Improving the Social Security Disability Decision Process (2007)

An expert committee will provide recommendations to the Social Security Administration (SSA) on how to (1) improve the Listing of Impairments (Listings), a screening tool SSA uses as part of its process of determining eligibility for disability payments under the Social Security Disability Insurance and Supplemental Security Income programs, and (2) access and use effectively appropriate medical expertise to support the Social Security disability adjudication process at all stages, including the appeals process. Specifically, in addressing the Listings, the committee will consider:

1. The value and utility of the current Listings for all users (claimants, SSA, health care professionals, state offices, and officials involved in the adjudication process)

2. Conceptual models for organizing the Listings, beyond the current “body systems” model specified in federal regulations

3. Processes for determining when the Listings require revision and criteria upon which to add new listings or remove old ones

4. Feedback mechanisms to continuously assess and evaluate the Listings for the purpose of improving consistency in application by all adjudicators throughout the country

5. Adaptability of the Listings, including methods to account for variable access to health care services (including diagnostics and pharmaceuticals) in determining whether an individual’s condition meets or equals the Listings

6. Methods to assess and quantify the effects of multiple impairments that may not individually cross the eligibility threshold (i.e., SSA’s “equivalence” concept)

7. Advisability of and methods for integrating functional assessment into the Listings In addressing the organization of medical expertise, the committee will:

8. Review SSA’s list of presumptive disability conditions and suggest revisions, additions, and/or deletions. The committee will recommend essential criteria for establishing candidate conditions for presumptive disability and recommend the level of professional expertise needed to certify that a presumptive diagnosis is adequately established.

9. Advise on how best to provide medical expertise needed to support the entire disability adjudication process. This will involve describing the type of experts needed (academic specialists, practicing specialists, practicing generalists or nonphysicians), necessary credentials, and where best to locate them (from university medical centers, centers of excellence for specialized care, or community practice settings).

10. Recommend needs for standardized training and certification for consultative examiners who assess claimant’s level of function based on integrated evaluation of medical impairment and functional capacity. Advise on content of a training curriculum, appropriate personnel to train, and mechanisms for the certification process.

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