[Federal Register Volume 62, Number 121 (Tuesday, June 24, 1997)] [Notices] [Pages 34097-34101] From the Federal Register Online via the Government Publishing Office [www.gpo.gov] [FR Doc No: 97-16490] ======================================================================= ----------------------------------------------------------------------- SOCIAL SECURITY ADMINISTRATION Progress Report on Development of a Redesigned Method of Evaluating Disability in Social Security Claims AGENCY: Social Security Administration. ACTION: Notice and solicitation of comments. ----------------------------------------------------------------------- SUMMARY: This notice updates and requests further comment on SSA's research plan for developing a new method for determining whether an individual is ``disabled,'' as defined in the Social Security Act (the Act), for purposes of entitlement or eligibility to disability benefits under titles II or XVI. Notice of the original research plan, including a request for comments, was published in the Federal Register on September 9, 1996 (61 FR 47542). This notice discusses:Preliminary research that has been conducted on functional assessment tools and occupational classification systems; Independent review and oversight of the research, including the related disability evaluation study (DES), by the National Academy of Sciences (NAS); Expert, technical guidance being provided by outside consultants; and The role of external stakeholders. In addition, this notice describes SSA's plans for future research and development activities. DATES: Comments should be received in writing on or before August 8, 1997. ADDRESSES: Please submit comments on the Research Plan or requests to be placed on the External Stakeholder [[Page 34098]] mailing list (see External Stakeholders, below) in one of the following manners: By E-mail, to [email protected]. By telefax, to 410-966-0148. By mail, to Disability Process Redesign Staff, Office of Disability, Social Security Administration, 6401 Security Boulevard, Room 560 Altmeyer, Baltimore MD 21235. FOR FURTHER INFORMATION CONTACT: David Barnes, 410-965-9121. SUPPLEMENTARY INFORMATION: Background On September 9, 1996, SSA published, in the Federal Register, notice of the Research Plan For the Development of a Redesigned Method of Evaluating Disability in Social Security Claims (61 FR 47542). That notice described SSA's research plan for developing a new method for deciding whether an individual is ``disabled'' for purposes of Social Security disability program claims, but without changing the statutory definition of disability. The notice also discussed integration of the DES and the disability decision methodology research. (A summary of the research plan may also be accessed on the Internet at: http:// www.ssa.gov/DPRT/research.html.) In the September 1996 notice, SSA also stated its intention to publish future notices to update the research plan at major milestones in the research and development process. This is the first of these intended notices. Research Plan To Develop Redesigned Disability Decision Methodology The current research plan includes three steps: (1) Initial Research; (2) Integration of Initial Research and Development of a Prototype Disability Decision Process (including DES Stage 1 activity); and (3) Final Testing (including DES Stage 2 activity). The research plan also calls for independent review and oversight; use of outside technical expert consultants; and use of stakeholder input. Step 1: Initial Research A. Four Reviews of Current Literature The research plan calls for four literature reviews to gather background information and data in subject areas of importance to the disability decision process. The four reviews, two of which have been completed, are described below. 1. Functional Assessment Instruments The purpose of the functional assessment research was to define the state of the art in assessing functional capacity, and to identify instruments that might be used in, or adapted for, a new decision process. This review has already been conducted by Virginia Commonwealth University (VCU). It involved thoroughly researching the literature about systems, methods, and instruments for measuring functional ability and capacity to perform activities and tasks, and developing a systematic method of describing, categorizing, comparing, and evaluating those systems, methods, and instruments for the purpose of determining their potential application in the disability decision process. VCU began research in August 1995. In March 1996, VCU completed its work and issued its report, titled Summary Report. At SSA's request, VCU prepared a follow-up report, Report on Findings and Recommendations for Future Directions which was issued in July 1996. These reports are available on the Internet (http://www.ssa.gov/DPRT/ functional__assessment.html) and are summarized below. Summary Report. In the Summary Report, issued in March 1996, VCU reported that its initial search of literature and other sources identified approximately 700 functional assessment instruments. In conjunction with SSA, VCU developed selection criteria in order to focus on those instruments most appropriate to SSA's needs. Forty-six (46) instruments met the criteria and were further reviewed and analyzed. VCU described the 46 instruments and made the following findings from its analysis of those instruments. Finding #1: The search yielded a large number of instruments currently in use. Finding #2: The search yielded no truly global measure of function. Finding #3: Most functional assessments in use relied upon self- reported data. Finding #4: Self-report scales offer few mechanisms for validation of data. Finding #5: Automated functional capacity systems offer more mechanisms for validation of data, but require more time and equipment. Finding #6: Self-report questionnaires can be modified to offset potential exaggeration of symptoms. Finding #7: Predictive and concurrent validity of clinical instruments may not generalize to SSA claimant populations. Finding #8: Specialized training for administering instruments needs to be a consideration in