Statement of Michael Astrue Commissioner of
Social Security Administration
before
the House Ways and Means Committee
Subcommittee on Income Security and Family Support
and Subcommittee on Social Security

April 27, 2010

 

Chairman Pomeroy, Chairman McDermott, Members of the Subcommittees:

Thank you for the opportunity to discuss our ongoing work to improve our disability process.

We are facing a surge in workloads due to the economic downturn and the aging of the Baby Boomers. Nevertheless, with your support, we are on-track to reduce pending initial disability claims to a pre-recession level by 2014 and eliminate the hearings backlog in 2013.

In order to frame the rest of this statement, I will briefly explain the steps in the disability process. Initial applications for disability benefits may be filed online, by telephone, or at a field office. After receiving an application, we send the case to a State Disability Determination Service (DDS) to make a determination of disability. If the initial disability application is denied, our rules provide for three levels of administrative review. The first level is a reconsideration from the DDS; the second level is a hearing before an administrative law judge (ALJ); and the third level is a review by our Appeals Council. If the Appeals Council review is denied, the applicant may appeal to Federal court. In 10 States, we are currently running a prototype project that eliminates the reconsideration step.

The most important thing we can do to improve the disability process is to make the right decision as soon as possible. Improvements must begin at the first steps of the process.

Initial and Reconsideration Levels

Our strategy to improve the first steps of the disability process implements technology solutions, updates and simplifies program rules, and adapts initiatives that worked so well in reducing our hearings backlog.

Starting at the time a claim is filed, we have developed faster and easier online services to meet the Baby Boomers' expectations and keep pace with the increase in economy-driven disability claims.

Our new, easy-to-use online application, iClaim, has been a huge success. In fiscal year (FY) 2009, we rolled out the first phase of iClaim, and we immediately saw a significant increase in Internet claims as a result. Our numbers continue to increase. Currently, almost 25 percent of disability applications are filed online, an increase of about 130 percent in just two years. This increase has benefited both the public and us. Disability applicants can now file for benefits online at their own pace and on their own schedule. Meanwhile, the increase in online claims has helped us to deal with the additional economy-driven claims and to reduce our field office waiting times.

We have also eliminated unnecessary sections of the online Adult Disability Report, one of our key data collection forms in the disability process, as part of our Disability Direct initiative.

Disability Direct will streamline online disability claims over the next several years. Disability Direct has multiple components, including building a simplified online application that includes an application for Supplemental Security Income (SSI), developing an online service for professional representatives of disability applicants, and integrating electronic medical records and direct data exchanges with medical providers. We believe that, over time, Disability Direct will help us complete our disability claims more effectively and efficiently.

Although our hard work is far from complete, we are pleased to be expanding our online presence to better serve the public.

Another important service to the public is that our disability notices now provide helpful healthcare information to over 3 million disability claimants each year, regardless of the outcome of their claims. Working with our partners at the Department of Health and Human Services (HHS), we direct our disability claimants to extensive information provided by HHS on the Internet, where they can find tools to help them better understand and cope with their conditions.

As we expand and improve our online services, we must provide the DDSs with the tools they need to make more accurate decisions as early as possible.

Our Quick Disability Determination (QDD) and Compassionate Allowances (CAL) initiatives fast-track claims that are likely allowances in the earliest stages of the disability process. QDD uses a predictive model to identify certain claims that are likely allowances, such as low birth-weight babies, cancer, and end-stage renal disease. CAL allows us to quickly identify applicants who are clearly disabled based on the nature of their disease or condition. The list of CAL conditions originally contained 25 rare diseases and 25 cancers. We added 38 new CAL conditions on March 1, 2010. We have held five public hearings to obtain critical information to develop and enhance this list of conditions and plan additional hearings in the near future. The information obtained at these hearings is also helpful for making other improvements to the disability process, such as updating our program rules. In FY 2010, we expect that our enhancements to QDD and CAL will allow us to fast-track about 140,000 applications for the most severely disabled Americans while maintaining accuracy. Identifying and paying eligible claimants early in the disability process clearly benefits those with severe disabilities, while at the same time helping our backlog reduction efforts.

Recently, we proposed a regulation to expand the single decision maker (SDM) authority to cases that are identified as QDD or CAL. SDM allows a disability examiner to adjudicate a case without a mandatory concurrence by a doctor.

