chapter vi agency services issues--including … · staff training--including sensitivity...

CHAPTER VIAGENCY SERVICES ISSUES-- INCLUDING ADDITIONAL STAFFING TO

FULFILL THE PROMISE TO SERVE THE NEEDY

A. PREAMBLE TO CHAPTER

The Social Security Administration role has expanded overthe years to encompass:eligible for benefits;

identifying individuals potentiallyensuring their awareness of that

potential eligibility: assisting the public by providinginformation and referral to other agencies for socialservices: helping the homeless, and recruiting representativepayees when needed. This chapter addresses areas requiringadditional resources and other necessary improvements toenable SSA to effectively and efficiently fulfill its servicedelivery role.

Members of the public have consistently stated that SSA'sservice to the SSI population is inadequate. Some said thatthis was due to SSA's downsizing over the past 10 years.Commenters said that processing initial applications,especially those based on disability, has taken too long.They also said that improvements are needed in the areas ofinformation and referral, and outreach--including assistanceto the homeless.

SSA's field office staff throughout the nation reportedthe effect downsizing has had on the agency since the early1980's. Some staff stated that downsizing has hampered theagency's ability to provide consistent and adequate publicservice on a nationwide basis. Some also said that, whiledownsizing was taking place, the SSI population in need ofservices from SSA was constantly growing.

B. STAFFING

Background Information:

Between 1984 and 1990, SSA underwent a planned staffreduction in excess of 17,000 positions from approximately80,000 to 63,000 positions. Although increased use ofcomputers provided some basis for downsizing, in the judgmentof the Chairman, the 21 percent cut was arrived at in, to usean expression often used by the courts, an arbitrary andcapricious manner.

The downsizing ended in 1990 but current staffing levelsremain approximately 21 percent below the pre-1984 levels.During the same period, SSA's ongoing workloads increased.

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SSI claims based on disability, for example, increased bymore than 20 percent.

Currently there is a backlog of approximately 762,000disability cases. For 1993, the President's budget projectsa backlog of 1.4 million SSI and social insurance disabilitycases. On average, a person currently filing a claim for thefirst time waits up to 4 months to receive benefits.

The Chairman of the House Ways and Means Subcommittee onSocial Security asked the Commissioner of Social Security howa staff increase of 6,000 would improve SSA's services. TheCommissioner responded that funds for additional staff wouldbe devoted to priority workloads such as processingadditional disability and appellate cases: processingadditional workloads generated by provisions of recentlegislation; reducing the busy rate on the 800 numberservice: and increasing time spent in field offices on newclaims, postentitlement actions, and continuing eligibilityreviews.

Public testimony. Many public commenters familiar withSSA1s workload said there is a need for additional SSA staffin order to improve the agency's performance in meeting thepublic's expectation of service. For example:

"There is an urgent need for the hiring of additionalstaff at‘the district office level....we receivecomplaints from the elderly and disabled regarding thelength of time they have had to wait...before they wereable to meet with a representative. Often times, theywere told to come back and were given an appointment for alater date.. ..They rarely have sufficient monies to payfor transportation to and from the district office. Ifthey were lucky enough to obtain transportation via afriend or family member, the latter may not be able totake another day off from work or child care duties so asto provide transportation....11

"Some seniors show up at the office at 6 a.m. so theywon't have to wait half a day or more. When you are oldor sick, or have arthritis or other disabilities, youcan't wait like that. You just give up on applying forbenefits you're entitled to."

"Many of the staff people who cared the most abouthelping the needy aged and disabled recipients have becomefrustrated and disillusioned and moved on to differentjobs. The ones who have stayed are stressed out andoverwhelmed . . ..We believe the single most important changethat can be made to humanize the SSI program is toincrease staffing levels.11

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‘I . . ..the SSI recipient is being deprived of his initialMedicaid card and his benefits because of the [processing]time delay that [is] taking place...."

Other areas identified by the public as needingimprovement include such things as eliminating delays inprocessing reports of changes which affect benefit amounts;doing a better job of assisting claimants in pursuing theirrights, providing information and referral, conductingoutreach, and processing applications which result fromeffective outreach. They also described the need for morestaff training--including sensitivity training--and bilingualstaff.

Field office staff members also spoke and wrote to theexperts. In addition to addressing specific issues, someaddressed the staffing situation:

"'Not having enough staff has created low morale andfeelings of despair. A workload is consisted of humanbeings--disabled, blind and aged. Human beings who call theclaims representative asking when benefits will start. Manydie, become sicker, or become homeless waiting for our agencyto make a decision and process the claim....The claimsrepresentatives in my office have worked long hours and halfdays on weekends to keep ahead of workloads. We have oneclaims representative that has nearly had a nervousbreakdown, but she's trying to hang in there....1 hope . ..shegets better, but in the meantime we all suffer with addedworkloads because her slot can't be filled."