selection. Finding #9: Functional assessments often include performance of social roles and expectations, not just symptoms. Report on findings and recommendations for future directions. After receiving the initial report, SSA asked VCU to use the knowledge gained in their research on functional capacity assessment instruments to expand and elaborate on their analysis. In July 1996, VCU issued the Report on Findings and Recommendations for Future Directions. In this follow-up report, VCU expressed the opinion that the addition of functional assessment strategies to the SSA disability determination process would greatly enhance the effectiveness and efficiency of current assessment strategies. The report stated that the development and use of appropriate functional assessment instruments for screening and as domain-specific batteries could complement clinical assessment, increase the accuracy of residual functional capacity assessments, and potentially reduce cost related to administrative reviews and litigation. However, VCU also said that, currently, there is no one functional assessment instrument which will measure the effects of all types of impairments on mental and physical functioning and that the present status of functional assessment is not sufficiently refined to allow a total reliance on this approach. The VCU report identified six functional domains that the authors felt should be addressed in an SSA-devised instrument for the measurement of general function: Activities of Daily Living. Mental Functioning Limitations. Physical Functioning Abilities. Psychiatric or Mental Health Status. Medical Information. Social Support Networks. The VCU report recommended that SSA undertake the following activities as the next steps in the methodology research and development process: a. SSA should develop a global functional assessment screening instrument that could be standardized and validated on the SSA applicant pool. SSA should directly develop or coordinate the development of a functional assessment instrument for use in the disability determination process. The following steps should be completed. Determine the domains to be included in the assessment. Develop a draft instrument for subsequent standardization and validation. Standardize and validate the instrument on a representative sample of SSA applicants. Based on the results of the initial analyses, develop a ``second draft'' of [[Page 34099]] the instrument for additional, more advanced, validation analyses. Based on the results of the second round of validation analyses, the instrument can then be readied for large scale field-test implementation within the national disability determination system. b. SSA should directly develop or coordinate the development of detailed assessment batteries in each of the domains identified above. Initial batteries should be developed in each of the domains. Particular care should be given to the development of batteries in the areas of Mental Functioning Limitations and Psychiatric or Mental Health Status. The domain-specific functional batteries should be prepared for a series of validation analyses. 2. Occupational Classification Systems The purpose of the review of occupational classification systems was to review existing systems and methods of classifying occupations, particularly in terms of the physical and mental capacities required to do those occupations, and evaluate such systems and methods in terms of their potential applicability to the redesigned Social Security disability decision process. This research related to one of the key concepts in the disability decision process proposed in the disability process redesign-- ``baseline work.'' The redesign plan called for determining disability in some cases by comparing an individual's functional ability to a baseline of work that represents substantial gainful activity. This baseline was expected to describe the basic physical and mental demands of work (i.e., a range of functional activities that realistically reflects the demands of occupations that can be performed in the absence of prior skills or formal job training). The baseline would be used to evaluate whether an individual's functional ability is consistent with the ability to perform substantial gainful work activity. The review was designed to assist SSA in determining whether there exists a standard to describe basic physical and mental demands of a baseline of work (or whether it is feasible to develop such a standard). If such a standard were not found to exist and could not be developed, the research should assist in determining an alternative process(es) determining whether an individual is unable to do not only his or her previous work, but also unable to engage in any other kind of substantial gainful work which exists in the national economy. This research was begun in May of 1996 by the American Institutes for Research (AIR). In November 1996, AIR issued the Final Report: Identification and Analysis of Occupational Classification Systems. This report is available on the Internet at: http://www.ssa.gov/DPRT/ execsum.html. The initial search yielded 126 documents identifying and describing 33 occupational classifications systems of 5 different types. Although AIR did not find a candidate system that was exactly or ideally suited to SSA's needs, it did find one database that closely matches SSA's needs--the Department of Labor's (DOL's) Occupational Information Network (O*NET), which is currently under development. Based on discussions with SSA, together with its review and analysis of occupational classification systems, AIR made five recommendations: Recommendation 1: Use O*NET; Recommendation 2: Establish a working relationship with the Department of Labor; Recommendation 3: Compare the occupational classification and functional assessment taxonomies before the Disability Evaluation Study; Recommendation 4: Conduct analyses of the O*NET database; and Recommendation 5: Develop a prototype. 