
Medical Insurance Benefits Paid
Use of Current Medicare Survey to Obtain Current Medical Insurance Utilization Data
Use of and Charges for Medical Services
The Medicare Statistical Program
Monthly Variations
Carrier Performance in Processing Medical Insurance Bills
Medical Insurance Carrier Workloads
Performance Indicators for Medical Insurance Carriers
Administrative Costs of Carrier Operations
METHODS TO BRING DOWN THE COSTS OF MEDICAL CARE
The Gorham Report
National Conference on Medical Costs
Conference on Private Health Insurance
Regional Conferences
Study of Prices of In-Hospital Medical and Surgical Services for the Aged
Task Force on Prescription Drugs
Medicare Today
Other Legislation During the Johnson Administration
OTHER LEGISLATION DURING THE JOHNSON ADMINISTRATION
Cash Benefit Provisions of the 1965 Amendments
Legislative Activity in 1966
The Social Security Amendments of 1967
Disability Changes
DISABILITY CHANGES
Broad Program Development
The 1965 Amendments
A New Definition
Recovered Individuals May Still Collect
Special Provisions for the Blind
Workmen's Compensation Offset
The 1967 Amendments--Current Program
Background
Clarification of Definition
Liberalized Earnings Requirement
Benefits for Widows
Costs of Rehabilitation Services from Social Security Trust Funds
CREATION OF A SYSTEM TO ANNUALLY REEVALUATE BENEFICIARY'S EARNINGS AND WHERE INDICATED INCREASE BENEFITS
LEGISLATIVE CHANGES AFFECTING FEDERAL CREDIT UNIONS
Organizational Changes
SOCIAL SECURITY ADMINISTRATION IN 1963
REORGANIZATION OF 1965
Background
Specific Changes
Field Organization
Summary
IMPLEMENTATION OF THE 1965 AMENDMENTS
Planning--Administrative Strategy Committee
Administrative Planning Binder
Brief Summary on Implementing the 1965 Amendments
IMPLEMENTATION OF THE 1967 SOCIAL SECURITY AMENDMENTS
Getting Ready for Legislation
Summary of Planning Binder Activities
The Payment Center Problem
Claims Processing Backlogs
Manpower and Space
Manpower
Space
Summary
Personnel Changes
PERSONNEL CHANGES
Career Development Programs
Employee Management Relations and Equal Employment Opportunity Special Staff.
Hiring the Handicapped
Operating Methods
SSA PUBLIC INFORMATION ACTIVITIES
PROVIDING BETTER SERVICE TO THE PUBLIC
Extended Office Hours in the District and Branch Offices
Specialization in District Offices
ESTABLISHMENT OF THE TOTAL DATA SYSTEMS PLAN FOR INTEGRATION OF CLAIMS PROCESSES
ESTABLISHING NEW SYSTEMS OF APPRAISAL TO IMPROVE THE QUALITY OF CLAIMS PROCESSING
Appraisal Program--Bureau of Disability Insurance
Management Information and Appraisal
The Evaluation and Measurement System
Optical Scanning
Disability Case Control System Operating Methods
Tape Reporting of Earnings by Employers
VOCATIONAL EXPERT PROGRAM
MEDICAL ADVISOR PROGRAM
PROJECT MONEYWISE
The Beginnings
Program Content
Acceptance of the Moneywise Approach
Project Moneywise "By-Products"
Interagency Relations
COORDINATION WITH THE TREASURY DEPARTMENT
The Superendorsement Procedure
ZIP Code Mailing of Social Security Benefit Checks
Expediting Payments--1967 Amendments to the Social Security Act
Social Security Benefit Increases--1965 and 1967
Letters of Credit
Coordination with the Internal Revenue Service
COORDINATION WITH THE RAILROAD RETIREMENT BOARD
COORDINATION WITH THE VETERANS ADMINISTRATION
WORKING WITH THE STATE DEPARTMENT ON PAYMENT OF BENEFITS TO BENEFICIARIES IN FOREIGN COUNTRIES
Training Programs for Foreign Officials Conducted by the Social Security Administration in Cooperation with the Agency for International Development
Individual Participant Training
Social Security Seminars
Technical Assistance Missions
SURVEYS CONDUCTED WITH THE AID OF THE CENSUS BUREAU AND THE BUREAU OF LABOR STATISTICS
1963 National Survey of Widows with Children under Social Security
1963 Survey of the Aged
Poverty and Low-Income Index
National Survey of Disabled Adults
WORKING WITH THE BUREAU OF EMPLOYMENT SECURITY
External Relations - Labor, Business, Etc.
THE INTERNATIONAL SOCIAL SECURITY ASSOCIATION XVth GENERAL ASSEMBLY
ADVISORY COUNCIL ON SOCIAL SECURITY
ADVISORY COMMITTEE ON RESEARCH DEVELOPMENT
THE APPOINTMENT OF AN ADVISORY COMMITTEE ON NONPROGRAM USE OF THE SOCIAL SECURITY ACCOUNT NUMBER
SERVICE PROVIDED THE HEINEMAN COMMISSION
COMPLIANCE
SOCIAL SECURITY ADMINISTRATION RECOGNITION PROGRAM FOR STATE AGENCY DISABILITY STAFF
COMMUNITY RELATIONS ACTIVITIES
District Office Involvement in the Model Cities Program
LIST OF ORAL HISTORY INTERVIEWS CONDUCTED ON MEDICARE
APPENDICES
(Note: Several of the exhibits in the Appendices are presented in the form of graphic images. The quality of some of the images is poor and the image size is large.)
