NATIONAL CENTER FOR APPROPRIATE TECHNOLOGY

OCA has worked with the Community Services Administration in the planning and development of the National Center for Appropriate Technology which is funded with grants totalling $3,086,546. The center will carry out a program of research and development, with a specific mission in its first year of developing, modifying, adapting, and implementing technologies which can be helpful to poor people. This is especially necessary in dealing with the problems of rapidly increasing energy cost and will tie in with CSA's weatherization program. The center will tap the research and development of other appropriate technologies to help low income communities. Working with community action agencies throughout the country, the center hopes to apply that technology toward improving the general quality of life in their communities. OCA expects the new technology to be especially beneficial for the elderly consumer.

SOCIAL SECURITY ADMINISTRATION

The Social Security Administration (SSA) administers the Federal old-age, survivors, disability, and health insurance (OASDHI) programs of the Social Security Act (titles II and XVIII) that provide retirement, survivors, disability, and health insurance for the aged. This program today is the basic method in the United States of assuring income to individuals and families when workers retire, become disabled, or die, and for providing hospital and medical insurance protection for people who have reached age 65, are disability insurance beneficiaries, or need kidney dialysis or transplantation.

SSA administers the supplemental security income (SSI) program for the aged, blind, and disabled (title XVI of the Social Security Act).

SSA is also responsible under the Federal Coal Mine Health and Safety Act, for payment of black lung benefits to coal miners and their families who applied for those benefits prior to July 1973 and for payment of black lung benefits to certain survivors of miners.

1. LEGISLATION

Legislation enacted in 1976 which amended the programs administered by SSA included the following public laws:

SSI LEGISLATION

Public Law 94-241, signed June 21, 1976, will extend the SSI program, as well as the OASDI programs (including Special Age-72 (Prouty) benefits) to the Northern Mariana Islands after the islands have become a commonwealth of the United States.

Public Law 94-331, signed June 30, 1976, excludes for SSI purposes any support and maintenance received by an individual forced to leave his home due to a disaster, occurring during the period June 1, 1976 through December 30, 1976, which is subsequently declared by the President to be a major disaster for purposes of the Disaster Relief Act of 1974. Such support and maintenance would not be counted until the 6th month after the individual first received it. Public Law 94-455 extends the exclusion until the 18th month after support and maintenance are first received.)

Public Law 94-365, signed July 14, 1976, extends for 1 year, the provisions of Public Law 93-233 relating to the eligibility of SSI recipients for food stamps and makes permanent the temporary authority in present law for the reimbursement to States for interim assistance provided SSI applicants.

Public Law 94-375, signed August 3, 1976, excludes from income and resources under the SSI program, the value of assistance provided under several Federal housing programs effective October 1, 1976.

Public Law 94-379, signed August 10, 1976, permits the State of California to retain its food stamp cash-out status under the SSI program.

Public Law 94-455, signed October 4, 1976, excludes until the 18th month for SSI purposes, any support, and maintenance received by an individual forced to leave his home because of a national disaster during the period June 1, 1976 through December 30, 1976 (see Public Law 94-331, also). This law also includes four other provisions which are listed under the subsection on OASDI legislation. Public Law 94-540, signed October 18, 1976, specifies that funds awarded and distributed to the Ottowa Indians will not be counted as income or resources for SSI benefit purposes.

Public Law 94-566, signed October 20, 1976, the "Unemployment Compensation Amendments of 1976," includes the following amendments to the SSI program: (1) It provides for the referral of disabled and blind SSI recipients under age 16 for appropriate services; (2) it provides that members of an eligible SSI couple will have their income treated separately if one member is in a medical facility for a full calendar month; (3) it preserves medicaid eligibility for individuals who become ineligible for SSI payments due to cost-of-living increases in social security benefits in June 1977, and later; and (4) it authorizes SSI payments to persons in publicly operated community residences serving no more than 16 persons and excludes from income assistance based on need (including vendor payments) made to or on behalf of SSI recipients by State or local governments beginning with October 1, 1976. Another provision, affecting social security recipients is discussed in the OASDI-legislation section.

Public Law 94-569, signed October 20, 1976, excludes the value of a home in which an individual resides from the determination of resources under SSI and it authorizes the payment of SSI benefits for up to the 3 months to presumptively blind applicants.