3. Other Disability Programs Systems and Methods The purpose of the third review is to: Survey existing systems and methods of deciding disability in other public and private programs, both domestic and foreign; and Identify methods, instrumentation, criteria, research findings or other features that may be appropriate to incorporate into, or otherwise be used in developing, our new decision process. There are many disability benefit programs and other similar programs, worldwide, that evaluate individuals to determine whether or not they have an impairment and to determine the extent to which such impairment(s) limit their ability to function, particularly in relation to work. These programs use their own methods, instrumentation, and criteria to make decisions. Despite significant differences between other programs' standards or purposes and those established by law for SSA's disability programs, some other programs may have features that can be adapted to SSA's new disability decision process, resulting in time and cost savings. This research has not been conducted yet. We expect to initiate this research in the near future. The research should be completed in early 1998. Note: This notice does not constitute a request for proposals or grant applications. Any unsolicited proposals or applications submitted to SSA at this time, related to this notice, will not be considered nor will their receipt be acknowledged. Any acquisitiion or grant activity will be undertaken under the normal procedures for such activity. 4. Vocational Factors Research The final review is expected to be a survey and analysis of the literature on the relationship between what SSA calls ``vocational factors'' (i.e., age, education, and work experience) and an individual's ability to work. The statutory definition of disability specifies that these vocational factors are to be considered when assessing disability: An individual shall be determined to be under a disability only if his physical or mental impairment or impairments are of such severity that he is not only unable to do his previous work but cannot, considering his age, education, and work experience, engage in any other kind of substantial gainful work which exists in the national economy * * * (Section 223(d)(2)(A) of the Act. Emphasis added.) The purpose of the research is to review current thinking on the actual effects of age, education, and work experience on the ability to work. With this knowledge base, we will be able to begin developing an appropriate way to account for those effects in a new decision process. This research has not been conducted yet. We expect to initiate this research in the near future. The research should be completed early in 1998. Note: This notice does not constitute a request for proposals or grant applications. Any unsolicited proposals or applications submitted to SSA at this time, related to this notice, will not be considered nor will their receipt be acknowledged. Any acquisition or grant activity will be undertaken under the normal procedures for such activity. B. Independent Review and Oversight On September 26, 1996, SSA awarded a four-year contract to the Institute of Medicine and the Committee on National Statistics of the National Academy of Sciences (NAS) to conduct an independent, scientific review of SSA's research and development of a new disability decision process, including the DES. In November 1996, NAS established a committee of 14 experts, the Committee to Review the Social Security Administration's Disability Decision Process Research (the committee), which first met in January 1997. The committee's review (study) will provide [[Page 34100]] independent scientific analysis of all aspects of SSA's approach and methods for researching and developing the new decision process and conducting relevant DES research activities. Consistent with the need for independence and impartiality, final decisions about study management and work plan reside with the committee, which has authority and responsibility for the conduct and oversight of the study. The committee determines the best means to approach the conduct of the study, sets its own agenda, and designs its plan of work. Study activities may include (but will not be limited to) the following broad issues: Review of SSA's research plan and timeline for developing a new disability decision process; Review of SSA's DES design and activity; Review of other related SSA sponsored research, including research findings; and A final report containing the committee's findings and recommendations. C. Consultants In September 1996, SSA began consultation with three outside experts in the subject areas of functional assessment of physical impairments, occupational analysis, and health measurement. In March 1997, SSA added consultants in two additional subject areas: functional assessment of mental impairments and research methodology. The five consultants will provide technical guidance in their respective specialties to SSA's research workgroup. D. Internal and External Stakeholders SSA is committed to conducting this research in an inclusive environment. To that end, SSA is providing updated information to, and requesting comments of, the general public in this notice. In addition, SSA is sending the same notice and request for comments to a comprehensive list of internal and external stakeholders. External stakeholders are individuals and organizations with a special interest in SSA disability programs. By directing updates and requests for comments not only to the general public, but to a list of individuals and organizations who have expressed a particular interest in this project, we hope to receive more specific feedback and commentary than might be received by simply publishing notices to the general public. Individuals or organizations interested in being considered external stakeholders should submit their request as explained in ADDRESSES, above. The role of the external stakeholder is to comment on the research, but not to be an active participant in any research or testing. A number of individuals and organizations who responded to the September 9, 1996 notice, appear to have misinterpreted the request for comment as a solicitation of potential sources for research grants or contracts. Any grant