R 950.5 D611d 2003 c.l
Oklahoma Department of Rehabilitation Services
HOpening Doors To Opportun itY'
DISABILITY DETERMINATION DIVISION
The Disability Determination
Program in Oklahoma
Table of Contents
Tab A Regulations Pages 3-7
Tab B Process .. .. .. .. ... .... .. ... .... .. .. .... .. .. Pages 8-10
Tab C Oklahoma Specifics Pages 11-13
Tab D. . .... Performance ... .. ... ... ... ... .. .... .. . Pages 14-18
Tab E Budget Pages 19-21
TAB A Regulations
The Social Security Administration (SSA) administers the Social Security and
Supplemental Security Income (SSI) disability programs. SSA employs the
services of state Disability Determination Services (DDS) to make disability and
blindness determinations on behalf of the Commissioner for individuals living in
The Regulations governing the relationship between SSA and the DDS are found
in two separate places in Title 20, Code of Federal Regulations, Chapter III.
Part 404, Subpart Q (Sections 404.1601 through 404.1694)
Part 416, Subpart J (Sections 416.1001 through 415.1094)
The language in these sections is identical. One section pertains to title II of the
Social Security Act, and the other to title XVI of the Act. (Note: title II relates to
Social Security benefits and title XVI to SSI benefits.) The duplication is required
because, although the programs fall under separate titles, they have many
similarities including the fact that they are administered by the same agency, SSA.
The following are excerpts from these regulations. We have reorganized the
material for clarity. For convenience, we are only citing regulation references
from Part 404. Comments that are not direct quotes from the Regulations are
shown in brackets.
Responsibility of the State
• The State is responsible for making accurate and prompt disability
• The State will
1. Provide management needed to insure that the State agency carries out the
disability determination function so that disability determinations are made
accurately and promptly;
2. Provide an organizational structure, adequate facilities, qualified personnel,
medical consultant services, and a quality assurance function;
3. Furnish reports and records relating to the administration of the disability
4. Submit budgets;
5. Cooperate with audits;
6. Insure that all applicants for and recipients of disability benefits are treated
equally and courteously;
7. Be responsible for property used for disability program purposes;
8. Take part in the research and demonstration projects;
9. Coordinate with other agencies;
lO.Safeguard the records created by the State in performing the disability
11.Comply with other provisions of the Federal law and regulations that apply
to the State in performing the disability determination function;
l2.Comply with other written guidelines;
l3.Maintain liaison with the medical profession and organizations that may
facilitate performing the disability determination function; and
l4.Assist us in other ways that we determine may promote the objectives of
effective and uniform administration.
CFR 404.1603 (c)
Selected Additional Requirements
• The State will make personnel available to attend meetings or workshops as
may be sponsored or approved by us for furthering the purposes of the disability
• Subject to appropriate Federal funding, the State will, to the best of its ability,
facilitate the processing of disability claims by avoiding personnel freezes,
restrictions against overtime work, or curtailment of facilities or activities.
• The State will permit us access to the premises where the disability
determination function is performed and also where it is managed for the
purposes of inspecting and obtaining information about the work and activities
required by our regulations and assuring compliance with pertinent Federal
statutes and regulations.
• The State may not incur or make expenditures for items of cost not approved by
us or in excess of the amount we make available to the State.
• Any monies paid to the State which are used for purposes not within the scope
of these regulations will be paid back to the Treasury of the United States.
Responsibility of SSA
• We will work with the State to provide and maintain an effective system for
processing claims of those who apply for and who are receiving benefits under
the disability program. We will provide program standards, leadership, and
oversight. We do not intend to become involved in the State's ongoing
management of the program except as is necessary and in accordance with these
regulations. The State will comply with our regulations and other written
• [SSA] will:
1. Periodically review the regulations and other written guidelines to determine
whether they insure effective and uniform administration of the disability
program. To the extent feasible, we will consult with and take into
consideration the experience of the States in issuing regulations and
guidelines necessary to insure effective and uniform administration of the
2. Provide training materials or in some instances conduct or specify training;
3. Provide funds to the State agency for the necessary cost of performing the
disability determination function;
4. Monitor and evaluate the performance of the State agency under the
5. Maintain liaison with the medical profession nationally and with national
organizations and agencies whose interests or activities may affect the
T B B.....faces.