We are creating centralized Extended Service Teams (EST) in 4 States that will have the ability to help other States timely adjudicate the increase in economy-driven claims. We adopted our best practices from the hearings backlog reduction plan to create the ESTs. We placed these new units in States that have a history of high quality and productivity and the capacity to hire and train significant numbers of additional staff. We have already placed ESTs in Arkansas and Mississippi, helping Maryland and Georgia, and plan to add teams in Virginia and Oklahoma by the end of June 2010.

Along with deploying the ESTs, we are expanding our Federal capacity to adjudicate more cases. We currently have a Federal unit in each of our 10 regions and 2 units in Baltimore that assist the DDSs in adjudicating cases. In FY 2010, we will provide about 200 additional hires in these units.

At the same time, our innovative use of technology continues to provide DDSs the tools they need to make more accurate decisions early in the disability process.

Our automated Electronic Claims Analysis Tool (eCAT) is proving to be extremely valuable to improving the quality of our disability determinations. eCAT aids examiners in documenting, analyzing, and adjudicating the disability claim in accordance with regulations. We expect that the use of eCAT will produce well-reasoned determinations with easy-to-understand explanations of how we reached our decision. This documentation is particularly useful for future case review if an appeal is filed. We are considering adapting eCAT for use at the hearings level.

In addition to enhancing the documentation, quality, and consistency of our disability decisions, eCAT has been an extremely useful training tool for the many new examiners we are hiring in the DDSs. All States have the training version of eCAT. Training through eCAT is helping new examiners more quickly gain proficiency in handling complicated cases.

We are accelerating the expansion of eCAT, since we have determined that it is working well in the DDSs that have piloted it. We are currently planning for every State to have this tool by April 2011.

Developing and implementing a common Disability Case Processing System (DCPS) for all 54 DDSs is chief among our future disability technology challenges. Currently, each of the DDSs has its own unique case processing system, many of them based on an old programming language. In FY 2011, we will begin beta testing a common, web-based system that will provide additional functionality and the foundation for a state-of-the-art disability process. We believe full DCPS implementation will make it easier to implement other important technology changes to improve the disability process.

Health Information Technology (Health IT) is one of those important technology changes. Health IT has the potential not only to enhance our online presence but more fundamentally to revolutionize our disability determination process. We need medical records to decide disability claims. We rely upon doctors, hospitals, and others in the healthcare field to provide medical records in a timely fashion. We are moving towards a totally electronic system of requesting and receiving medical records. With the consent of our claimants, we will have near instantaneous access to their medical records.

For almost two years, we have been piloting the use of Health IT to help speed decisions on disability claims. Applicants who have been treated at Beth Israel Deaconess Medical Center in Boston, Massachusetts or at MedVirginia facilities in Richmond, Virginia can authorize their medical records to be transferred electronically to the DDSs. Generally, we receive medical records from these facilities in less than a minute.

Encouraged by these results, we used over $17 million in Recovery Act funds to expand Health IT with 15 healthcare organizations in 12 States. We anticipate our latest Health IT expansion will further improve the speed, accuracy, and efficiency of the disability determination process, while reducing the cost of making a disability determination for both the medical community and the American taxpayer.

Beyond paradigm-changing technology, streamlining and updating our business processes is another way to make timely, more accurate decisions while improving our overall disability process.

To make consistent, better-informed decisions on whether disability claimants meet our disability criteria, we are developing a new Occupational Information System to replace the Dictionary of Occupational Titles, which has not been updated since 1991. The Dictionary of Occupational Titles is outdated because it does not reflect current job requirements. In FY 2009, we convened a panel of experts to guide us in the development of the Occupational Information System. In FY 2011, we will begin to design and test the Occupational Information System, laying the groundwork for pilot testing scheduled to begin in FY 2012.

We also are regularly updating the Listing of Impairments (Listings) and have a schedule to ensure we update all of them at least every five years. The Listings describe for each major body system the impairments considered severe enough to prevent an adult from working, or for children, impairments that cause marked and severe functional limitations. As we update entire body systems, we are also implementing a process that will allow us to make targeted changes to specific rules as necessary, instead of the entire body system. In the last five years, we have revised approximately half of the Listings.

Taking a new look at how we handle our disability caseloads in States without the reconsideration step is another important way for us to evaluate possible improvements to the disability process.