or contracting activity will be clearly described as such and conducted under the usual grant or contracting procedures with appropriate public and industry notice. As noted above, this notice does not constitute a request for proposals or grant applications. Any unsolicited proposals or applications submitted to SSA at this time, related to this notice, will not be considered nor will their receipt be acknowledged. Any acquisition or grant activity will be undertaken under the normal procedures for such activity. Step 2: Integration of Initial Research and Development of a Prototype Disability Decision Process, Including Stage 1 of the DES After step one activities are completed, the next step will be to review the findings of the four initial research surveys (i.e., functional assessment instruments, occupational classification systems, other program methodologies, and vocational factors) and begin the development of a prototype of a new decision process. This will require coordination and integration of the knowledge acquired in the preliminary research, development of proposals for a new disability decision process, and conceptualization of testing scenarios. Stage 1 of the Disability Evaluation Study (DES) (for a detailed explanation of the DES, refer to the notice published in the Federal Register (61 FR 47542) on September 9, 1996) can provide the facility to test proposed components of a new decision process (e.g., specific functional assessment tools), with appropriate control and sampling techniques. In addition, SSA envisions methodology laboratories within which other potential components of a new disability decision process may be tested in a controlled setting. Step 3: Final Testing and Stage 2 of the DES The purposes of this final step will be to: Refine the prototype decision process and develop data about the potential effects and consequences of implementation of the prototype; and specify the precise features of a new decision process and identify all the likely costs and benefits of implementing that process. This will involve additional testing to address scaling, thresholds, validity, and reliability as well as the potential effects of a new disability decision method on both applicants and the adjudication process, e.g., potential changes in decision outcomes in individual cases or for certain kinds of cases, workload, short and long-term administrative expenses, trust fund expenditures, and timeliness of decisions. Analysis of the testing must address: whether the new process is accurate; whether it changes decision outcomes; whether it is simple to administer and facilitates consistent decisions at each adjudicative level; and whether claimants, advocates, and stakeholders view the new method as straightforward, understandable, and fair. The DES will play an important role in gathering test data. However, it will not be the only source of data. We expect to need other sources of test data, and these will have to be developed. The envisioned methodology laboratories may provide controlled settings and representative samples within which data may be gathered and a new disability decision process may be tested. Comments on the September 1996 Notice The SSA received comments from 27 individuals or groups in response to the September 1996 Notice concerning the Research Plan. We found the comments that related to the research plan or to the development of a new disability decision process very helpful. Not all of the comments related to the research plan or decision process. Some comments related to other aspects of SSA's disability redesign, to rehabilitation or return-to-work issues, or to other matters beyond the scope of this project. SSA considered all the comments received, although it does not plan to respond directly to each comment. Many of the suggestions were already part of the research plan and added weight for their inclusion as integral parts of the plan; some of the suggestions are still under consideration; and others are beyond the scope of this project. We appreciate all of the input we have received and we encourage comments on this notice and on future notices, which will update the status of the research. [[Page 34101]] Timeline A timeline of research plan actions and completion date goals is shown below. ------------------------------------------------------------------------ Action Date ------------------------------------------------------------------------ Development of Research Plan.................. Completed. Initial Research on Functional Assessment Completed. Instruments. Publication of Research Plan in Federal Completed. Register; Request for Internal and External Stakeholder Comments. Completion of Initial Research on Occupational Completed. Classification Systems.. Publication of Federal Register Notice 06/97. Describing Initial Research Products and Updating Research Plan. Other Disability Programs Research............ 09/97-02/98. Vocational Factors Research................... 09/97-02/98. Integration and Prototype Development......... 09/97-09/98. Award of DES Contract......................... 12/97. Federal Register Notice Updating Research 12/97. Plan; Request for Internal and External Stakeholder Comments. Supplemental Research (as needed) and Testing. 04/98-04/99. DES Stage 1 Planning and Pilot for Field Work 01/98-06/98. Begins.. Federal Register Notice Updating Research 10/98. Plan; Request for Internal and External Stakeholder Comments. Review of All Research, Comments, and Testing 05/99-10/99. in Conjunction with DES Stage 1 Data; DES Stage 2 Pilot. DES Stage 2 Field Work........................ 10/99-09/00. Federal Register Notice Updating Research 10/99. Plan, Including Any Interim Results; Request for Internal and External Stakeholder Comments. Final Review of All Research, Testing, 10/99-12/00 Comments, and DES Data; Recommendations for Possible New Final Disability Decision Process. ------------------------------------------------------------------------ Dated: June 16, 1997. Carolyn W. Colvin, Deputy Commissioner for Programs and Policy. [FR Doc. 97-16490 Filed 6-23-97; 8:45 am] BILLING CODE 4190-29-P