1. Reforming the Social Security Disability System: A Clarion Call for Action and Change Dr. Bruce S. Growick The Ohio State University

2. Dr. Growick’s Background Faculty at OSU in the areas of disability and rehabilitation for 20 years As rehab educator, trained MA level rehabilitation counselors in disability issues and service delivery Presidential Appointee to U.S. Access Board 2 yrs- Director of Rehab Services for OH Bureau of Workers’ Compensation Vocational Expert for SSA, federal and state court systems for 20+ yrs Actively involved in passage of Ticket to Work on behalf of private sector rehab providers

3. Three Areas of Investigation Definition and Process of Disability Determination used by SSA Connection between Disability Status and Return to Work (RTW) Delivery of RTW Services to SSA Beneficiaries

4. Restructuring the Disability Determination (DD) Process Need to create new classifications of disability status similar to Workers’ Compensation and Long-Term Disability categories: Permanent total and temporary total Permanent partial and temporary partial Time-limited, medical only benefits Eliminate all or nothing approach to disability

5. Restructuring the Disability Determination (DD) Process Eliminate over reliance on medical listings and medical-vocational grids Does not recognize individual differences or functional limitations of applicants Many different definitions of disability based on purpose and use Civil rights – ADA; employment - SSA

6. Establishing a Viable Connection between Disability and RTW All disability indemnity systems have 3 principal components Medical care Cash payments Vocational (RTW) services

7. Establishing a Viable Connection between Disability and RTW Critical components of the “Ticket” Consumer choice of providers: deregulation of the vocational rehabilitation industry Continued medical coverage Reinstatement of benefits -“Easy on and off”

8. Establishing a Viable Connection between Disability and RTW Limitations of the “Ticket” Outcome only payment system for providers is not working Lack of interest by beneficiaries – RTW services should occur before disability determination Reluctance to change by State Federal VR and its partners Resistance is similar to changes created by introduction of supported employment in the 1980’s.

9. Delivery of RTW Services to SSA Beneficiaries Make mandatory referral for RTW a part of DD process Most DD Services at the state level are administered by the State Vocational Rehabilitation agency Have RTW information in the file at the appeal level for a more informed disability decision by the ALJ Private sector and public sector delivery of services What are the advantages and disadvantages of each system?

10. Comparison of Private Sector vs. Public Sector RTW Services 1) Hierarchy of RTW Same job-same employer Different job – same employer Same job – different employer Different job – different employer Retraining 1) No hierarchy of RTW

11. Comparison of Private Sector vs. Public Sector RTW Services 2) Sources of funding Operates on earned income No appropriated $$$ Greater accountability for $$ spent per case 2) Sources of funding Operates on appropriated $$$ Accountable for number of people served, not $$ spent per case

12. Comparison of Private Sector vs. Public Sector RTW Services 3) Provides direct job placement and RTW services 3) Does not provide direct job placement and RTW services Provides $$ mostly for training and educational services Sub contracts with vendors for RTW and direct job placement services Order of selection and waiting lists

13. Comparison of Private Sector vs. Public Sector RTW Services 4) Measurement of Success Success measured by 3 variables: Time to RTW (case velocity) Cost per case ($$$) Outcome (hierarchy and RTW) 4) Measurement of Success Successful closure defined by 2 factors: Greater independence Quality of life