in the duration of benefits. Programmatic factors include increase in program outreach and public awareness, changes in other support programs, and cost shifting by states associated with cuts in state and locally funded general assistance and other welfare programs, and the deinstitutionalization of people with mental disorders and mental retardation and other disabilities who were previously cared for by state hospital systems.

The analysis further showed that over the years, legislative and regulatory changes and judicial interpretations of eligibility criteria also have extended the scope of the program. Many other factors also have contributed to the growth of the programs, such as incentives to apply for benefits affected by changes in the structure of alternative public and private income support programs for persons with disabilities and the increases in benefit amounts and level of substantial gainful activity allowed for people receiving disability benefits. (These factors and their impact on the growth of the disability programs are discussed further in Chapter 2.)

As a result, SSA often has been faced with large workload increases in the disability programs and consequent backlogs in processing claims and appeals. These increases, however, have not been matched by increases in administrative resources. This imbalance has resulted in significant delays in processing disability claims determinations. A study conducted by SSA (1993) of the disability claim and appeal processes found that the processing time for a claim from the initial inquiry through receiving an initial claims decision notice can take up to 155 days, and through receipt of hearing decision notice, can take as long as 550 days. However, the actual time during this period that employees devote to working directly on a claim was found to be 13 hours up to the initial decision notice and 32 hours through receipt of hearing decision notice. The need to develop extensive medical evidence in every case, delays in the receipt of required medical evidence and consultative examinations at each level, and the wait at each stage of the application process because of missing information as the case is developed, impede timely and efficient decision making (SSA, 1994a).

Errors in making denial decisions by the state Disability Determination Service (DDS) adjudicators, backlogs in appeals, and inconsistencies in decisions reached by DDS adjudicators and administrative law judges (ALJs) are also a matter of concern. The decision-making standards and procedures used by the ALJs are not always the same as those followed by the DDS adjudicators. The subjective element in the disability decision process also contributes to the differences in disability decisions made at different levels of the application process and among different states (DHHS, 1982; GAO, 1994, 1997b; Hu et al., 1997). The number of decisions being appealed for reconsideration and then approved at the higher level has increased. Over time the process has become lengthy and compli-

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