In 1999, we eliminated the reconsideration step in 10 States, 1 from each region, as part of the Disability Redesign Prototype (Prototype) initiative. The Prototype States are: Alaska, Alabama, California (Los Angeles West and North Branches), Colorado, Louisiana, Michigan, Missouri, New Hampshire, New York, and Pennsylvania.

We expected that eliminating the reconsideration step in the Prototype States would result in earlier decisions and reduced waiting times for claimants; however, we have found the opposite is true. In 1998, prior to the start of the Prototype test, the proportion of initial decisions that ended up at the hearings level was 1.4 percentage points higher in the Prototype States than in the non-Prototype States. By 2007, that difference between Prototype and non-Prototype States had grown to 7.5 percentage points. The 10 Prototype States generate approximately 25 percent of the disability applications nationwide, yet appeals from these States account for more than 31 percent of the decisions made at the hearings level.

In Michigan, an economically hard-hit State, we have concluded that too many cases are needlessly going to the hearings level from the DDSs. Therefore, we plan to reinstate reconsideration in Michigan next fiscal year.

Of all the Prototype States, Michigan has the highest percentage of hearing requests, not to mention some of the most backlogged hearing offices in the country. Reinstating reconsideration would allow a significant number of cases to be allowed at reconsideration, resulting in earlier payment to those claimants and a reduction in the number of hearing requests. Moreover, those cases that do go to hearing would be more thoroughly developed, having already been through the reconsideration step.

I appreciate that the Governor of Michigan has proposed legislation as part of her FY 2011 budget, which the State Legislature is now considering, that would authorize the State to hire 175 new DDS employees to reduce the initial claims processing times and re-implement the reconsideration step.

In addition to Michigan, we are also looking at reinstating reconsideration in Colorado, at the request of the Governor. In all cases, we thoroughly evaluate the potential reinstatements from a programmatic, budgetary, and legislative perspective.

Although many difficult challenges lie ahead, we are confident that our assertive strategy and future plans to improve the disability process will produce continuously more accurate and faster decisions. These improvements to the first steps of the disability process are helping to minimize the effects of the surge in claims caused by the economic downturn and the aging of the Baby Boomers.

Hiring in the DDSs also has helped us handle the surge in initial disability claims. Addressing this workload will be an uphill battle because disability claims are our most labor-intensive workload. Our goal is to return to a pre-recessionary pending claims level by 2014. 

Over the past few years, we anticipated and planned for the additional disability claims caused by the aging of the Baby Boomers who are now entering their most disability-prone years. Regrettably, the deterioration we saw in the national economy exacerbated our already fragile situation. Nationwide, we expect to receive more than 3.3 million disability applications in FY 2010, which represents about 700,000 more applications than in FY 2008.

DDS employees deserve our full support during this critical time. With the funding provided by Congress in FY 2009 and the Recovery Act, we completed over 175,000 more initial disability claims than originally budgeted last fiscal year. Despite our efforts to complete initial disability claims timely and accurately, we saw pending cases grow to nearly 780,000 at the end of FY 2009—over 200,000 more cases than at the end of FY 2008. Recently, we have managed to reduce our pending level. However, our pending disability claims could reach over 1 million this year. We know this pending level is unacceptable and are working diligently to minimize the increase.

We also are seeing a steady increase in our national reconsideration workload, which is a direct result of the increase in initial disability claims. Reconsideration filings rose about 15 percent, or approximately 45,000 over this time last year. Despite these challenges, the DDSs have handled about 331,000 reconsiderations through the first 6 months of this fiscal year, or 46 percent of the reconsiderations budgeted for this fiscal year. Although we are slightly behind in reconsideration case processing, we fully expect to meet the budgeted level by fiscal year-end. We are encouraged that reconsideration case processing has increased dramatically throughout the fiscal year, from 11,800 average weekly clearances in October 2009 to 15,000 average weekly clearances in March 2010.

Last fiscal year, we expanded our adjudicative capacity by hiring above the rate of attrition. While these new hires helped the DDSs increase their productivity by 3 percent and reduce processing time by 5 days in FY 2009, they spent a lot of their time in training and were not fully productive. This year, we expect that the additional fully trained staff will handle substantially more cases.