Public Law 94-585, signed October 21, 1976, requires the States, as a condition for receiving Federal medicaid funds, to maintain their levels of supplementation under SSI whenever the Federal SSI level is increased beginning with SSI increases after June 1977. The act also provides that any cost-of-living_or general increases in Federal SSI benefits after June 30, 1977, will be disregarded for purposes of determining the amount which the Federal Government must contribute towards the cost of supplemental benefits provided by the three "holdharmless" States of Hawaii, Massachusetts, and Wisconsin.

OASDI LEGISLATION

Public Law 94-241, signed June 21, 1976, will extend the OASDI (including Special Age-72 (Prouty) benefits) and SSI programs to the Northern Mariana Islands after the islands have become a commonwealth of the United States. Public Law 94-455, signed October 4, 1976, the "Tax Reform Act of 1976," has five provisions pertaining to SSA: (1) It permits the States to use the social security number in the administration of any motor vehicle registration, driver's license, tax, or general public assistance law, and makes it a misdemeanor to willingly, knowingly, and deceitfully use the social security number for any purpose; (2) it excludes from "employment" and covers as "net earnings from self-employment" remuneration received by certain fishermen; (3) it amends the provisions of the Internal Revenue Code affecting the social security coverage of self-employed U.S. citizens outside the United States; (4) it excluded until the 18th month for SSI purposes any support and maintenance received by an individual forced to leave his home because of a natural disaster during the period June 1, 1976, through December 30, 1976 (see Public Law 94-331); and (5) it extends the earned income credit provision of Public Law 94-12 through the end of 1977.

Public Law 94-563, signed October 19, 1976, deals with the coverage of individuals employed by nonprofit organizations where the organization failed to file a certificate electing coverage but paid the social security contributions and reported the earnings.

Public Law 94-566, signed October 20, 1976, the "Unemployment Compensation Amendments of 1976," provides that beginning October 1, 1979, the amount of unemployment compensation payable to an individual will be reduced by the amount of any public or private pension (including social security and railroad retirement benefits) received which are based upon the individual's work. The SSI-legislation section discusses the four SSI provisions of this law.

MEDICARE LEGISLATION

Public Law 94-368, signed July 16, 1976, provides that the prevailing charge for a physician service under medicare shall not be lower than the charge for that service in fiscal year 1975. It also provides that allowable charges under part B of medicare will continue to be updated each July 1 based upon actual charges made by physicians in the preceding calendar year. Finally, this public law delays until October 1, 1977, the implementation of the provisions of the 1972 amendments dealing with the reimbursement of teaching physicians.

Public Law 94-437, signed September 30, 1976, permits medicare reimbursement under certain conditions to Indian health service facilities.

Public Law 94-460, signed October 8, 1976, amends the definition and requirements of a health maintenance organization under medicare to better conform with those of title XIII of the Public Health Service Act but makes no change in the services a HMO must provide medicare beneficiaries.

Public Law 94-581, signed October 21, 1976, clarifies what the reimbursement will be by medicare for services to patients in certain Veterans' Administration hospitals under sharing agreements with non-VA hospitals.

GENERAL LEGISLATION

Public Law 94-505, signed October 15, 1976, establishes the Office of the Inspector General within the Department of Health, Education, and Welfare with the responsibility for conducting audits and investigations of DHEW programs and operations.

2. OASDI BENEFITS AND BENEFICIARIES

At the end of October 1976, 32.8 million people were receiving monthly social security cash benefits (an increase from 31.8 million in October 1975). Of these beneficiaries, 17 million were retired workers, 3.6 million were dependents of retired workers, 193,000 were uninsured individuals receiving “Special Age-72” (Prouty) benefits, 4.6 million were disabled workers and their dependents, and 7.4 million were survivors of deceased workers.

The monthly rate of benefits for October 1976 was $6.3 billion compared to $5.7 billion for October 1975. Of this amount, $4.2 billion was paid to retired workers and their dependents, $779 million was paid to disabled workers and their dependents, $1.3 billion was paid to survivors, and $14 million was paid to special age-72 beneficiaries.

Retired workers received an average benefit in October 1976 of $224 (up from $206 in October 1975), while disabled workers received an average benefit of $244 (up from $225). Retired workers receiving their first social security benefits in October 1976 averaged $232, while disabled workers reecived average initial benefits of $272.