"1 beg to differ with the attitude that . ..SSA claimsrepresentatives no longer seem to want to help people.Y...Inthe 5 years I have worked in this district office I have:(a) Given mouth to mouth resuscitation to a heart attackvictim in the front end interview area. (b) Assisted apregnant SR who had collapsed at the public service counter.(c) Assisted a young man who was having an epileptic seizureon the floor of the reception area. I am not discussingthese experiences because I want kudos. I wish to emphasizethat, although there are 'burn out' CRs who don't care, thereare more of us who will take the extra step....1 amresponsible to interview, process claims, process a multitudeof post-eligibility items, answer phones, etc. etc. But Imust also, (a) Try to convince a young woman that life isworth living. (B) Talk to a representative payee about herretarded brother who wants to wander to Colorado.(C) Advocate to get emergency medical stickers for an elderlyclaimant. (D) Console a woman because her mother just died.(E) Phone the young woman to make sure she is alive, Discussreferrals to local agencies where she might findsupport/motivation. So, while there is dialogue about how

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involved we should get as SSI CRs, we are getting involvedbecause our claimants NEED US NOW.

"1 have thought of quitting many times. I keep tellingmyself 'who needs it--let someone else do it.' But I seefaces. The mother who brought her son in for hisredetermination interview. He is dying of aids. As theinterview ended she looked at me with tears in her eyes andsaid 'thank you for being so patient with my questions andshowing respect to my son.' Or the young woman in awheelchair. She is completely disabled and has two disabledchildren, one who walks and one who lays across her lap. Atthe end of the interview she looks at me and says, 'thank youfor not treating me like I am stupid'. So, I am still an SSICR. I do not know how long I will stay. I have my bad dayswhen I get cranky and am rude to coworkers and claimantsalike. But I do CARE. That is why I stay.....we need toremember that although this is a battleground--it is a waragainst poverty, illiteracy, disease, apathy, etc.--the SSICR is WITH the CLAIMANT not against the CLAIMANT.ff

Experts' Discussion of Staffing Issues:

The experts view an improved staffing picture as integralto resolving a variety of the problems discussed in thisreport. Almost all agreed with the comments during theexperts' public meetings that SSA needs more, better-trainedstaff in order to improve the timeliness and quality of itsservice to the public.

The subject of staffing arose during the experts'discussions of almost every issue. It was emphasized duringevery public hearing in connection with the need for morepersonalized service for many SSI claimants, and especiallyin connection with the mounting backlogs in the Stateagencies which make disability determinations for SSA.

The experts viewed the disability backlogs in the Stateagencies as unacceptable. The average waiting period is upto 4 months, and some claimants and their representativesdescribed much longer delays. The 1993 budget will increasethe backlogs.

An expert commented that with the projected backlogincreases, the average delay may be expected to increasesubstantially. This expert recalled that when theCommissioner of Social Security was asked recently by thesubcommittee on Social Security what she would need to clearup the backlog of disability cases, she replied that it wouldrequire 5,000 persons and $500 million.

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The experts recognized that behind all statisticsregarding backlogs and processing times are hundreds, eventhousands, of persons who are suffering. They alsorecognized that there are also thousands of career civilservants who are blamed for these delays. One expert said,"Now and then the public may have to deal with a callouscivil servant. But the overwhelming majority of civilservants are eager to clear up the backlogs and arefrustrated because of the shortage of staff."

The experts recognized that the disability backlogs arenot the sole problem. One expert said that in the OmnibusReconciliation Act of 1990, Congress required extensivechanges in SSA% operations with respect to representativepayees. This included more extensive investigations ofpotential payees;dates specified;

a variety of studies with reports due byand the development of an extensive master

file of representative payees which must be in place byOctober 1, 1992. The expert pointed out that currently,5 million beneficiaries of social insurance and SSI haverepresentative payees, and while there are fewer than5 million different payees, creating this system is anenormous task. The expert noted that Congress has neverappropriated a single dollar for the design andimplementation of this very extensive system.

