Measuring Functional Capacity and Work Requirements Summary of a Workshop (1999) / Chapter Skim
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6 Adapting Measurement of Functional Capacity to Work to SSA's Disability Decision Process
6 Adapting Measurement of Functional Capacity to Work to SSA's Disability Decision Process
Pages 74-84
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From page 74... ...
measures of functional capacity to work; technical issues of incorporating reliability, validity, sensitivity, and specificity in the context of SSA's disability decision process; and the feasibility and manner of linking these measurement approaches to work requirements in the context of SSA's disability decision process. Virginia Reno Director of Research, National Academy of Social Insurance A discussion about the practical application of new measures of functional capacity to SSA's disability decision process calls for assessing the effectiveness of trying to shift far from the medical assessment tools that SSA uses, or at least that model, to focus more heavily on functional assessment.
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From page 75... ...
The purpose is to help disabled workers pay their bills while they deal with other consequences of their ill health and job loss. SSA has the unenviable task of deciding who among millions of applicants for these benefits have medically determinable impediments to work that are so severe that they meet the very strict test of disability in the Social Security Act-that is, inability to engage in any substantial gainful activity by reason of a medically determinable physical or mental impairment that is expected to last at least a year or result in death.
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From page 76... ...
Using these criteria, the Disability Policy Panel evaluated SSA's multistep decision process for determining whether applicants meet the Social Security test of disability. It evaluated both the decision process as a whole and the various steps in the process: initial screens for eligibility (a person's insured status, work status, and application for benefits)
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From page 77... ...
That is, for disability insurance benefits, the medical listings are considered only if: an individual is out of work (not engaging in substantial gainful activity) ; yet has recent and fairly steady work experience (is insured)
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From page 78... ...
The best way to evaluate disability for awarding cash benefits is by combining diagnostic and functional approaches and using a holistic view that not only looks at these clinical variables, but also looks at education, job experience, and other aspects of the patients' lives that influence employability. Motivation is important in whether people continue to work or not, especially if enabling factors are present, such as assistive technologies and reasonable accommodations.
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From page 79... ...
So when Medicare denies reimbursement for a motorized scooter on the grounds that it is not "medically necessary," should SSA's policy for disability determinations in this venue compensate for this medical necessity barrier toward getting people the assistive technologies they need to obtain jobs that give them not only income, but also allow them to maintain their dignity? David Stapleton, Ph.D.
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From page 80... ...
SSA's efforts to redesign the disability decision process can only have limited success. The various reasons can be illustrated with this model.
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From page 81... ...
81 True Environment .
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From page 82... ...
However, SSA will run into trouble when applying functional assessment measures to people who are motivated to show that they "are disabled." By definition, they are so motivated if they are trying to obtain benefits. If SSA goes through with its current plan of adopting increased use of functional status in its redesigned decision process, it needs to carefully assess the effect of motivation on the outcomes of functional assessments.
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From page 83... ...
As the income limit went up based on the average Medicaid expenditures in a state, the earnings of the SSI beneficiaries accordingly increased. Because of their earnings they are not receiving much in cash benefits under SSI.
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From page 84... ...
When all these factors are put together, two questions arise: What do they mean for program growth, and what could they mean for the Health Care Financing Administration, which manages the Medicaid and Medicare programs? Accelerating health care costs and the growing difficulty for a person with severe medical problems in getting health insurance in the private market are likely to be contributing to the growth of the disability rolls.
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