In March 2006, SSA published a final rule to establish DSI, which is  intended to improve the accuracy, consistency, and fairness of decision  making and to make correct decisions as early in the process as possible. Concerns Include Fear of Increased Court and Claimant Hardship, while SSA Believes Its New Process Will Reduce the Need for Appeal

In their written comments to SSA and discussions with us, public and  stakeholder groups, such as claimant representatives and disability  advocacy groups, expressed two broad areas of concern regarding the  replacement of the Appeals Council with the Decision Review Board:   (1) potential for increasing the workload of the federal courts and   (2) anticipated hardship for claimants in terms of loss of an administrative  appeal level and difficulties associated with pursuing their claims in  federal court. SSA’s response to concerns regarding the federal court  workload is that all changes associated with new DSI process—taken  together—should reduce the need for appeal to the federal courts. At the  same time, SSA plans to implement this final step gradually and with  additional safeguards to minimize the impact on the courts. In response to  concerns about the loss of appeal rights, SSA contends that under the new  DSI process, claimants will have a new level of federal review earlier in the  process, and should experience a decline in the amount of time it takes to  receive a final agency decision without being overly burdened by the  Decision Review Board under the new process. To reduce the likelihood of too many appeals  reaching the federal court level, SSA stated in its final rule that it is  pursuing a gradual rollout by implementing the DSI process in one small  region—the Boston region—and plans to have the board initially review all  of the ALJ decisions in that region. SSA Has Taken Constructive Steps to Implement the New DSI Process, but Its Schedule Is Ambitious and Many Details Are Not Yet Finalized

SSA has prepared in significant ways for DSI, but the agency’s timetable is  ambitious and substantive work remains. SSA has moved forward in key  areas that should underpin the new system—human capital development,  technical infrastructure, and quality assurance. SSA Has Readied eDib for the Boston Region, but Time for Resolving Last- Minute Glitches before Rollout Will Be Limited

SSA has also taken steps, as we had previously recommended, to ensure  that key technical supports, particularly an electronic disability case  recording and tracking system known as eDib, are in place in time for  Boston staff to adjudicate claims under DSI electronically. For example, SSA has not yet revealed  the types of reports it will be able to provide decision makers based on the  decision-writing tools. For example, significant aspects  of the DSI rollout are consistent with our recommendations to focus  resources on what is critical to improving the disability claims process,  such as quality assurance and computer support. The first is  quality assurance, which entails both effective monitoring and evaluation. The eventual elimination of the Appeals Council and its replacement with  the Decision Review Board with a very different purpose has been a great  cause of concern for a number of stakeholders. Appendix I: Objectives, Scope, and Methodology

To learn more about the public’s and stakeholders’ views with regard to  the Appeals Council and the Decision Review Board, we reviewed and  analyzed a large sample of comment letters they submitted to the Social  Security Administration (SSA) in response to its July 2005 notice of  proposed rule making on the Disability Service Improvement process  (DSI) that were related to these topics. There is a risk that the Decision Review Board may not select the  most appropriate cases for review.
Why GAO Did This Study

In March 2006, the Social Security Administration (SSA) published a rule that fundamentally alters the way claims for disability benefits are processed and considered. The rule establishes the Disability Service Improvement process (DSI)--intended to improve the accuracy, timeliness, consistency, and fairness of determinations. DSI's changes include an opportunity for an expedited decision during the initial determination process and the elimination of the Appeals Council, which had given claimants the right to appeal administrative law judge (ALJ) decisions before pursuing federal court review. DSI replaces the council with a Decision Review Board, which will selectively review ALJ decisions. However, dissatisfied claimants whose cases are not selected for board review must now appeal directly to the federal courts. Based on its ongoing work, GAO was asked to testify on (1) public and stakeholder concerns about the elimination of the Appeals Council and its replacement by the Decision Review Board and SSA's response to these concerns, as well as (2) the steps that SSA has taken to help facilitate a smooth implementation of the DSI process.

What GAO Found

Concerns regarding the replacement of the Appeals Council with the Decision Review Board--raised by the public and stakeholder groups, such as claimant representatives--generally fall into two areas: (1) potential for increasing the workload of the federal courts and (2) anticipated hardship for claimants in terms of the loss of an administrative appeal level and difficulties associated with pursuing their claim in federal court. SSA's response to concerns regarding the federal court workload is that all changes associated with the new DSI process--taken together--should reduce the need for appeal to the federal courts; at the same time, SSA plans to implement this final step gradually and with additional safeguards to minimize impact on the courts. In response to concerns about the loss of appeal rights, SSA contends that DSI introduces enhanced levels of federal review earlier in the process and that claimants should experience a decline in the amount of time it takes to receive a final agency decision. SSA has prepared in significant ways for the initial rollout of DSI in its Boston region, but the agency's timetable is ambitious and much work remains. The agency has moved forward in key areas that underpin the new system--human capital development, technical infrastructure, and quality assurance--taking actions consistent with past GAO recommendations for improving the disability determination process. For example, SSA has taken steps to ensure that key technical supports, particularly its electronic disability case processing system, are in place--even though it has allowed itself little time to address and resolve any glitches that may arise prior to implementation. SSA has also taken several steps to lay a foundation for quality assurance by centralizing its quality assurance reviews, establishing a Decision Review Board for reviewing decisions, and developing writing tools that should foster consistency and thorough documentation at all phases of the determination process. Further, we found that SSA's decision to implement DSI first in one small region prior to its introduction nationally is a good change management strategy that reflects our earlier recommendations. Additionally SSA has taken a proactive, collaborative approach to both the design and the implementation of the new determination process. Nevertheless, key facets of SSA's plan to monitor and evaluate the Boston rollout remain to be developed. For example, performance measures for assessing the execution of the rollout are still unclear to us, and mechanisms for delivering feedback to staff on the clarity and soundness of their decision writing have not yet been fully developed.