This same expert described other staffing problems relatedto SSA% installation of large telephone service centers tohandle an 800 number. The expert reported that the cost ofdoing this was absorbed by the budgets in the field offices;and when the large telephone service centers becameoperative, SSA directed phone calls to those centers.Recently the Congress has directed that the local SSA officesshould once again publicize and use local phone numbers. Theexpert said that Congress has not provided resources torestore this service in local offices. The large telephoneservice centers with their attendant 800 numbers continue inplace. The expert pointed out that the result is that localoffices have been forced to absorb the costs of creating thetelephone service centers and the costs of reestablishingtelephone services in local offices.

For these, and other reasons, a majority of the expertsalso concluded that the restoration of 6,000 staff positionsis not enough to do the job being asked of SSA. However,they viewed it as a reasonable and desirable first step.

A majority identified increased staffing as one of the toppriorities for modernizing and improving the SSI program.Two experts viewed increased staffing as the single highestpriority of all since they concluded it could eliminate, orgreatly reduce, many of the other problems discussed.

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The experts specified that funds provided for additionalstaffing must be used to improve staffing in the Statedisability determination services as well as in SSA. Oneexpert, while agreeing that adding 6,000 positions wasreasonable as an initial goal, urged that this number bedoubled, at least, over a period of 2 to 3 years. Anotherurged placing emphasis on the need for near-future increasesbeyond the initial 6,000.

Nearly all the experts expressed the view that, withadditional staff, SSA should place renewed emphasis onrestoring more personal contact and individualized assistanceto those it is intended to serve. One expert,in principle,

while agreeingadded that such emphasis should not be

considered separately but viewed as an integral aspect ofadditional staffing.

Recapitulation of Experts 1 Opinions on Staffing Issues:

Option

1. Increase SSA's administrative budget, asquickly as possible, to provide for atleast 6,000 additional positions as a firststep toward adequate staffing.

2. With additional staffing, place renewedemphasis on personal contact andindividualized service.

ExpertsSupporting

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Comment: The one expert who did not favorthis option said that the first priority ofadded staff should be the reduction ofprocessing times in all areas.

C. FUNDING FOR OUTREACH ACTIVITIES


Historically-- and especially following enactment of theSSI program--the Social Security Administration has assumedthe obligation to provide people with information and otherassistance in obtaining benefits for which they are eligible.At times the Agency has been admonished to do more in thisregard, but rarely has there been any budgetary recognitionthat this type of work has an impact on agency resources.

Beginning in 1989, SSA made SSI outreach an ongoing agencypriority. SSA has undertaken an outreach campaign throughits field offices, working with community-based agencies.

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For example, offices have used other agencies' lists to sendletters to potentially eligible individuals; workersregularly visit homeless shelters, facilities for theelderly, and other sites where needy individuals might befound: and computer matches between SSA and other agenciesidentify potential recipients. Information and referralagreements with advocacy and service groups have been a keyaspect of outreach. However, many groups within thepopulation, including the homeless, the frail isolatedelderly, children, and Native Americans, have beenunderserved. (For additional discussion on this issue, seeParts D and E below concerning Vnformation and Referral" and"Helping the Homeless.ff)

In fiscal year 1990, Congress appropriated $3 million forSSI outreach demonstrations. SSA funded 33 outreachdemonstration projects operating in 46 sites nationwide whichtested or are testing methods of overcoming the barriers thatprevent potentially eligible individuals from filing for SSI.In fiscal year 1991, Congress appropriated another $6 millionto continue this outreach program. SSA published a grantannouncement which closed on November 19, 1991, and SSA willfund additional cooperative agreements based on what has beenlearned from the first group of projects. The mostsuccessful methods from all of the projects will beincorporated into future outreach initiatives.

The experts noted that, although Congress has awardedoutreach monies for cooperative agreements to outsideorganizations, it has not provided additional funds for SSAstaff support. Out of necessity, staff support for outreachactivities is being absorbed by SSA's existing staff. Theexperts said that this detracts from other SSA activities,and processing backlogs increase as a result.

Expert& Discussion on Funding for Outreach Activities:

A majority of the experts agreed with the majority ofpublic commenters that SSA should continue outreachactivities. These experts concluded that many potentiallyeligible disabled and elderly individuals are notparticipating in the program.

Most experts agreed that the SSI administrative budgetshould be increased by some specific percentage and theadditional amount should be dedicated to SSA staff outreachactivities. Some of the experts were concerned that theoption, as previously published, was not specific regardingthe percentage of the budget which would be dedicated tooutreach activities. They wanted to ensure that outreachactivities would not be reduced. They reworded the option tostate that the SSI administrative budget should be increased

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by at least 5 percent, with the increased amount dedicatedsolely to outreach. One expert commented that 5 percentseemed too high and suggested that 2.5 percent would bepreferable with the remaining 2.5 percent allocated toincrease personnel, and service improvement.