Regrettably, at a time when DDS employees need our support, furloughs continue to be a problem in many DDSs across the country. As nonsensical as it is for States to respond to fiscal crisis by furloughing employees whose salaries and benefits we fully fund, many of them have done so. We have spent a lot of time over the last year and a half trying to educate State officials on the unnecessary and harmful effects of furloughing DDS employees. I have personally spoken to many governors or State officials, and I wrote letters to every governor and to the National Governor's Association. In addition, each of our 10 Regional Commissioners has been aggressively pursuing DDS furlough exemptions at the local level.

We have received considerable support from the Administration and Members of Congress. I am especially grateful to Vice President Biden and many Members present today who helped me persuade some governors not to take this misguided action.

We succeeded in gaining exemptions or partial exemptions in several States, like Michigan, Nevada, New York, and Colorado. Other States, such as California, Wisconsin, Ohio, and Hawaii imposed furloughs on DDS employees. Currently, 16 States have implemented furloughs that affect DDS employees. I know that, like me, you are frustrated by these decisions.

While some States argue that the furloughs are not affecting their ability to make disability determinations, these assertions are simply not true. For example, California continues to furlough DDS employees three days each month. In FY 2010, this decision will delay $11 million in disability benefits to over 40,000 of California's most vulnerable residents, at a time when the State has one of the highest unemployment rates in the country. We see many clear signs of the deterioration in service. In spite of the hard work of the dedicated DDS employees, the number of initial claims currently pending in California rose about 37 percent higher over 2008 levels. The percentage of California cases pending over 90 days has grown.

The residents of California should not be penalized for the actions of their officials. We are trying to mitigate the problems in California. Specifically, we decided to: maximize the use of overtime; obtain medical consultant (MC) assistance from another State; and provide Federal assistance with State medical reviews.

As we began developing our strategy to handle the additional economy-driven disability claims, we knew that certain States and regions had been harder hit by the recession than others. Since unemployment rates correlate with the number of disability claims we receive, we began to take a closer look at the unemployment rates and forecasts of disability receipts at the State level. We analyze this information to decide how to allocate our resources—based on not only the current situation, but also on future population and unemployment trends.

In addition, we are analyzing a combination of DDS key indicators to determine a State's ability to keep pace with its current and future receipts. We focus on the indicators that most directly demonstrate the State's ability to handle additional claims. For example, we look at how old the cases are, how long they have been pending, the level of receipts, the processing time, the rate at which we are losing our employees, and whether the DDS is under a hiring freeze or furlough. Monitoring these indicators enables us to provide assistance quickly to the most overwhelmed States.

Under our FY 2010 budget, we plan to hire DDS employees above the rate of attrition. By the end of FY 2010, we expect to have 2,800 more DDS employees on board than we did at the end of FY 2008.

In addition to hiring more disability examiners to handle the claims, we need to increase our MC staff to support the examiners. An MC reviews and approves disability claims, in addition to providing expert advice on medical issues. Due to the volume of initial claims and a national workload imbalance, we have a critical need for MC case reviews in certain geographical locations across the country.

To address this problem, we are increasing the available funds and hours of the existing MC contracts for both State and Federal MCs. We will shift Federal MC case review support to the most distressed workloads to ensure balanced service. Meanwhile, the DDSs continuously work with the medical community to increase the number of doctors available to be MCs or provide consultative exams, which are medical examinations of claimants on behalf of our agency. We are also developing a recruitment strategy to market disability-related career paths to medical students and recent graduates. Finally, we are considering allowing individual flexi-place arrangements and creating virtual-centralized MC pools where we could locate a number of MCs who would support multiple DDSs across the country.

If not for all of our efforts to improve service at the first steps of the disability process, we would be facing much greater challenges. Prior to the economic downturn, we were steadily reducing average processing time in the DDSs until we were overwhelmed by the increase in claims. Remarkably, despite our challenges, we have managed to improve DDS performance accuracy from 93.4 percent in FY 2006 to 97.2 percent through March of this fiscal year.

Under the President's FY 2011 Budget, we will build upon our hiring in recent years, as well as adopt policy and procedural simplifications and expand upon our productivity gains. With full funding, we will decide over 3.3 million initial disability claims in FY 2011, which is over 200,000 more claims than we are expected to complete this fiscal year. We anticipate reducing the initial disability claims backlog by 42,000 claims in FY 2011.

Hearings Level and Appeals Council

As we issue more decisions on the increasing initial disability applications, the number of hearing requests will also rise. We remain committed to improving both the timeliness and quality of our hearing decisions, while aggressively reducing the backlog.

