The Beginning of the End for Prototype States

Posted December 18, 2018 by Premier Disability Services, LLC®

Before a case for Social Security disability benefits may be filed in federal court, claimants must give the Social Security Administration (SSA) an opportunity to review the claim and render a final agency decision. Administratively, there are typically four stages of review: initial determination, reconsideration, a hearing before an administrative law judge (ALJ), and review by the Appeals Council.

The initial determination in each state is made by Disability Determination Services (DDS), which applies strict guidelines set forth in the Programs and Operations Manual (POMS). If a claim is denied initially, most states have a reconsideration process which allows a different examiner at DDS to review the case again before the claimant may file a request for a hearing.

In 1997, the SSA introduced a redesign program to bypass the reconsideration process, allowing claimants to file a request for a hearing immediately after the initial determination in ten (prototype) states, including New York, Pennsylvania, Alabama, Michigan, Louisiana, Missouri, Colorado, Alaska, and parts of California. The intent was to achieve earlier decisions and shorter wait times. Yet, in a 2010 statement before the House Ways and Means Commission, the SSA found the opposite was true of its implementation in prototype states.

This past summer, the SSA announced plans to reinstate the reconsideration process in those prototype states, citing to data from a 2001 detailed study of the prototype procedure as well as the need for a uniform process. The announcement spurred opposition from legislators in both parties, who criticized the 2001 data as obsolete and cited to shorter wait times in the prototype states since the inception of the redesign program. Without more recent data and analysis from the SSA, it may be difficult to predict the likely effects. Still, others have suggested that such broad changes to our Social Security program ought to be handled by a duly appointed Commissioner confirmed by the Senate, though there has not been one since the Bush Administration.

Several prototype states will now be instituting reconsideration on January 1, 2019: California (Los Angeles North and Los Angeles West), Colorado, Louisiana, New Hampshire and New York. This means that for any case in which an initial denial is issued on or after January 1, 2019, in those states, the next level of appeal is to file a request for reconsideration, not a request for an ALJ hearing.

Reconsideration is scheduled to be reinstituted in Pennsylvania on April 1, 2019. Alabama and Michigan are scheduled to start reconsideration on October 1, 2019; Missouri on January 1, 2020; and Alaska on March 1, 2020.

By: Joyce Trudeau of Premier Disability Services, LLC®