Recapitulation of Experts'Activities:

Opinions on Funding for Outreach

OptionExpertsSupporting

1. Establish specific funding foroutreach by increasing the SSIadministrative budget by at least5 percent. 16

Comment: Two of the experts indicatedthat SSA should not establish specificfunding for outreach, but instead shoulduse the 5 percent to invest in more staffand better service.

D. INFORMATION AND REFERRAL


When Congress established the SSI program, it separatedresponsibility for income maintenance from that for socialservices. The new program placed responsibility for cashassistance payments delivery in SSA, and social serviceassessment and delivery in the hands of State and localgovernments and private nonprofit agencies. This separationof payment delivery and social service delivery wasconsistent with the historic operation of most State programsprior to the 1974 implementation of SSI.

SSA initiated information and referral activities to helplink SSI claimants and beneficiaries with other public andprivate agencies which could meet other needs. This hadpreviously been done for claimants and beneficiaries of thesocial insurance programs.

The Social Security Act requires SSA to provide referralto vocational rehabilitation programs for certain categoriesof SSI and disability social insurance beneficiaries. Also,the food stamp law requires SSA offices to inform SSIclaimants that they may be eligible for food stamps and thatfood stamp application forms can be obtained at SSA offices:

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also, SSA staff is required to assist certain claimants inapplying for food stamps.

SSA has committed to assisting the public in obtainingsocial services they need. By recognizing the importance ofinformation and referral responsibilities, SSA acknowledgesthat people have needs beyond those met by SSA programs.

SSA field office staff reported during SSI ModernizationProject meetings that, as a result of heavy workloads andinadequate staffing, information and referral is oftenshortchanged. They said that the public expects SSA to havethe capacity to provide support to individuals in need ofsocial services, but with the current level of staffing thisis not realistic.

Models for expanded information and referral serviceswhich the experts considered are:

Expanded community liaison model. This model would- --p---e -------em-----broaden the scope of SSA's referrals to include more in-depthcommunity liaison activities. This activity would providelinkage with community organizations and ensure thatindividuals receive assistance through other organizations;e-g- I the mental health system, local charity or culturalgroups and State agencies. SSA field offices would dedicateadditional staff resources to contacting community agenciesand institutions and to working with them on a continuingbasis. The goal would be to use community organizations inconcert with local SSA offices. Ongoing dialogue would keepSSA aware of changes in local service agencies. Feedbackfrom the other organizations would help SSA improve itsinformation and referral process.

Case manager model.-------- -T------ Case management would furtherincrease SSA's information and referral responsibilities.SSA would make referrals by contacting other organizations onbehalf of the individual rather than providing the individualwith information regarding whom to contact. SSA would followup to ensure that referrals were effective and met the needsof the individual.

A still more comprehensive approach to the case managermodel would have SSA work face-to-face with beneficiaries,their families and caregivers, taking responsibility for theprogress of each person. Case management would provide foran active and ongoing link between people who want or needservices and people who provide those services.

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Experts' Discussion of Information and Referral:

Generally, the experts believed that SSA's information andreferral services should be expanded. They said thatinformation and referral services are especially important toSSI claimants, many of whom are vulnerable and requirespecial assistance in order to obtain needed services.

The Chairman concluded, based on his visits to SSA fieldsites, that there is room for more effective relationshipsbetween the telephone service centers and field offices.

A majority of the experts favored the expanded communityliaison model for providing information and referralservices. This was also favored by a majority of the publiccommenters who addressed this issue. The experts believedthat, even though its use might require increased staffing,this model represents an appropriate increase in the scope ofSSA field office responsibility for in-depth communityliaison activities.

The experts believed SSA field office staffs could developreferral lists and expertise in identifying the particularresources which would be helpful to individual claimants.They also felt adoption of this model would be rewarding toSSA employees. One expert stated that a background in socialservices would be helpful to staff engaged in such activity.

Some experts stated emphatically that SSA should notbecome involved in the case management model. They alsonoted that case management is very labor intensive and wouldrequire a major increase in staff. One expert expressed theview that there would be potential for conflicts of interestand abuse of confidentiality if entitlement agencies were toperform social service functions.