Our substantial progress driving down the hearings backlog tells us our plan works. Over the last 15 months, we have reduced pending hearings by almost 10 percent despite receiving 30,000 more hearing requests in FY 2009. We now have fewer than 700,000 cases pending hearing for the first time since 2005. Over the last three years, we have decided nearly half a million cases that were 825 days or older; at the end of this year, we will have essentially none. Even as we eliminated the oldest, most time-consuming cases first, we reduced the average time it takes to make a decision by more than three months, from a monthly high of 532 days in August 2008 to 437 days in March 2010.

Focusing on the oldest cases first plays a key role in driving down average processing times in the hearing offices. We try to follow a first-in, first-out policy at every major step of the hearing process; however, there are many factors that may cause us to deviate, such as the need for additional evidence and scheduling conflicts. While sometimes we deviate from our basic policy, our goal is to process the oldest cases first.

The greatest improvements occurred in the most backlogged offices. For example, processing time in the Atlanta North hearing office has dropped nearly 45 percent since February 2007, and we expect that it will further improve when the Covington, Georgia office opens in the fall.

A recent Government Accountability Office report has validated our substantial progress, finding that we have a 78 percent chance of meeting our target date of 2013 for backlog elimination.

Much of our success flows from our efforts to hire more employees and open new offices. Congressional support played an especially critical role. In FY 2009, we hired 147 ALJs and over 1,000 support staff. We plan to hire another 226 ALJs and 1,300 support staff this fiscal year. We now have four National Hearing Centers (NHC) to hear cases by video conference for the hardest hit areas of the country.

With full funding under the President's FY 2011 Budget, we will be able to hire 70 ALJs and the support staff necessary to maintain at least a 4.5 to 1 support staff to ALJ ratio nationally. These hires will increase our ALJ corps to 1,450. To accommodate this additional staff, we plan to open 25 new hearing offices and our fifth NHC in St. Louis, Missouri over the next 18 months. We opened the first of the new hearing offices in Anchorage, Alaska on February 19. With these additions, we expect to reduce processing times by nearly a month and to issue nearly 800,000 dispositions, an all-time high for the agency. Our goal is to reduce the hearings backlog by another 50,000 cases next fiscal year.

To meet our ambitious service improvement goals at the hearings level, we must work closely with our partners at the Office of Personnel Management (OPM) to find and hire the finest ALJ candidates. We believe it is critical that OPM regularly refresh the ALJ register so that we can continue to have access to high-quality candidates who are capable of adjudicating workloads with a high degree of accuracy. We are striving to hire and train all of the additional 226 ALJs budgeted for FY 2010 within the fiscal year. OPM has indicated that it is in the process of refreshing the ALJ register again so there should be adequate candidates for the near future. We are waiting for this new register to hire additional ALJs. We hope to be able to request a new certificate in the coming days.

Along with hiring and office space expansion, we have innovative plans to streamline our employees' work.

Senior attorney adjudicators continue to screen cases in our hearing offices to determine if a favorable decision can be made on-the-record without the need for a hearing. Through the end of March, senior attorney adjudicators have made a total of 25,902 decisions in FY 2010.

We are building upon the success of our senior attorney adjudicators this fiscal year by deploying a Virtual Screening Unit (VSU) of 100 senior attorney adjudicators to assist our most heavily backlogged hearing offices. These senior attorney adjudicators who are from hearing offices throughout the country screen electronic cases and write favorable decisions that result from the screening. The VSU started screening cases in November 2009 and went into full production in January 2010. So far, the VSU has screened 19,547 cases and issued 5,757 favorable decisions, while referring 239 cases to ALJs for favorable decisions. The VSU's work has resulted in fewer remands to the already burdened DDSs. The VSU has assisted 43 hearing offices.

Meanwhile, our outstanding ALJ corps continues to do its part driving down the hearings backlog. We see more and more ALJs meeting our annual disposition guideline of 500-700 legally sufficient decisions. As of March 2010, 64 percent of ALJs were on pace to reach 500 decisions, as compared to 56 percent in March 2009.

We are in-sourcing verbatim hearing reporting to further improve ALJ productivity. This initiative aligns with the President's multi-sector workforce plan, which directs agencies to strengthen the management of Federal employees and private-sector contractors. Verbatim hearing reporters will assist ALJs with completing the record for hearing proceedings. At remote sites, verbatim hearing reporters will have access to building and room keys, government files, and verbatim hearing equipment and will prepare the site for a verbatim hearing session. In the interest of developing complete hearing records, we will authorize the verbatim hearing reporters to make phone calls and to make copies of files and other documentation.

