SSA may also conduct CDRs  that are not required by law as it deems appropriate. CDR Process

SSA contracts with state Disability Determination Services (DDS)  agencies to initially determine whether applicants are disabled and to  conduct periodic CDRs to determine whether beneficiaries continue to be  disabled. SSA Prioritizes CDRs Using Several Inputs but Does Not Fully Incorporate Potential Cost-Savings

		SSA Uses a Variety of Inputs, Including Legal Requirements and Statistical Models, to Prioritize CDRs

Because SSA does not complete all CDRs as scheduled due to  competing priorities and existing resources, the agency must decide  which cases will receive a full medical review. The extent to which the statistical models have been used to select cases  for full medical reviews has varied by year, but the models have been  consistently used for determining who receives mailers. SSA Considers Cost Savings Information to a Limited Extent When Prioritizing CDRs

Although SSA considers cost savings when prioritizing CDR cases, it  does not do so in a manner that will maximize potential savings. According to federal internal control standards, federal agencies should  ensure effective stewardship of public resources. As a program integrity effort, CDRs are intended to assess  the continued eligibility of beneficiaries to ensure that payments are made  only to those individuals who should be receiving them, and SSA’s  statistical models use an appropriate proxy of eligibility—potential for  medical improvement—to prioritize cases for review. Although SSA has reported high nationwide CDR accuracy rates in recent  years, we identified shortcomings in how SSA prevents errors, defines  and reports accuracy, and samples CDRs for quality review:
Preventing errors: Although SSA tracks the number and types of  CDR decision errors and disseminates this information to state DDSs,  it does not analyze the characteristics of CDR errors to help identify  error trends associated with particular types of cases and address  root causes. As a result, decision makers do not have a complete picture of  the CDR errors that affect disability payments. In conducting and reporting on these reviews,  however, SSA does not specifically focus on CDRs. To calculate the federal program savings  generated by CDRs in a particular year, SSA estimates the present value  of expected future benefits over 40 years that are saved as a result of the  reviews. Conclusions

In light of SSA’s current backlog of CDRs and the long-term financial  challenges of the Disability Insurance Trust Fund, conducting timely, high- quality, and cost-effective CDRs is particularly important. Direct the Deputy Commissioner of Budget, Finance, Quality, and  Management to adjust its approach to sampling CDRs to efficiently  produce reliable accuracy rate estimates for continuances and  cessations separately in each state. However, in  fiscal year 2014 as an example, SSA identified over 600 CDRs  with errors. Regarding our recommendation to track the number and rate of  date errors and consider including them in its reported CDR  accuracy rates, SSA disagreed and stated that, per SSA  regulation, the agency does not consider date errors when  calculating accuracy rates because date errors do not affect the  decision to cease or continue benefits. Appendix I: Objectives, Scope, and Methodology

The objectives of this report were to examine (1) how the Social Security  Administration (SSA) selects which Continuing Disability Reviews (CDR)  to conduct, (2) the extent to which SSA reviews the quality of CDR  decisions, and (3) how SSA calculates cost savings from CDRs. CDR Prioritization

To evaluate how SSA selects which CDRs to conduct, we reviewed  relevant federal laws and interviewed SSA officials from the agency’s  offices of Public Service and Operations Support, Budget, and Quality  Improvement. From the  total number of full medical reviews completed during a fiscal year, we  subtracted completed full medical reviews that were prioritized because  they were statutorily required (e.g., reviews of SSI children at age 18 and  reviews of children under 1 year old who are receiving SSI benefits due in  part to low birth weight) and because of SSA policy (e.g., mailers with  certain responses and first-time reviews for beneficiaries in the “medical  improvement expected” diary category). We  also interviewed state Disability Determination Services officials about  factors that challenge CDR quality.
Why GAO Did This Study

To help ensure that only eligible individuals receive disability benefits, SSA conducts periodic CDRs to assess beneficiaries' medical condition. CDRs have historically saved the government money. However, in recent years, SSA has had difficulty conducting timely CDRs resulting in a backlog of over 900,000 CDRs in fiscal year 2014. With this backdrop, GAO was asked to study SSA's ability to conduct and manage timely, high-quality CDRs.
This report evaluates, among other things, how SSA selects which CDRs to conduct and the extent to which SSA reviews the quality of CDR decisions.
GAO analyzed CDR data for fiscal years 2003 through 2013 (the most recent year for which complete data were available); assessed SSA's models used to prioritize CDRs; reviewed relevant federal laws, regulations, and SSA documentation about CDR prioritization and accuracy review procedures; and interviewed SSA and state Disability Determination Services officials.

What GAO Found

The Social Security Administration (SSA) selects cases for continuing disability reviews (CDR) using several inputs, but it does not do so in a manner that maximizes potential savings. SSA first prioritizes CDRs required by law or agency policy such as those for children under 1 year old who are receiving benefits due in part to low birth weight. Then SSA uses statistical models to identify the remaining CDRs to be conducted each year. The models also determine which cases will receive an in-depth review of medical records by the Disability Determination Services—the state agencies that conduct CDRs—versus a lower-cost questionnaire sent directly to the beneficiary. As shown in the figure below, a growing number of cases have been set aside for future review (backlogged) over the last 10 years. Although SSA somewhat considers potential cost savings when selecting cases for in-depth reviews, its approach does not maximize potential savings for the government. For example, estimated average savings from conducting CDRs are higher for some groups of Disability Insurance (DI) beneficiaries than others, but SSA's selection process does not differentiate among these groups. As a result, it may be missing opportunities to efficiently and effectively use federal resources.
SSA reviews a sample of CDRs for quality, but its analysis and reporting of errors is not comprehensive. Specifically, SSA randomly selects CDR decisions to check for a variety of potential errors. For example, SSA regularly monitors and reports on the frequency of errors that affect whether benefits are continued or ceased. However, contrary to federal internal control standards, SSA does not systematically analyze errors to detect and address root causes. Consequently, SSA lacks information that could help improve the quality of the reviews conducted by the Disability Determination Services. Further, in determining CDR accuracy rates, SSA does not count date errors, including incorrect cessation dates, which can affect disability benefit payments. As a result, decision makers do not have a complete picture of the CDR errors that affect disability payments.

What GAO Recommends

GAO recommends SSA, among other things, further consider cost savings as part of its prioritization of CDRs, analyze the root causes of CDRs with errors, and track date errors. SSA agreed with most of GAO's recommendations, but disagreed that there is a need to track date errors and to adjust its approach to sampling CDRs for quality review. GAO maintains actions are warranted and feasible as discussed in the report.