Recapitulation of Experts' Opinions on Information andReferral:


1. Adopt the expanded communityliaison model. 14

2. Adopt the case manager model. 1

Comment: An expert, whodisagrees with this option,opposes SSA's getting intocase management because itWiolates the principle of

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allocating appropriate dutiesto appropriate levels ofgovernment. Federal aid isavailable to the States forthis function through...otherprograms.ff

E. HELPING THE HOMELESS


Provisions of law. Certain provisions of the SSI statuteare intended to help prevent homelessness. They establishexceptions to provisions of the statute that prohibit SSIeligibility for people in public institutions and set apayment limit (currently $30 per month) with respect to aperson who is confined to a medical facility when Medicaid ispaying a substantial portion of the cost of his/her care.These provisions address:

Eligibility while in an emergency shelter for thehomeless. Although an individual generally is noteligible for SSI benefits for any month throughout whichhe or she is a resident of a public institution, there isa statutory exception for persons in public emergencyshelters. In any g-month period, a qualified person maybe eligible for SSI for'any 6 months throughout which s/heresides in a public emergency shelter for the homeless.There is no similar limit on eligibility with respect to aresident of a privately operated shelter.

Continued payments during a medi'cal confinement. Undercertain circumstances, full SSI payments can be continuedtemporarily for individuals who are institutionalized(where payments would otherwise be reduced or suspended).Under one provision, the person must have expenses formaintaining a home, and a physician must certify thathis/her confinement will be for 90 days or less. Under aseparate provision, the person need only to have beeneligible for SSI under work incentive provisions prior toinstitutionalization.

Prerelease program. The prerelease program is designed toidentify potentially eligible people who are about to bedischarged from institutions and assist them in filing forSSI benefits before discharge. The goal is to expeditethe processing of the application so that payments canbegin as quickly as possible after the person isdischarged.

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certain action items designed specifically to help preventhomelessness.

Emergency payments. Nearly all of the experts stated (asdid the majority of public commenters) that emergency SSIpayments should be provided to individuals who are homeless,as defined by the Stewart B. McKinney Homeless AssistanceAct, and who, in the judgment of a qualified mental healthprofessional, exhibit symptoms of severe mental illness. TheMcKinney Act defines a homeless person as someone without afixed, adequate nighttime residence or whose primarynighttime residence is a shelter, a temporary holding placefor individuals intended to be institutionalized, or a placenot intended as sleeping accommodation for human beings.

These experts believed that applications from such personsshould be processed for a final decision within 30 days orbenefits continued until a final decision is reached. Theysaid that the payments should not be considered overpaymentsif it is decided that these individuals are not disabled orblind.

One expert commented that these provisions are neededbecause severely mentally ill and homeless persons are notlikely to stay in one location and pursue their claimsthrough the normal adjudication period.

Continued benefits for people in medical facilities.-------m-e--- -- w-----------T-- -______Almost all of the experts concluded that there is a need tomodify the provision which permits continued SSI payments forcertain hospitalized individuals. They concluded thatrestrictions regarding a physician's certification and therequirement to provide evidence that the eligible individualneeds continued payments to maintain his or her livingarrangement should be removed for those entering hospitals.They believed that the requirements could be retained forthose entering other medical institutions. An expert notedthat many individuals, especially those suffering from mentalimpairments, are not able to provide the informationrequired. This modification would help all SSI recipientswho are hospitalized to maintain living arrangements in thecommunity to which they can return, reducing the likelihoodof homelessness.

Benefits for people in public emergency shelters for the- - - - - - - m e - - - -homeless. Nearly all of the experts stated that residents ofpublic emergency shelters for the homeless should be eligiblefor SSI indefinitely, without the current restriction thateligibility is limited to any 6 months in any g-month period.There was some discussion concerning the fact that residentsof private shelters are not subject to this restriction oneligibility, and it was noted that the public shelter issue

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is localized in that in some areas there are no publicemergency shelters.

Barriers to benefits. Almost all of the experts favoredthe expansion nationwide of outreach services currently beingtested by SSA. Almost all of the experts concluded that SSAshould develop a ffbackupff mailing address for homeless ormentally ill individuals. There was some discussionexplaining that this provision refers to establishing asecondary address at the time of application, and not merelya post office box.

Recapitulation of Experts' Opinions on Helping the Homeless:


1. Provide emergency payments tohomeless persons with severemental illness. 16

Comment: One expert indicated thatemergency payments should be left toState/local governments andprivate agencies.

2. Provide continued payment protectionfor all hospitalized individuals.

3. Pay SSI benefits to individualsin public emergency shelters forthe homeless without any time limit.

Comment: One expert favored ago-day eligibility rule for bothpublic and private shelters. Anotherexpert suggested that the current6-out-of-9 month rule be extendedto private shelters.