Auto-scheduling software will also help improve our productivity at the hearings level. Auto-scheduling is an automated calendaring function that will incorporate scheduling of experts, hearing sites and hearing rooms, equipment, and ALJ availability. We continue our work to develop auto-scheduling software this fiscal year.

To assist with decision writing and case preparation in our hearing offices, we will establish National Case Assistance Centers (NCAC) in McLean, Virginia, and St. Louis, Missouri. The McLean NCAC is scheduled to open in May 2010 and will perform decision writing only. The St. Louis NCAC will be co-located with the new St. Louis NHC, opening in July 2010, and will both write decisions and prepare cases.

Our centralized printing and mailing initiative continues to reduce the amount of time needed to transmit notices from our hearing offices. Under the initiative, we electronically transmit documents from our hearing offices to a centralized print server for mailing. All hearing offices received this functionality in FY 2008. We added the functionality for ALJs and senior attorney adjudicators to e-sign and centrally print the Notice of Decision to all hearing offices in FY 2009. Through the first half of this fiscal year, we have released over 1.8 million notices using centralized printing and mailing.

The success of our centralized printing and mailing initiative demonstrates how critical a standardized process is to efficiently completing our work. For this reason, we began work in 2007 to develop a standardized electronic business process (eBP) for all hearing offices. We designed the eBP to facilitate timely and legally sufficient hearings and decisions by establishing and maintaining effective, efficient, and consistent case processing methods and office organizational structures. After successful testing and piloting, we began rolling out the eBP to all of our hearing offices last year and will complete the rollout, including employee training, by the end of this fiscal year. In the future, we are aiming to develop and implement an eBP for the NHCs.

We are also aiming to expand our Representative Video Project (RVP), which allows representatives to purchase video-conferencing equipment and attend hearings from their offices. As of the end of March 2010, we have approved 23 representatives for RVP. Since FY 2009, we have held over 2,000 hearings using RVP.

Representatives and their clients will likewise benefit from the efficiencies offered by the Appointed Representative Suite of Services, which will allow representatives to perform much of their business with us over the Internet. While it has taken longer than we had anticipated to roll out these enhancements, we have been working closely with the representative community to ensure that, once implemented, the suite of services will meet both theirs and their clients' needs and result in significant efficiencies in the process.

While we maintain sharp focus on our backlog reduction initiatives at the hearings level, we must not forget the hard work of our dedicated employees at the Appeals Council. They, too, are beginning to see a rise in their workloads, and we must give these outstanding public servants our full support in achieving the goal of fast and accurate Appeals Council decisions.

To expand adjudicative capacity at the Appeals Council, I authorized substantial recruitment and hiring there during the second half of FY 2009. We revamped training programs to take advantage of recent technological improvements, and many of our employees have exceeded performance expectations during their training period. As the newly hired employees have become more productive, Appeals Council dispositions of requests for review have begun to approach the level of receipts. We expect dispositions to exceed receipts at the Appeals Council during some months in FY 2010. We expect the tipping point, when dispositions begin to outpace receipts on a regular basis, to occur during the second quarter of FY 2011.

We are also committed to timely adjudicating our court case workloads at the Appeals Council, which include preparing certified administrative records for filing with the courts, processing court orders of remand, and processing decisions following court remand. Currently, there is no backlog in this workload. However, backlog reduction efforts at the hearings level, coupled with increased staffing and disposition levels at the Appeals Council, will inevitably lead to increased court filings. We are planning to hire additional staff to keep pace with the anticipated increase in this workload and ensure that a backlog does not develop. We are striving to reduce court orders of remand by improving the overall quality and policy compliance of our decisions through training, quality assurance efforts, and the expanded use of electronic case analysis tools.

As we continue to drive down the hearings backlog, we cannot afford to sacrifice the accuracy of our decisions. For this reason, we plan to create a quality review branch at the Appeals Council that will begin to review unappealed favorable hearing decisions during the last quarter of FY 2010. We may expand this review later to include unappealed denial decisions and dismissals. The quality review staff will evaluate and capture information about the policy compliance and legal sufficiency of selected hearing decisions and will take corrective action as needed. The staff will also collect and analyze quality-related data from its review of cases to provide feedback to adjudicators, identify training needs, and suggest improvements in disability policies and procedures. We plan to hire additional staff and reposition some current staff into this branch in the near future.

