Social Security Administration Processing Claims Improvement Act of 2024

Bill: 118-hr-8546
Sponsor: full_name: Rep. Neguse, Joe [D-CO-2]
Introduced: 2024-05-23
Policy area: Social Welfare
Latest action: action_date: 2024-12-17
text: Referred to the Subcommittee on Social Security.

Summaries:

tv_txt: I 118th CONGRESS 2d Session H. R. 8546 IN THE HOUSE OF REPRESENTATIVES May 23, 2024 Mr. Neguse introduced the following bill; which was referred to the Committee on Ways and Means A BILL To require the Commissioner of the Social Security Administration to take certain actions to improve the processing of claims and appeals for disability insurance benefits and supplemental security income, and for other purposes.

1. Short title This Act may be cited as the Social Security Administration Processing Claims Improvement Act of 2024 . 2. Findings Congress finds the following: (1) A recent Social Security Administration Inspector General report found that nearly half of the 151,000,000 callers to field offices and the national 800-number went unanswered. (2) In 2021, over 9,000,000 people received Social Security disability insurance benefits. (3) According to the National Academy of Social Insurance, over half of all beneficiaries rely on Disability Insurance and Supplemental Security for 90 percent or more of their income. (4) Benefits are interrupted following the denial and often remain paused until a review—which can take anywhere from 14 to 22 months—is complete. (5) Since 2011, the number of beneficiaries increased by more than 22 percent while over the same period, Social Security Administration’s operating budget fell by more than 17 percent, after adjusting for inflation. 3. Social Security Administration claims processing review Not later than 1 year after the date of enactment of this Act, and on an annual basis thereafter, the Commissioner shall conduct a review to— (1) identify— (A) processing error trends of claims processors and the training needs of claims processors and case managers; (B) possible improvements to the processing of claims with respect to covered benefits, including decision-making of claims processors; (C) the most common causes of overpayments of covered benefits; and (D) the most common reasons for denying an application for a covered benefit; (2) evaluate— (A) any written or verbal instructions or training given to benefits counselors; (B) any guidance or regulation promulgated by the Commissioner that is related to determinations of eligibility for covered benefits and whether updates to such guidance are necessary to provide claims processors with better resources to carry out the duties of such processors, including any guidance regarding the processing of claims for a covered benefit; and (3) after the training programs under section 4 are established, identify improvements to the training programs with regard to— (A) the processing of claims for a covered benefit; and (B) decision-making for claims processors when reconsidering the eligibility of a claimant for a covered benefit. 4. Trainings for claims processors (a) Annual training program (1) Establishment Not later than 1 year after the first review under section 3 is conducted, the Commissioner shall establish, and update on an ongoing basis, a national training program for claims processors who review claims for covered benefits, including appeals of continuing disability reviews. (2) Participation Not later than 180 days after the date that the annual training program under paragraph (1) is established, the Commissioner shall require that each claims processor participates in such program at least once each year, beginning in the second year in which the claims processor carries out the duties of a claims processor for the agency. (3) Required elements The training established under paragraph (1) shall include the following: (A) Training on the quality assurance standards established under section 6. (B) Disability etiquette training for case managers and claims processors to learn effective communication and empathy. (C) Training regarding internal communications to prevent overpayments and subsequent benefit denials. (b) Ongoing training program (1) Establishment Not later than 1 year after the first review under section 3 is conducted, the Commissioner shall establish, and update on an ongoing basis, an ongoing training program for claims processors who review claims for covered benefits, including appeals of continuing disability reviews. (2) Participation Not later than 180 days after the date that the ongoing training program under paragraph (1) is established, the Commissioner shall require each claims processor to participate in such program on an ongoing basis, beginning in the second year in which the claims processor carries out the duties of a claims processor for the agency. (3) Required elements The training program established under paragraph (1) shall include the following: (A) Workshops with claims processors every 6 months. (B) Collaborative review of a complex case by all claims processors at a field office every 2 months. (4) Definitions In this subsection: (A) Complex case The term complex case means a case that— (i) has its processing time increased because of a mistake or error that is attributable to the Social Security Administration; (ii) has conflicting evidence from multiple health care providers; or (iii) involves an individual with a lapse for a period of time that is greater than 2 weeks. (B) Lapse The term lapse means, with respect to an individual receiving a covered benefit, a physical or mental impairment, as determined by a health care provider, that prevents the individual from providing information required for a continuing disability review (as defined in section 201(g)(1)(A) of the Social Security Act ( 42 U.S.C. 401(g)(1)(A) ). (c) Consultation required When establishing the training programs described in subsections (a) and (b), the Commissioner shall consult with an entity that advocates for, and provides resources and information to, individuals with disabilities to assist such individuals in overcoming barriers to independent living, including an entity carrying out a community rehabilitation program (as such term is defined in section 7 of the Rehabilitation Act of 1973 ( 29 U.S.C. 705 )). 