Under New CDR Plan, All Required CDRs Will Be Complete or Under Way by End of Fiscal Year 2002

By the end of fiscal year 2002, if SSA’s new CDR plan is completed as envisioned, all the CDRs required by law will be complete or under way, including those that are overdue and those due to begin by the end of 2002 (see app. When DDSs award disability benefits, they set dates for starting CDRs, and every month these prescheduled CDR start dates come due for many beneficiaries. Once CDRs are initiated, however, the time required to complete them can be lengthy. SSA estimates that DDS full medical reviews require about 1 year to complete from the time cases are identified and selected. Thus, many CDRs cannot be completed by the end of the year in which they come due. SSA estimates that about 835,000 required CDRs that are due to start in fiscal year 2002 will not be completed by year-end; according to SSA, these CDRs will be completed in fiscal year 2003. Adequacy of CDR Processing Capacity and Authorized Funding Hinge on Key SSA Assumptions

According to SSA, in formulating its CDR plan, SSA consulted with DDSs to plan caseloads for fiscal years 1998 through 2002 that will not exceed the DDSs’ case processing capacity. However, DDSs could potentially encounter additional caseloads not envisioned in SSA’s plan. Furthermore, if the volume of initial disability applications or requests for reconsideration of denied applications is larger than assumed by SSA, DDSs may have to accumulate larger backlogs of these cases in order to complete CDR full medical reviews. Such events, if they occur, could lead SSA to decide to increase DDS capacity; but timely expansion of DDS capacity faces potential barriers. DDSs May Need to Conduct More CDR Full Medical Reviews If Mailers Cannot Be Used to the Full Extent Planned

Of the 8.1 million CDRs planned for fiscal years 1998 through 2002, SSA plans to conduct 4.3 million (53 percent) through the use of mailers and 3.8 million (47 percent) through DDS full medical reviews (see table 2). However, for several beneficiary groups, SSA is still developing statistical formulas for selecting appropriate beneficiaries to receive mailers. For example, state DDSs could request that SSA use its federal DDS in Baltimore, Md., to process CDRs or to process initial disability applications, thus freeing up state DDS staff to process CDRs. Authorized Funding Should Be Adequate to Fund Substantial Increases in Full Medical Reviews

Under the assumptions in the new CDR plan, the CDR funding authorized by the Congress should be sufficient to process the 8.1 million CDRs planned for fiscal years 1998 through 2002. If SSA’s assumptions do not hold, unexpected increases in these other disability workloads could result. SSA plans to publish the results of this study during fiscal year 1998. II.1 for an example of the CDR mailer.)
Why GAO Did This Study

Pursuant to a congressional request, GAO provided information on whether: (1) the Social Security Administration's (SSA) plan to process 8.1 million continuing disability reviews (CDR) during fiscal years 1998 through 2002 will result in CDRs being done for all beneficiaries for whom CDRs are required by law; and (2) disability determination services' (DDS) CDR processing capacity and the CDR funding authorized by Congress for fiscal years 1998 through 2002 will be sufficient to process the CDRs required by law.

What GAO Found

GAO noted that: (1) by the end of fiscal year (FY) 2002, if SSA completes its new CDR plan as envisioned, all CDRs required by law will be complete or under way, including those that are overdue and those due to be started by the end of FY 2002; (2) when DDSs award disability benefits, they set due dates for starting CDRs, and every month these prescheduled CDR start dates come due for many beneficiaries; (3) because CDRs can require up to 1 year to complete from the time beneficiaries are selected for CDRs, many CDRs cannot be completed by the end of the fiscal year in which they become due; (4) SSA estimates that about 835,000 of the required CDRs due to be started in FY 2002 will not be completed by yearend; (5) these CDRs will be completed in FY 2003, according to SSA; (6) of the 8.1 million CDRs planned for fiscal years 1998 to 2002, SSA plans to complete 53 percent through brief questionnaires mailed to selected beneficiaries and 47 percent through full medical reviews conducted by DDSs; (7) according to SSA, in formulating its plan, SSA consulted with DDSs to plan caseloads that will not exceed the DDSs' case processing capacity; (8) however, DDSs could potentially encounter additional caseloads not envisioned in SSA's plan; (9) for several beneficiary groups, SSA is still working to develop statistical formulas for selecting appropriate mailer recipients; (10) if DDSs have to conduct more full medical reviews to replace CDR mailers, the authorized funds could prove inadequate because full medical reviews cost significantly more than mailers; (11) if SSA's assumptions about economic growth and unemployment do not prove accurate or if the test results for SSA's disability process redesign plan are not positive, the volume of initial disability applications and requests for reconsideration of denied applications could potentially be larger than assumed by SSA; (12) if so DDSs could face even larger backlogs of these non-CDR cases in order to complete CDR full medical reviews in a timely manner; (13) recognizing the potential uncertainty of the CDR and non-CDR workloads, SSA plans to monitor them closely; (14) SSA acknowledged that its CDR plan may require revisions and that unexpected workload increases, if they occur, could lead SSA to decide to increase the case processing capacity of state DDSs; and (15) potential barriers to the timely expansion of DDS capacity exist as well, such as shortages of qualified applicants and office space, state hiring freezes, and the time required to train and mentor new staff.