APPENDIX A
Exhibit 1- Social Security Administration Organization Charts
IA- SSA, top-level, 12/28/61
IB- Bureau of Old Age & Survivors Insurance, 2/8/61 and SSA, top-level, 1963
IC- SSA, top-level, 1/18/68
Exhibit 2- Bureau of Health Insurance Organization Chart
Exhibit 3- Members of the Health Insurance Benefits Advisory Council (As of June 30, 1967/April 28, 1968)
Exhibit 4- Participating State Agencies
Exhibit 5- Intermediaries for Hospital Insurance Program
Exhibit 6- Carriers for Medical Insurance Program by State
Exhibit 7- Group Practice Prepayment Plans Reimbursed Directly by SSA on Reasonable Cost Basis
Exhibit 8- Group Practice Prepayment Plans Reimbursed through Carriers on Reasonable Charge Basis
APPENDIX B
Exhibit 1- Enrollment for Hospital and Medical Insurance, by type of Enrollment, Geographic Division, and State, as of July 1, 1966
Exhibit 2- Enrollment for Hospital and Medical Insurance, by type of Enrollment, Geographic Division, and State, as of July 1, 1967
Exhibit 3- States With "Buy-In" Agreements for Medical Insurance Coverage of Welfare Recipients, June 30, 1968
APPENDIX C- PROVIDERS OF SERVICES
Exhibit 1- Table 1: Hospitals and Number of Adult Beds by Type of Hospital, Geographic Division, and State, July 31, 1968
Exhibit 2- Table 2: Number of Participating Extended Care Facilities and Home Health Agencies, by Geographic Division and State, July 31, 1968
Exhibit 3- Table 3: Number of Participating Independent Laboratories, by Geographic Division and State, July 31, 1968
APPENDIX D- EXPERIENCE UNDER THE HOSPITAL INSURANCE AND MEDICAL INSURANCE PROGRAMS
Exhibit 1- Table: Health Insurance Benefits Payments, July 1967 to June 1968
Exhibit 2- Table: Number and Percentage Distribution of Hospital Insurance Claims Approved for Payment and Amounts Reimbursed, By Type of Benefit, July 1, 1966 - May 31, 1968
Exhibit 3- Table: Number and Percentage Distribution of Hospital Insurance Claims for Inpatient Hospital Care Approved for Payment, Covered Days, Total Charges and Amounts Reimbursed, By Type of Hospital, July 1, 1966 -June 28, 1968
Exhibit 4- Table: Number of Inpatient Hospital Admissions, Extended Care Facility Admissions, and Name Health, Start of Care Notices and Rates per 1,000 Enrollees, By Region, Census Division, and State, July 1, 1966 - June 30, 1967
Exhibit 5- Table: Inpatient Emergency Hospital Services in Nonparticipating Hospitals by SSA Region and State, Fiscal Year 1968
Exhibit 6- Table: Number of Reimbursed Bills for Physicians' and Related Services, Total Charges, and Amount Per Bill, By Type of Service, July 1, 1966 -June 28, 1968
Exhibit 7- Table: Number of Reimbursed Bills for Physicians' and Related Services, Total Charges, and Reimbursed Amount, By Type of Bills, July 1, 1966 - June 28, 1968
Exhibit 8- Table: Cumulative Number and Percentage Distribution of Medical Insurance Enrollees and Charges for Covered Medical Services, By Use of Covered Service and Deductible Status, 6 Months Ending December 1966 and June 1967
Exhibit 9- Table: Estimated 6-Month Cumulative Number and Percentage Distribution of Medical Insurance Enrollees, By Selected Characteristics and Use of Covered Medical Services, January-June 1967
Exhibit 10- Table: Estimated 6-Month Total and Average Charges Per Medical Insurance Enrollee Using Covered Medical Services, By Selected Characteristics and Deductible Status, January-June 1967
Exhibit 11- Table: Estimated Number and Percentage Distribution of Medical Insurance Enrollees By Use of Covered MedicalServices, July 1966-June 1967
Exhibit 12- Table: Estimated Number and Percentage Distribution of Medical Insurance Enrollees Using Covered Medical Services by Month and Amount of Deductible Used By the End of Each Month, January - June 1967
APPENDIX E-
PRINCIPAL CHANGES IN MEDICARE MADE BY THE 1967 AMENDMENTS
APPENDIX F-
STATEMENT OF ACTUARIAL ASSUMPTIONS AND BASES EMPLOYED IN ARRIVING AT THE AMOUNT OF THE STANDARD PREMIUM RATE FOR THE SUPPLEMENTARY MEDICAL INSURANCE PROGRAM BEGINNING APRIL 1965
APPENDIX G-
Exhibit 1- Selected Medicare Publications
Exhibit 2- Medicare Regulations
Exhibit 3- Publications Relating to the Financing of the Health Insurance Program
Exhibit 4- Social Security Bulletin Articles
Exhibit 5- Miscellaneous Publications
Exhibit 6- Medicare Statistical Highlights
Exhibit 7- List of Contributors