During fiscal year 1976, $71.4 billion in social security cash benefits were paid compared to $62.5 billion in fiscal year 1975. Of that total, retired workers and their dependents received $45.1 billion, disabled workers and their dependents received $9.2 billion, survivors received $16.5 billion, and special age-72 beneficiaries received $186 million. In addition, lump-sum death payments amounted to $337 million.

3. MEDICARE

Medicare, provided under title XVIII of the Social Security Act, is a federally administered program providing two types of health insurance: (1) hospital insurance (part A), which covers inpatient hospital, skilled nursing facility and home health care; and (2) supplementary medical insurance (part B), which covers physicians' services and many other medical services. Medicare protection is available to people aged 65 and older, people who have been entitled to cash social security benefits for at least 24 consecutive months on the basis of their disability, and certain end-stage renal disease patients. The hospital insurance program is financed on a self-supporting basis through contributions on current earnings paid by employees, employers, and self-employed persons. The supplementary medical insurance program is voluntary and is financed through monthly premiums paid by eligible individuals who elect to enroll for such coverage and from Federal general revenues. The basic monthly premium was $7.20 for the 12-month period beginning July 1, 1976.

As of June 30, 1976, about 24.7 million persons in the United States were eligible for hospital insurance protection. Of this number, 22.3 million were age 65 and over, representing about 95 percent of the aged population. The remaining 2.4 million persons were disabled beneficiaries under age 65.

As of June 30, 1976, about 24.5 million persons in the United States had protection under the voluntary supplementary medical insurance plan. Of this number, 22.3 million were persons, aged 65 and over, representing about 95 percent of the aged population. The remaining 2.2 million persons were disabled beneficiaries under age 65.

About 95 percent of the population under age 65 in the United States have both hospital insurance and supplementary medical insurance protection in the event of the occurence of chronic kidney disease requiring kidney transplantation or hemodialysis.

For fiscal year 1976, payments for services covered under the hospital insurance program were made on behalf of an estimated 5.7 million persons, of which 5.0 million were aged 65, and over, and 0.7 million were disabled beneficiaries under age 65. Benefits under the hospital insurance program amounted to $12.3 billion in fiscal year 1976-an 18.2-percent increase over the $10.4 billion paid in 1975. For fiscal year 1976, payments for services covered under the supplementary medical insurance program were made on behalf of an estimated 13.7 million persons, of which 12.2 million were aged 65 and over and 1.5 million were disabled beneficiaries under age 65. Expenditures under the supplemental medical insurance program for fiscal year 1976 totalled $4.7 billion-a 24-percent increase over the $3.8 billion paid in 1975.

4. SUPPLEMENTAL SECURITY INCOME

Beginning July 1976, maximum monthly Federal SSI payment levels increased from $157.70 to $167.80 for an individual and from $236.60 to $251.80 for an eligible couple. The monthly rate of benefits for federally administered SSI payments was $507 million in October 1976, with 4.3 million persons receiving monthly benefits-2.2 million aged persons were receiving $204.1 million; 2 million disabled persons were receiving $291.3 million; and 76,831 blind persons were receiving $11.7 million in benefits. During fiscal year 1976 $5.9 billion in SSI payments were made-$4.5 billion in Federal benefits and $1.4 billion in State supplementation benefits. This is an increase from fiscal year 1975 SSI payments of $5.5 billion, which included $4.1 billion in Federal benefits and $1.4 billion in State supplementation.

5. BLACK LUNG BENEFITS AND BENEFICIARIES

During October 1976, 471,810 individuals received $77.6 million in black lung benefits from general revenues which were administered by the Social Security Administration. Of these individuals, 159,248 were miners who received $46.8 million, while 142,170 widows and 170,392 other dependents received $30.8 million. During fiscal year 1976, SSA administered black lung payments in the amount of $892.6 million.

Black lung benefits increased by 4.39 percent in November 1976 due to a general cost-of-living increase adjustment under the law. The monthly payment to a coal miner disabled by black lung disease increased to $205.40 from $196.80. The monthly benefits for a miner or widow with one dependent is $308.10, and with two dependents is $359.50. The maximum monthly benefit payable when there are three or more dependents is $410.80.

