The Single Decision Maker Pilot: A 16 Year Flight and Still No Clear Landing
Two disability programs administered by the Social Security Administration (SSA) provide cash benefits to workers who can no longer engage in substantial gainful activity because of a disabling condition that is expected to last more than one year or end in death. Adjudicators aim to make these determinations both quickly and accurately; accuracy in this context means that claimants meet SSA’s definition of disability. Normally, after a case has been developed by a disability examiner, a medical consultant—a physician or psychologist—must ‘sign off’ on each case. In 1999, SSA launched the Single Decision Maker (SDM) program—authorizing disability examiners to process some cases without a medical consultant’s sign off. The objective was to shorten the determination process, without degrading accuracy. Twenty case processing offices have had SDM authority for the past 16 years.
SSA is now considering whether to extend SDM authority nationally, eliminate the program altogether or possibly extend the authority to a subset of cases that can be decided most easily. Some data exist regarding cost, accuracy, and speed of determination for the SDM. Unfortunately, the quality of those data is deficient in many ways. High-quality data would have been difficult to develop and generalize as the disability determination process is administered differently in each state. To do so would have required a well-considered research design and data-collection plan with tight administration over the past 16 years. We find little indication of effort by SSA to establish a research design or data collection plan that could have generated the data necessary to make a fact-based recommendation.
UPDATE: As part of the Bipartisan Budget Act of 2015, the Congress directed SSA to end Single Decision-Maker authority.