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SOAR Fundamentals Part II SSI/SSDI OUTREACH, ACCESS, AND RECOVERY SAMHSA SOAR TECHNICAL ASSISTANCE CENTER Sponsored by: Substance Abuse and Mental Health Services Administration U.S. Department of Health and Human Services April 2014 Welcome Pamela Heine, MSW, LSW Senior Project Associate SAMHSA SOAR Technical Assistance Center Policy Research Associates, Inc. Logistics Recording Downloading materials Poll questions Chat questions Live Q&A Review SOAR Leadership Academy Webinar Series: 4/10- SOAR Fundamentals Overview: New Opportunities SOAR Online Course Local Implementation Intro to the SOAR Fundamentals training 4/17- SOAR Fundamentals: Part I The Basics Getting Started Preview Continuation of SOAR Fundamentals Refresher Medical Summary Report Tracking Outcomes Special Populations Veterans, SSA Children, Justice Involved Persons Appeals Process Next Steps Poll and Chat Questions Q&A POLL QUESTION #1 Medical Summary Report Refresher The Importance of the Medical Summary Report Critical component of the SOAR model Provides a vivid picture of the individual for the DDS examiner who never sees them Provides a clear link to the functional impairment Often takes place of the SSA-3373 Function Report Helps to avoid the limited space and check-boxes of these forms Is medical evidence when co-signed by a physician or psychologist Can be sent directly to the DDS examiner or hand delivered to SSA Receives positive feedback from DDS examiners around the country Tips for Writing Collect medical records after Releases of Information are signed Go through medical records and organize in chronological order Set aside several hours at a time to begin writing the report with no interruptions Sit down with all information -- medical records, intake packet, completed MSR worksheet (personal, medical, employment and substance use history) and any current mental status exams Components of the MSR Reference Section Introduction Personal History Diagnostic and Treatment Information Link to Functional Impairment Summary Contact Information Introduction Section Demographics Physical description – hygiene, grooming, dress, make-up, any unique characteristics Include diagnoses and impairment information Help the DDS examiner “see” the individual as you do! Diagnoses and Treatment Psychiatric and physical Chronological treatment history Specific quotes from the applicant or record that illustrate diagnosis Observations of behavior Durational issues Current mental status exam Link to Functional Impairment Critical to connect symptoms/effects of illness with marked functional impairments To the extent possible in all four functional areas Demonstrate impact of illness(es) on ability to work Medication – effects and side effects Support and effect of support Compare with lack of support Make the Link The MSR is the link that connects the diagnosis to the limitations that the applicant experiences Being able to document this link is very important in order to demonstrate the applicant’s inability to engage in substantial gainful activity Diagnosis Limitations in Functioning Why can’t the applicant work? Medical Summary Report Worksheet Tool for gathering information needed to write the MSR Open-ended questions Tell me about … How often … When was the last time … Functional questions Context of questions – SGA Distinguish between access and ability Do not turn the worksheet in to DDS! Summary and Contact Information Ties all information together for a concise picture of the individual Contact – names and numbers Co-signed by case manager, treating physician/psychologist MSR Samples & Support Visit the SOAR website for MSR samples and abbreviated versions The SOAR TA Center will review redacted MSR letters and provide feedback upon request Worth the Effort The overall process of applying for benefits is time-consuming Putting forth the initial effort for an earlier, more successful outcome may seem difficult, but it is worth the effort! Programs with higher outcomes submit medical summary reports Tracking Outcomes POLL QUESTION #2 Online Application Tracking (OAT) https://soartrack.prainc.com A web-based program that allows case managers to keep track of their outcomes Free Easy to use Accessible from any web browser Nothing to download On a secure server HIPAA compliant No personal identifying information is collected Registration Outcomes in OAT Outcomes for initial applications & appeals Approval rates Time to decision Critical components Optional outcomes Housing Employment Medicaid and other public benefit reimbursements Applicant Identification (ID) No personally identifiable information Alpha-numeric ID First 2 letters of first name Last 2 digits of the birth year First 2 letters of last name Last 4 digits of the Social Security Number Case workers should record Applicant ID in the case file for cross reference Example: Summary Report Special Populations Special Populations Veterans Children Justice-Involved Persons Veterans and SSA Benefits The definition of disability and application process is different for VA and SSA benefits Discharge status is not a factor in SSI/SSDI determination Those denied for VA benefits may still be eligible for SSI/SSDI Veterans can access SSA benefits while they are waiting for VA benefits Veterans who receive a partial disability rating and limited VA benefits may also receive supplemental SSA benefits Health insurance associated with SSA benefits can be important for Veterans without VA health care SSA has special provisions for expediting disability applications for Wounded Warriors, that also apply to appeals VA Staff and SOAR Staff are encouraged to participate in SOAR training and assist with SSI/SSDI applications May disclose VA records to SSA if Veteran signs the