mental disorders and mental retardation, and other disabilities previously cared for and financed by state hospital systems.

Despite all these factors and the resulting workload increases, the procedures for processing disability claims have not changed in any important way since the beginning of the SSDI program in the 1950s. Many people have complained that SSA's current disability decision process is lengthy and complicated, resulting in untimely and inconsistent decisions that are often based on subjective judgments (GAO, 1994; 1995; 1996).

SSA'S Redesign Plan for Determining Program Eligibility

Recognizing the need to improve its claims process, SSA has developed a long-term strategy for reengineering the disability decision process (SSA, 1994). The redesigned process is meant to be simpler than the one currently in place. SSA's basic objectives for the redesigned disability decision process are that it should be user-friendly, prompt and accurate, and that the work should be satisfying for its employees.

As one part of the reengineering effort, SSA has proposed a new decision process for determining whether individuals are "disabled" as defined by the act and SSA's implementing regulations. Briefly, under the present system, the disability decision process consists of four stages: (1) the initial claim, (2) a reconsideration, (3) a hearing before an administrative law judge, and (4) Appeals Council review. SSA's plans call for elimination of two of these stages, namely, reconsideration and Appeals Council review. At present, the decision process for initial claims involves a five-step sequential process (SSA, 1994).2 Claimants whose applications are denied can have their claims reconsidered. If benefits are denied after the reconsideration, the claimant may request a heating before an administrative law judge at the SSA. Further appeals options include a request for the Appeals Council or the federal district courts to review the decision.

The concept of disability in recent years has generally shifted from a focus on diseases, conditions, and impairments to one on functional limitations caused by these factors (Adler, 1996). "The goal of the new decision process is to focus decision making on the functional consequences of an individual's medically determinable impairment(s)" (SSA, 1994, p. 21). Although the presence of a medically determinable impairment will remain the central requirement for eligibility as required by law, the redesigned process will focus directly on the applicant's functional ability to work and will rely on standardized instruments for measuring functioning to reach decisions.

Because of its complexity and far-reaching impact, SSA has concluded that the re-engineering effort, including the decision process, requires extensive research, testing, validation, and further development of some of its components prior to implementation (SSA, 1996c). Consideration of the specific functional and vocational criteria to be used in the new decision

2  

The decision process involves (1) determining whether the claimant is engaging in substantial gainful activity (GSA), (2) determining the severity of the claimant's limitation, (3) determining whether the claimant's impairment meets or equals the medical listings and how long the impairment has lasted or is expected to last, (4) determining the claimant's residual functional capacity (RFC) to perform past relevant work, and (5) determining the claimant's RFC to perform another type work in the nation's economy.



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