4. Expand nationwide the outreachservices now being tested.

5. Create backup mailing addresslocations for homeless and/ormentally ill persons.

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17

15

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F. REPRESENTATIVE PAYMENT


Most people entitled to social insurance or SSI benefitsreceive their payments directly. When a beneficiary cannotmanage or direct the management of monthly payments becauseof severe mental or physical limitation, SSA appoints arepresentative payee to use the payment in the beneficiary'sbest interest.

Each month, SSA pays benefits to about 43 million SSI andsocial insurance beneficiaries. Of these, about 5 millionare paid through representative payees who receive more than$1.6 billion monthly. Representative payments are made forabout 27 percent of the SSI population.

Representative payees are required for beneficiaries whoare children under 18, legally incompetent adults, and

disabled persons receiving SSI payments because of alcoholismor drug addiction. In other cases, SSA determines that abeneficiary is incapable of managing funds based on evidencefrom the beneficiary's doctor and/or reports of persons whoare familiar with the beneficiary's day-to-day activities.

Payee responsibility. A representative payee is requiredto use benefits in the best interests of the beneficiary, andto act on behalf of the beneficiary in dealing with SSA. Forexample, a payee must report changes which may affect theperson's entitlement or benefit amount, and s/he must decidewhether to appeal SSA decisions. In addition, a payee mustaccount, annually, to SSA for the benefits received.

Payee recruitment. Most beneficiaries who need-----w-w------representative payees are served by family members or closefriends. If a beneficiary does not have family or closefriends, SSA must look to the community for a suitable payee.A custodial institution such as a nursing home or Statehospital may be appointed as payee. State and private socialservice agencies likewise may be appointed. However, in someStates, social service agencies are precluded by law orpolicy from serving as payees. In others, budget constraintsprevent agencies from serving. When other sources are notavailable, SSA has the often difficult task of finding avolunteer payee. Persons most often in need of volunteerpayees include those who are severely mentally ill, substanceabusers, and the homeless.

Payment for services.- -r------- Beginning July 1, 1991, the lawpermits certain nonprofit community-based social serviceorganizations to collect fees for expenses incurred inperforming payee services. Such organizations may deduct

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from a beneficiary's social insurance and/or SSI monthlypayment the lesser of 10 percent of that payment or $25.This is a first-time authority to collect fees of any kindfor payee services. It is a temporary authority whichexpires on July 1, 1994.

Payee monitoring. Certain State institutions are subjectto onsite reviews of their payee functions by SSArepresentatives. All other payees are required to submit anannual accountability report. There is no routine audit ofthese reports and there are questions about theireffectiveness in preventing and detecting misuse. However,use of sampling techniques to audit use of funds by payeeshas shown little misuse.

When a payee misuses a beneficiary's funds, the payee isliable to the beneficiary for restitution. Restitution ofmisused benefits is always sought from the payee who causedthe misuse. In these cases, SSA usually appoints a new payeeand tries to recover the misused funds from the former one.Effective November 1990, Federal legislation provides thatSSA is liable for restitution of benefits in cases of misusewhere it is determined that there was negligent failure bySSA to investigate or monitor a representative payee and thepayee misuser has not refunded the misused benefits. Misusecases may be referred for prosecution but referral andconviction levels are low.

Study. SSA commissioned the Administrative Conference ofthe United States, an independent Federal agency, to studyprocedural aspects of the representative payee program. Thestudy findings were published in the FEDERAL REGISTER onJuly 24, 1991. Congress had addressed some of the proceduralissues reviewed by the study as part of the Omnibus BudgetReconciliation Act of 1990.

Several of the recommendations by the AdministrativeConference address issues similar to those discussed by theexperts:

1. SSA should develop and promulgate regulatory criteriaon monitoring and evaluation of representative payeeperformance.

2. SSA should search for appropriate representative payeesby identifying organizations that offer representativepayee services on a volunteer basis. After gainingexperience with these organizations as representativePayee% SSA should evaluate their performances incomparison with other payees.

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3. SSA should evaluate the need for further use oforganizations that serve as representative payees on areimbursed or compensated basis.

4. Congress should authorize SSA to require payees whohave misused funds to pay restitution and to imposecivil monetary penalties.

SSI Modernization ProjectJublic meetings.- ---P-P During thepublic hearingsanexpert noted that, over the years,Congress has increased SSA's responsibilities forrepresentative payment but has never allocated specificresources for the activities. The Omnibus BudgetReconciliation Act of 1990 enhanced SSA's power toinvestigate prospective representative payees, but providedno additional funding for the activity.