5. Reports (a) Report on backlogs Not later than 180 days after the date after the date of enactment of this Act, and on an annual basis thereafter, the Commissioner shall submit to Congress a report on the status of backlogs for determinations of eligibility for covered benefits and continuing disability review determinations, including, with respect to both such determination backlogs— (1) information on wait times for such determinations; and (2) recommendations on streamlining and improving the determination processes. (b) Report on accessibility Not later than 180 days after the date of enactment of this Act, and on an annual basis thereafter the Commissioner shall submit to Congress a report that includes— (1) a plan to ensure that all services at the Social Security Administration, including appeals of covered benefit denials, are in a format that is appropriate for the specific needs of individuals with disabilities, such as audio versions of notifications, large print and braille options, and easy-to-read information; and (2) the amount of funding needed to carry out the plan described in subparagraph (A). 6. Quality assurance standards Not later than 180 days after the date of enactment of this Act, the Commissioner shall establish, and update on an ongoing basis, quality assurance standards to standardize how staff at field offices assist claimants, which shall include— (1) guidelines on how to answer questions of claimants in a timely and polite manner; and (2) a process for a claimant to submit feedback to the Commissioner on whether the claims processor who processed the application of such claimant met such standards. 7. Definitions In this Act: (1) Covered benefit The term covered benefit means— (A) a disability insurance benefit under section 223 of the Social Security Act ( 42 U.S.C. 423 ); and (B) a supplemental security income benefit under title XVI of the Social Security Act (42 U.S.C. 1381 et. seq). (2) Commissioner The term Commissioner means the Commissioner of the Social Security Administration. (3) Continuing disability review The term continuing disability review has the meaning given the term in subsection (g)(1)(A) of section 201 of the Social Security Act ( 42 U.S.C. 401(g)(1)(A) ). 8. Social Security Act amendments (a) Additional review (1) Title II amendment Section 205(b)(1) of the Social Security Act ( 42 U.S.C. 405(b)(1) ) is amended by striking Any such decision by the Commissioner of Social Security which involves a determination of disability and which is in whole or in part unfavorable to such individual and inserting the following: In the case of any such decision that involves a determination of disability and that is in whole or in part unfavorable to such individual, the Commissioner shall require a person, other than the person who made the initial unfavorable determination, to review the initial decision and make a recommendation as to whether the initial decision should be modified. The Commissioner shall make a final decision in accordance with such recommendation. Any such final decision which is in whole or in part unfavorable to such individual . (2) Title XVI amendment Section 1631(c)(1)(A) of such Act ( 42 U.S.C. 1383(c)(1)(A) ) is amended by striking Any such decision by the Commissioner of Social Security which involves a determination of disability and which is in whole or in part unfavorable to such individual and inserting the following: In the case of any such decision that involves a determination of disability and that is in whole or in part unfavorable to the individual, the Commissioner shall require a person, other than the person who made the initial unfavorable determination, to review the initial decision and make a recommendation as to whether the initial decision should be modified. The Commissioner shall make a final decision in accordance with the recommendation. Any such final decision that is in whole or in part unfavorable to the individual . (b) Modernization of information submission Part A of title XI of the Social Security Act (42 U.S.C. 1301 et. seq) is amended by inserting after section 1143 the following: 1143A. Modernization of information submission With respect to any information required to be submitted by an individual to the Social Security Administration regarding a proceeding or determination for a benefit under title II or a supplemental security income benefit under title XVI, the Commissioner shall accept such information in the following ways: (1) Email. (2) Fax machine, until December 31, 2045. . (c) Social security wage reporting app Part A of title XI of the Social Security Act (42 U.S.C. 1301 et. seq) is amended by adding at the end the following: 1150D. Social security wage reporting app The Commissioner of the Social Security Administration shall ensure that an individual who receives a disability insurance benefit under section 223 may use the SSA Mobile Wage Reporting App for the purpose of tracking the wages and employment of such individual. . (d) Effective date The amendments made by this section shall take effect 2 years after the date of enactment of this section.