Social Security regulations define disability as the inability to do any substantial
gainful activity (SGA) by reason of any medical determinable physical or mental
impairment which can be expected to result in death or which has lasted or can be
expected to last for a continuous period of not less than 12 months.
The following chart represents the evaluation process used to determine if an
individual's circumstances/condition meets the definition of disability.
Step 1 Is the person A person who is gainfully employed does not qualify for
engagmg m disability benefits. DDS examiners do not make SGA
SGA? decisions, but must be aware of the criteria used to assess
SGA and alert to reports of work activity.
Step 2 Is there a severe, Disability must result from a medical condition that can be
medically proven to exist. DDS examiners must know basics of
determinable anatomy and physiology as well as the tests that are normally
impairment? used to prove a diagnosis.
Step 3 Does the The listing of medical impairments is part of SSA regulations
impairment meet and provides examples of impairments that are considered to
or equal a be disabling. It also outlines our standards for documenting
Listing? and assessing medical conditions. Medical consultants are
available to help an examiner apply the listing criteria
consistently. Examiners are expected to be able to use the
listings independently in most cases.
Residual Thought not a step by itself, the RFC enables the examiner to
Functional move to step 4 and 5. RFC assessment is complex and must
Capacity (RFC) be unique to the case being decided. The examiner decides
Assessment what activities the person can do and how that conclusion
relates to the medical evidence, the allegations, and the
medical opinions in file. The RFC must contain sufficient
detail to allow comparison to the Dictionary of Occupational
Titles (DOT) and SSA instructional materials.
Step 4 Can the person The examiner must compare the RFC to the specific duties of
perform past work the person has done before. The examiner uses DOT
work? reference material as a baseline to understand how jobs are
generally performed in the national economy.
Step 5 Can the person This final step requires integration of DOT references and the
do other work? SSA vocational grid guidelines to assess whether sufficient
numbers of jobs are available to represent a meaningful
outlook for work and whether past work, age and education
inhibit or enhance the ability to adjust to other work.
• The allowance and denial decisions processed by DDS disability examiners
(DE) represent the determinations of the Commissioner of Social Security.
• The DE decides not only whether the facts support a finding of disability, but
also must determine when the medical impairment first became disabling. The
DE must consider work efforts before and after a medical onset and whether
prior determinations or non-medical eligibility requirements present a legal
barrier to effectuating an allowance.
• The DE must explain conclusions in a notice that is sent to the claimant and
• Determinations are sampled for review within the DDS and in a Federal quality
review component. All judgments that were made in reaching a decision are
subject to considerable scrutiny. The DDS is held accountable for the accuracy
of its examiners' work-that is, how well those judgments stand up to review.
• Decisions to award disability benefits are subject to special reviews to assure
that benefit dollars go only to people who truly meet the disability standards.
• All decisions are subject to appeal and must be legally supportable.
KLA OMA I I
• The Social Security program provides monthly benefits to workers and their
families when earnings stop because the worker becomes disabled. The amount
of the worker's disability benefit is based on the worker's level of earnings in
employment or self-employment covered by the Social Security program. The
benefit amount for the auxiliary or survivor beneficiary is based on a percentage
of the worker's benefit. This is the Title II program.
• In Oklahoma, disabled workers receive average monthly Social Security
payments of $773.
• Supplemental Security Income (SSI) is a federal cash assistance program that
provides monthly payments to low-income aged, blind, and disabled persons.
The program is based on nationally uniform eligibility standards and payment
levels. This is the Title XVI program.
• As of January 2002, the maximum monthly benefit for SSI is $545 for an
individual and $817 for a couple.
• In Oklahoma, disabled individuals receive average monthly Supplemental
Security Income payments of $378.