Effectuation of Benefits and Payment of Representation Fees

By any measure, we have been successful in reducing the length of time it takes for ALJs to render hearing decisions. However, we fully recognize that we still need to improve in the area of getting benefit payments to individuals as soon as possible after the hearing and getting representatives their fees shortly thereafter. The current effectuation process can be arduous and complex and often involves many steps and close coordination between field offices and the program service centers, particularly in cases involving SSI windfall offset, appointed representatives, worker's compensation, or public disability benefits.

We have slightly reduced the time it takes to release a benefit payment after we make a hearing decision. For October through March in FY 2010, the average time it took from hearing decision to payment was nearly 14 days, down from 18 days in the same time last fiscal year. For SSI, it was nearly 15 days, down from 19 days the previous year. These timeframes represent when an individual receives his or her first benefit payment, which may or may not include all past-due benefits. In many instances, we begin making monthly benefit payments while we are processing the sometimes-complex computation for the retroactive benefit amounts. The amount of time it takes for representatives to get their fees is also too long in some cases.

We have started the difficult task of streamlining our benefit and fee payment processes so that beneficiaries and representatives timely receive the benefits they are due and the fees they have earned. This is not an easy or inexpensive effort. It will require significant IT planning and resources, but it is clearly an area in which we need to improve.

Program Integrity

One of our ongoing challenges in our disability programs is how to effectively balance our important program integrity work with the growing need to serve the public. Both efforts profoundly affect peoples' lives, as well as the economic health of the Nation.

We cannot artificially segregate our stewardship and service missions from one another. They are complementary missions that serve a common purpose—making our programs more effective and efficient. We utilize the same limited resources to complete these workloads. These resources include highly trained staff and the physical and technological capacity to accommodate their work. In the past, we have been forced to make the difficult decision to divert resources from one mission to fund the other. We hope not to be placed in that position again.

The President's FY 2011 Budget includes resources for two types of program integrity efforts: continuing disability reviews (CDR), which are periodic reevaluations to determine if beneficiaries are still disabled, and SSI redeterminations, which are periodic reviews of non-medical factors of eligibility, such as income and resources. In FY 2011, we plan to conduct 360,000 full medical CDRs, and 2,422,000 redeterminations. Our FY 2011 budgeted levels continue our efforts to increase program integrity levels from their low point a few years ago.

Both CDRs and redeterminations are extremely cost-effective. We estimate that every dollar spent on CDRs yields at least $10 in lifetime program savings. Similarly, we estimate that every dollar spent on SSI redeterminations yields $8 in program savings over 10 years, including savings accruing to Medicaid. In addition, in FY 2011, we will continue nationwide rollout of our Access to Financial Institutions project, which automates verification of SSI applicants and recipients' assets held in banks.

We have a well-deserved reputation for providing excellent financial management of the administration of our programs. We take our responsibility to be good stewards of the funds entrusted to us very seriously.

Traditionally, our program payments are exceptionally accurate; however, our payment accuracy rate with respect to SSI overpayments has been a distinct challenge, which we have worked hard to address. In FY 2008, our SSI overpayment accuracy rate was 89.7 percent, the lowest rate since the early days of the program. To address this decline, we increased the volume of redeterminations we conducted in FY 2009.  As a result, the overpayment accuracy for 2009 has risen to 91.6 percent, which is a statistically significant improvement over the 2008 rate. 

Our success in improving the SSI overpayment accuracy rate is encouraging news and demonstrates the value of additional funding for program integrity efforts. Looking ahead, we require continued resources to fully address both our stewardship and service missions. We cannot improve our disability process without adequate resources that allow us to do all of the work for which we are responsible.

We know there are many challenges ahead of us. Our workloads will continue to grow beyond our earlier expectations while we work to fulfill our commitments to reduce the initial disability claims and hearings backlogs and to lay the foundation for an improved disability process.

With the additional funding Congress has provided to us, we are making a real difference in the service we deliver to the American people, beginning at the first steps of the disability process. At the same time, we are proving that we are a sound investment. During these difficult economic times, the public is depending on us now more than ever.

We cannot fulfill our service commitments to the American people without the continued support of Congress. Together, we will honor and reaffirm our promise of economic security to the most vulnerable among us.