The growth in the number of SSI beneficiaries with mentalillness has led to an increased need for representativepayment. Historically,among beneficiaries'

representative payees have been foundrelatives and friends. However, for

those disabled by substance abuse or severe mental illnessfinding and retaining a suitable representative payee i;difficult. During the public hearings, the experts heardfrom individuals and social service organizations concerningproblems encountered representingbeneficiaries.

this group ofSubstance abusers and severely mentally ill

persons often do not want a payee managing their money; thisresults in power struggles between the payee and thebeneficiary over the benefits.member,

When the payee is a familyfamily strife often leads to frequent payee changes.

Representative payees described being threatened or attackedby the eligible person in disputes over the use of SSAbenefits. Because of these difficulties, the experts saw acontinuing need for SSA to seek out social service agenciesto act as payees when suitable payees are unavailable amongfamily members or close friends.

As of July 1, 1991, the law permits certain nonprofitcommunity-based social service organizations to collect a feefor expenses occurred in performing payee services. This feeis deducted from the beneficiary's check.hearings,

During the publicsocial service organizations and representative

payees indicated that fees for representative payee servicesshould come from the administrative budget rather than fromthe beneficiary's check.

Members of the public emphasized the importance ofmonitoring representative payees. Instances of abuse, bothphysical and financial, were described. When arepresentative payee misuses funds or fails to report changesto SSA, the beneficiary suffers and is responsible for

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repaying any overpayments which may occur, even though s/hemay never have received use of the funds. People said thatwhen a change in payee occurs, overpayment notices are sentto the new payee and SSA makes little or no attempt torecover the overpaid monies from the previous payee. Publiccommenters urged that there be stricter monitoring ofrepresentative payees by SSA, and that payees providedocumentation to support their accounting for the use offunds. It was stated that SSA should have the ability torecover misused funds from the responsible payee.

Experts' Discussion of Representative Payment Issues:

Some experts stressed in particular that payments forrepresentative payee services should be made from SSA'sadministrative budget and should not be deducted frombeneficiaries' checks. Most experts also agreed that therewould need to be a special appropriation for the fees.

Also, most experts preferred that a fee should be paidonly to a payee who is neither a relative of the beneficiarynor a custodial institution. One expert stated that if thebenefit rate is raised to 120 percent of the poverty level,the $25 fee should come from the beneficiary's payment

During the discussions one expert expressed the view thatprosecution of a payee for misuse of funds should be left tothe discretion of SSA.

Most experts supported the development of legislationwhich would mandate a specific program of recruitment,training, and monitoring of representative payees andauthorize the appropriation of funds to implement theprogram. The legislative proposal would provide for:(a) payments of reasonable compensation by the FederalGovernment to nonrelative and noncustodial representativepayees for their services out of administrative budget fundsrather than from beneficiaries' checks; (b) contracting bySSA with agencies at Government expense when suitablevolunteers are not available (alternatively, if an SSIbeneficiary were required to pay some or all the cost of thefees of a representative payee, s/he would be reimbursed):(c) requiring payees, other than parents with custody ofminor children, to provide periodic documentation to supporttheir annual accountings: (d) recovery of misused funds bySSA from the monthly payment of any representative payeecurrently receiving benefits in his or her own right; and(e) prosecution of representative payees who have misusedfunds, regardless of the amount.

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Recapitulation of Expert9 Opinions on RepresentativePayment:


1. Develop legislation which mandatesrecruitment, training and monitoringof representative payees and authorizesthe appropriation of funds to implement theprogram. This legislation should providereasonable compensation to nonrelative,noncustodial representative payees fromadministrative funds; contracting by SSAwith agencies when suitable payees are notavailable; periodic documentation by payeesto support annual accounting: recovery ofmisused funds from the monthly check ofrepresentative payees receiving benefitsin their own right; and prosecution ofrepresentative payees who misuse funds.

Comment: An expert who did not supportthis option expressed the view thatrepresentative payee& fees should bepaid from social insurance benefit checks.However, with respect to beneficiariesreceiving only SSI, the fee should bepaid from the administrative budget.

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G. OPTIONS PREFERRED BY A MAJORITY OF EXPERTSSUMMARY AND COST ESTIMATES

Staffinq: adeqllacy.y-F--- --7 -- All of the experts who took aposition on this issue stated that one of their toopriorities is an increase in SSA's administrative budget topermit additional staff positions and related support (e.g.,training and equipment). These experts view an immediateincrease of 6,000 positions as a reasonable first step towardadequate staffing. The experts believe that an increase instaffing would help to alleviate backlogs and allow SSA tobetter serve the public.