• These disability programs make a huge difference to the citizens of the State of
• The Social Security Administration currently pays $79.1 million per month in
disability benefits to 146,439 Title II and Title XVI beneficiaries and
dependents in Oklahoma.
• This is $950 million dollars to the State of Oklahoma annually.
Disability Examiner Responsibilities
The main responsibility of the disability examiner (DE) is to make the
determination of the claimant's eligibility for disability benefits for both the
Title II and Title XVI programs.
The DE has a unique position in that there are both medical and non-medical
criteria that must be evaluated to determine eligibility.
The rules of eligibility are complex and difficult to administer and the DE is
directly accountable for a significant impact on the economy of Oklahoma.
Examples of work performed by the DE include the following:
• Examines applications and case records of claimants for completeness of
factual information to document eligibility.
• Interviews claimants, employers, agency officials, etc., to obtain information to
assess non-medical evidence for the determination of claims.
• Reviews medical evidence from claimants, physicians, and hospitals to ensure
conformance with established SSA regulations.
• Consults with DDS medical consultants and also with members of the medical
community at large to review medical evidence to determine eligibility.
• Approves or disapproves claims in accordance with guidelines established by
• Records findings, recommendations, and services provided during the claims
• Completes required case forms and necessary correspondence for cases.
• Total case clearances for Oklahoma have been increasing over the past several
• The Oklahoma DDS received 57,335 cases, 17.9% more initial cases than
received in FY 2001. They disposed of 55,306 cases in FY 2002,6.3% more
cases than they disposed of in FY 2001. The DDD exceeded the agency's
expectation by 3%.
FY 97 FY 98
FY 99 FY 00 FY 01 FY 02
Producti vity Per Work Year (PPWY) is a standard measure of DDS productivity.
It is computed by dividing DDS dispositions by the number of workyears used. A
workyear is a measurement of personnel effort and is the equivalent of one person
working for one year.
FY2000 FY 2001 FY 2002
Oklahoma 299 298 304
Nation 264 262 262
• Out of the 52 DDSs, Oklahoma ranked 8th nationally in PPWY in FY 2002,
and 9th in FY 2001.
Oklahoma DDS PPWY
3>aa..: 280 -1-----1
FY 97 FY 98 FY 99 FY 00 FY 01 FY 02
• Average processing time on disability decisions in Oklahoma has decreased 11
days from 96 days in FY 2001 to 85 days in FY 2002. In FY 2002, they
successfully reduced Social Security (SSA) and Supplemental Security Income
(SSI) processing times to an average of 82.9 and 88.6 days, respectively. These
times are down from 93.7 days for SSA and 98.9 days for SSI during the prior
year, and they are better than both the average Regional and national times for
Arkansas Louisiana New Oklahorra Texas
Average Processing Time
140.0 i i
Accuracy of Adjudication
• Accuracy is based on an ongoing statistical sample of cases that are reviewed
by SSA in a quality assurance component in Dallas.
• Comparing cumulative accuracy for each fiscal year, Oklahoma's accuracy has
remained good at 97.5% in FY 2000 and 95.3% in FY 2001. In FY 2002,
Oklahoma's overall accuracy was 94.9% compared to 94.2% nationally.
Initial Accuracy Cum. Sept. 02
• We spent $15.9 million for Oklahoma DDS expenditures in FY 2002.
• Over half of those costs are for personnel.
• We will spend about $1 million on Indirect Costs in FY 2002. Indirect costs are
payments to the Oklahoma Department of Rehabilitation Services (the DDS
parent agency) for the costs of overseeing DDS operations.
Oklahoma DDS Budget
Continuing Disability Review (CDR) Workload Processing
Individuals who receive SSA and/or SSI disability benefits must have their cases
re-evaluated periodically to determine if they are still disabled within the meaning
of the law. This re-evaluation is called a Continuing Disability Review (CDR).
• The Oklahoma DDS was budgeted to process 11,740 CDRs in FY 2002. Actual
FY 2002 production was 11,794 or 100.5% of the budgeted goal.
102.0% FY 2002 101.1 %
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