appropriate release (SSA-827) Can assist in gathering documentation, completing the SSI/SSDI application forms, and referring the Veteran to a SOAR representative, if needed May not serve as Authorized Representative (SSA1696) or Representative Payee (SSA-11), but can be listed as a contact who knows the Veteran How Do Children Qualify for SSI? Four main criteria considered: Disability Income Parent/household income Resources A medically determinable physical or mental impairment, which results in marked and severe functional limitations and which can be expected to result in death or which has lasted for a continuous period of not less than 12 months How does the child’s functional abilities compare to the functional abilities of a child of the same age who does not have the physical and/or mental impairments? Parent/household resources Citizenship/Immigration status Justice – Involved Persons Warrants (other than escape) should not hinder a person from applying or receiving payment A person can apply for benefits while incarcerated Prior history of incarceration alone does not make someone eligible for benefits Engagement Tips for People in Correctional Settings Jails and prisons have distinct cultures Anticipate how this culture or “code” affects behavior and functioning in prison Expand skills to engage individuals in this culture Life experience affects engagement Engagement involves creating a safe space SSA Appeals Process POLL QUESTION #3 SSA Appeals Process 1. Initial determination 2. Reconsideration 3. Administrative Hearing 4. Appeals Council Review 5. Federal Court Review Federal Court Review Appeals Council Review Administrative Hearing Reconsideration Initial Determination Appeal Online http://www.socialsecurity.gov/pgm/appeal.html Reconsideration First level of appeal in most states, except for these areas: Request for Reconsideration needed to initiate the appeals process Must be filed within 60 days of the date of the denial notice, plus an extra 5 days for mailing Three forms to file: Alabama, Alaska, California (Los Angeles North & WB), Colorado, Louisiana, Michigan, Missouri, New Hampshire, New York, & Pennsylvania Request for Reconsideration Disability Report - Appeal Authorization to Disclose Information All may be obtained and filed online at www.ssa.gov Reconsideration DDS takes an entirely new look at the case and makes a new determination on a person’s disability New disability examiner/analyst and new reviewing physician Many ways to support a claim at this stage: Complete more detailed Disability Report - Appeal Revisit the steps in the SOAR model to develop the claim for Reconsideration What To Do If the Deadline Has Passed? The applicant can appeal if he/she has “Good Cause” for missing the deadline Ask SSA to accept late filing by giving “good cause” or reason for the delay Related to applicant’s disability Limited English proficiency and/or education Failure to understand the requirements Failure to receive denial notice within 5 days of the date on the notice Unusual or unavoidable circumstances such as hospitalization Appeal vs. New Application Starting a new application results in: Requesting reconsideration: The loss of the earlier protective filing date and potential loss of months of back benefits Preserves the protective filing date and potential eligibility for months of back benefits Be sure the applicant knows the difference and is making an informed choice! Know the Reason(s) for Denial Request the electronic folder (CD) from SSA or the Office of Disability Adjudication and Review (ODAR) Review the CD to ascertain evidence on file and rationale for denial Review earnings record to make sure there are no SGA earnings Make note of errors, omissions and plan your strategy Administrative Hearing Administrative Law Judge (ALJ) Hearing If denied at Reconsideration or you are in a prototype state File appeal online within 60 days of decision Review the claim, including the evidence used to deny the claim Submit new evidence if applicable Plan to attend the hearing On the Record (OTR) Review A written request asking that the ALJ make a favorable decision based on the evidence in the case record You are requesting a decision based on new evidence that has become available since the DDS denial A favorable decision is the only decision possible through an OTR review Otherwise there is no decision and the hearing process goes forward as though the OTR never happened Can be as big as a catastrophic worsening of the claimant’s condition, or as small as an onset date that was entered incorrectly Can be requested by the claimant or SOAR representative but is often done through a screening process by the ODAR Attorney Adjudicators in an effort to clear hearing backlogs Now What? Next Steps Get started on your first application Reach out to your colleagues, local leads and the SAMHSA SOAR TA Center for assistance Keep in close communication with your SSA and DDS representatives Attend local SOAR steering committee meetings Track your outcomes in OAT Your State SOAR Team Attention Local Leads! Add your information below: State Team Lead contact information Local Lead(s) contact information SOAR Leaders Page http://soarworks.prainc.com Leaders Only Password: SOARWorks Case sensitive Leaders Tab Materials for SOAR Fundamentals trainings Trainers Tab Materials for 2-day trainings POLL QUESTION #4 POLL QUESTION #5 CHAT QUESTIONS Homework! Download the SOAR Fundamentals PowerPoint Peruse the SOAR Leaders page Enroll in the SOAR Online Course Contact the SOAR TA Center with any questions! For More Information Visit the SOAR website at http://soarworks.prainc.com Or contact: SAMHSA SOAR TA Center Policy Research Associates, Inc. Delmar, NY (518) 439 – 7415 [email protected] Facebook: SOARWorks Twitter: @soarworks