6. OMBUDSMAN PROJECT

The concept of an ombudsman was first mentioned before the Senate Special Committee on Aging in June 1975. The mission of the ombudsman-type individual (referred to as a Social Security Service Officer) and the support staff will be to attempt to resolve social security problems for private citizens. It is anticipated that, generally services will be provided to persons who feel they have been unable to resolve problems satisfactorily through regular channels. The Service Officer will be expected to pursue the problem until it is resolved or he is satisfied that the law and regulations were properly applied in determining the individual's rights under the program. The Service Officer will have authority to contact any source necessary within or outside SSA to request information and expedite handling. Upon completion of the investigation or study of the problem, the results will be communicated to the individual in the form of a decision, revised decision, or explanation of the prior decision or action, as appropriate.

The 12-month ombudsman demonstration formally began on October 12, 1976, in four locations throughout the United States-Boston, Dallas-Fort Worth, and the States of Washington and Georgia.

The ombudsman demonstration will be evaluated by an outside organization selected competitively. The evaluation should provide some basis for assessing the need for this type of service on a continuing basis. During the demonstration period, SSA will also be studying the types of problems being brought to the Service Officer, the reasons for the problems, and the results of the Service Officer's efforts. The objective will be to identify areas where improvements in policies, procedures, or services are indicated and take corrective measures.

7. PLANNED ACTIVITIES FOR 1977

Four major objectives have been approved by the Department of Health, Education, and Welfare for the Social Security Administration for fiscal year 1977:

Objective No. 1 is concerned with SSI processing goals and implementation of selected SSI study group recommendations. Objective one has four parts: (1) reduce the average processing time for initial SSI aged claims to 27 days and for SSI blind/disabled claims to 50 days; (2) complete about 73,000 SSI hearings cases; (3) reduce the overall SSI case error rate to 19 percent; and (4) improve working relationships with State governments and others.

Objective No. 2 is concerned with improving the disability process. Objective two also has four parts: (1) reduce the average time for initial social security (title II) claims to 50 days; (2) complete about 95,000 hearings cases; (3) implement a procedure to increase uniformity of decisions in cases involving adjudication of vocational factors; and (4) strengthen program management and accountability of the vocational rehabilitation programs for social security and

SSI beneficiaries.

Objective No. 3 is to prepare to begin processing annual wage reports from employers. Section 8 of Public Law 94-202 amends the Social Security Act and the Internal Revenue Code to provide for a single annual wage reporting system beginning January 1, 1979. Accomplishment of this objective will require much coordination of activities among the Social Security Administration, the Department of Health, Education, and Welfare, the Internal Revenue Service, and the Department of the Treasury.

Objective No. 4 deals with the master plan for the development of the future technological, management, and operational mechanisms required to accomplish the Social Security Administrations program responsibilities. The master plan will take place in four phases over a 6-year period and will include: Phase I, conceptualization; phase II, requirements definition; phase III, design and development; and phase IV, implementation.

SOCIAL AND REHABILITATION SERVICE

1. RESEARCH AND EVALUATION

No SRS programs are targeted on the aged population per se, but elderly persons make up a large percentage of the client population in the medicaid and social services programs, particularly in the long-term care area. The evaluation and research activities of SRS, therefore, consider the aged as a significant subgroup of the client population.

During fiscal years 1975 and 1976, evaluation activity most significant for the elderly is a project funded jointly with the Administration on Aging and the Health Resources Administration. This project focuses on deinstitutionalization and the question of what is appropriate care for impaired persons. Emphasis is on the testing of a methodology to classify functionally the impairment of adult persons requiring long-term care. A major field test of the functional classification system and survey instrument is scheduled to begin shortly in four States. Another evaluation effort initiated in fiscal 1975 is examining Federal and State standards for nursing home care and their associated costs to the homes. An additional project is analyzing existing accounting systems in the long-term care industry as a guide to States considering the adoption of a uniform chartof-accounts for long-term care. Uniformity of accounting systems could assist States in comparing facilities to encourage the most effective spending of the medicaid dollar on long-term care patients.

A nearly completed study of the spend-down provision of the medicaid program has obtained data on the sociodemographic and economic characteristics of persons who entered the program through the spend-down mechanism, including the effects of the spend-down on their income and assets, and the health service requirements which caused them to enter the program. Among the study findings were the determinations that a high proportion of individuals who entered medicaid via spend-down were aged and that the average spend-down individual spent over $1,000 in medical expenses in the year preceding his/her medicaid application. Spend-down is definitely a provision that helps the aged who are poor and have unusual medical expenses.