Estimated Cost(In millions)

Fiscal SSIYear Program

1993 None1994 None1995 None1996 None1997 None

Staffing: services.that SSA should renewindividualized service.badly needed by a largeSSI program is intendedto the program.

FiscalYear

All

* *

SSI MedicaidAdministrative Program

$ 280 None297 None315 None335 None356 None

* * *

A majority of the experts believesemphasis on personal contact andThese experts believe that this isportion of the population which theto serve. This would improve access


SSIProgram


None (a> None

(a) : Unable to estimate

* * * * *

Fundingfor outreach activities. A majority of the- - -experts expr~~~a~~~-~~~~~s-~~~on favor establishing aspecific funding stream to assure continuation of outreachactivities. These experts believe that many potentially

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eligible elderly or disabled persons are not receiving SSIbenefits. Outreach activities can help to remove barriers tofiling for SSI benefits, and appropriations should providefunds for outreach activities. The experts believe thatoutreach should have specific funding provided by an increasein the SSI administrative budget of atleast 5 percent.


Fiscal SSI SSI MedicaidYear Program Administrative Program

All (a> * (a) (a)

(a) : Unable to estimate.

* * * * *

Information and referral. Most of the experts expressinga view favor SSA's use of the expanded community liaisonmodel. The experts believe that SSA has a responsibility torefer individuals for services available from other agenciesand organizations.

Estimated Cost

FiscalYear

19931994199519961997

(a> :

(In millions)

SSI SSI MedicaidProgram Administrative Program

None $ 100 (a)None 110 (a)None 120 (a)None 130 (a)None 130 (a>

Unable to estimate

* * * * *

Helping the homeless--emergency payments.- --- A majority ofthe experts support providing emergency payments to homelesspersons who are severely mentally ill. Such payments areneeded since these persons are not likely to stay in oneplace during the normal adjudication period.

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FiscalYear

1993 $ 13 $ 10 $ 101994 45 10 351995 50 0 401996 55 0 501997 60 0 55

SSIProgram


*****

Continued payment protection for hospitalized persons. Allthe experts expressing a view on providing continued paymentprotection for hospitalized individuals favor elimination ofthe statutory requirements for a physician's certificationregarding the person's anticipated length of stay and therequirement that the individual have expenses for maintaininga home. The experts support continuation of full payment for3 months for all SSI beneficiaries who become hospitalized.This would help such beneficiaries to maintain a home or tosecure a place to live upon discharge.

FiscalYear

1993 $ 311994 431995 461996 481997 50

SSIProgram



Negligible NegligibleNegligible NegligibleNegligible NegligibleNegligible NegligibleNegligible Negligible

* * * * *

Public emergency shelters for the homeless. All but one----__of the experts expressing a view favor paying SSI benefits toindividuals in public emergency shelters for the homelesswithout a time limit. These experts believe that eliminationof the time limit would allow beneficiaries to continueliving in emergency shelters and eliminate the need for abeneficiary to choose whether to remain at a shelter or tocontinue receiving SSI.

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FiscalYear

All


SSI SSI MedicaidProgram Administrative Program

Negligible Negligible Negligible

* * * * *

Expand nationwide outreach services. Most of the expertsexpressing a view support expanding outreach services. Theexperts believe that outreach services for the homeless areneeded as this population encounters numerous barriers tofiling an application and obtaining documentation required tocomplete the application process and/or to provide necessary- . _medical evidence.


Fiscal SSI SSIYear Program Administrative

All (a> (a)

(a) : Unable to estimate.

MedicaidProgram

(a>

* * * * *

Create backup mailing address locations. All the expertsexpressing a view believe that when a homeless or mentallyill person files an application for SSI, SSA should ask for abackup mailing address. The experts believe that a backupmailing address would increase the likelihood that thebeneficiary will receive his/her benefits.

FiscalYear

All

SSIProgram

None



Negligible None

* * * * *

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Representative Payment.----------w--v __-- A majority of the expertssupports development of legislation to strengthen therecruitment, monitoring and training of representativepayees. A majority also stated that fees for representativepayee services should be provided when the payee is neither arelative of the beneficiary nor a custodial institution.Such fees should be paid from the administrative budget--needy persons should not have to pay them from monthlybenefit.


Fiscal SSIYear Program

All None

(a) : Unable to estimate


(a) None

* * * * *

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chapter vi agency services issues--including … · staff training--including sensitivity...

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