Transcript Slide 1
New Opportunities with SOAR:
SOAR Fundamentals, Part I
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
Abigail Lemon, MA
Senior Project Associate
SAMHSA SOAR Technical Assistance Center
Policy Research Associates, Inc.
Logistics
Recording
Downloading materials
Poll questions
Chat questions
Live Q&A
Webinar Call Agenda
One – Day SOAR Fundamentals Training
SOAR Fundamentals
SOAR
Basics
Getting
Started
Questions & Answers
POLL QUESTION #1
Preparing for SOAR
Fundamentals
Local Implementation of Online Course
Preparation
Advertising the training
SOAR Online Course support
Weekly progress expectations
SOAR Fundamentals Training
Sample training flyer
One-day training
Follow-up Support
Local leads
SAMHSA SOAR TA Center
SOAR Fundamentals
Introductions
Local SOAR Leads
Program Participants
Please tell us:
Your name and work location
What are your plans/goals for using SOAR in
your work?
What do you need to learn today to get you
there?
Logistics and Housekeeping
Take care of yourself
Restrooms
and breaks
Ground rules
Cell
phones
Ouch, Stretch, ELMO
Others?
Values and language
Parking Lot
SOAR
SOAR stands for SSI/SSDI Outreach, Access and
Recovery
Focus is on people who are homeless or at risk for
homelessness
Sponsored by the Substance Abuse and Mental Health
Services Administration (SAMHSA) in collaboration with
SSA since 2005
All 50 states currently participate; no direct funding
provided to states
Why is SSI/SSDI Important for Individuals?
SSA disability benefits can provide access to:
Income
Housing
Health
Insurance
Treatment
Other supportive services
For people with disabilities, SSI/SSDI can be a
critical step towards ending homelessness and
promoting recovery
Why is Access to SSI/SSDI Important for
States & Localities?
People experiencing homelessness are frequent users of
expensive uncompensated health care
Can recoup cost of this care from Medicaid for up to 90
days retroactive to date of SSI eligibility
States and localities can recoup from SSA the cost of public
assistance provided during the application process
SSI, SSDI and Medicaid bring federal dollars into states,
localities and community programs
Changing Lives Since 2005
19,008 persons experiencing or at risk for homelessness
have been approved on initial application
65 percent approval rate overall
Compares to 10-15 percent for unassisted applications from
people who are homeless and 29 percent for all applicants
Approvals were received in an average of 100 days in
2013
Appeals can take a year or more; many people give up
and do not appeal
Top Eight States
Served more than 4,000 persons
89 percent approval rate on initial applications
Approval rates are highest in places where more
SOAR critical components are implemented
SOAR Technical Assistance Center
SAMHSA funds the SOAR TA Center to support
states and communities
Offers virtual and on-site technical assistance
SOAR TA Liaisons are responsible for SOAR in
multiple states
Get to know your SOAR TA Liaison
Reach out for help or answers to questions about
any aspect of SOAR
Online Course Experience
Wows
Wishes
Activity: Reasons for the Work We Do
This program is about:
Ending
homelessness
Promoting
recovery
Transforming
lives
Discussion:
What
brought you to this work?
SOAR Fundamentals Agenda
The Basics
Getting Started
Who
is a SOAR
applicant?
Engaging the applicant
State SOAR process
Forms
Medical Summary
Report Refresher
Tracking Outcomes
Special Populations
Appeals
Now What?
SOAR Fundamentals Materials
PowerPoint slide handouts
Sample SSA Forms
MSR Worksheet
Sample Medical Summary Reports
Your State’s SOAR Process
Sample Application Packet
Any other materials that you want participants to have!
POLL QUESTION #2
SOAR Fundamentals:
The Basics
SOAR Has Broader Goals
Housing
Decrease in
adverse outcomes
(incarceration &
hospitalization)
Community
Investment
SOAR
Access to
treatment and
other services
Employment
Opportunities
SOAR Partners
Social Security Administration (SSA)
Federal agency that administers SSI/SSDI
Makes the non-medical decision
Disability Determination Services (DDS)
State agency under contract to SSA
Makes the medical/disability determination
Medical/treatment providers
Assessments/evaluations
Medical records
You!
SSI & SSDI: The Basics
SSI: Supplemental Security Income; needs based;
federal benefit rate is $721 per month in 2014;
provides Medicaid in most states
SSDI: Social Security Disability Insurance; amount
depends on earnings put into SSA system; Medicare
generally provided after 2 years of eligibility
The disability determination process for both
programs is the same
Application Process
Application
Initiated at
SSA
SSA
Determines
NonMedical
Eligibility
SSA
Transfers
Claim to
DDS
DDS
Determines
Medical
Eligibility
DDS
Returns
Record to
SSA
SSA
Notifies
Applicant
Criteria for Eligibility
1. Medically Determinable Physical or Mental impairment
Illness must either meet or be equivalent to the “listing” criteria
used by DDS. Supporting information must be documented in
medical records
2. Duration
The impairment tied to the illness(es) must have lasted OR be
expected to last 12 months or more OR be expected to result
in death
3. Functional Information
Applicants must demonstrate that significant functional
impairment related to the illness(es) exists that impede their
ability to work
Sequential Evaluation
Step 3 is Key!
Person can be found disabled at Step 3 and begin
receiving benefits
If adequate evidence is presented that impairment
meets the Listings and the applicant is unable to
work
Connecting functional limitations to their inability to
work with appropriate medical documentation is
key
Documenting the Disability
Case managers need to collect medical records from all
treatment sources
Applicant report
Collateral sources (friends, family, other service providers)
Common treatment providers
Two releases (agency and SSA-827) for each treatment
source are signed so that the case manager can share
these records with SSA and DDS
Used to meet the Listings
Organize your search!
Documenting the Disability
If medical records are not current, case managers
may need to arrange for assessments to be done
Mental status exams must be done within 90 days
of submitting application
DDS
requires that the applicant has a diagnosis from a
doctor (MD/PhD/EdD)
Make the Link to Work
The question DDS must answer is: “Can the person
work and earn SGA?”
Disability must meet the criteria in the “Listings”
Must make the link between a person’s illness,
his/her inability to function in a work setting
Functional Information
For mental illnesses, the applicant must demonstrate
functional impairments that meet the Listings
Document all four areas
Activities
of daily living
Social functioning
Concentration, persistence and pace
Repeated episodes of decompensation
Must demonstrate marked functional impairments in
at least two areas
Functional Information
For physical impairments, the application
must demonstrate significant limitations in meeting
physical, mental, sensory and other requirements
of work
A limited ability to perform certain physical
demands of work activity (e.g. sitting, standing,
walking, lifting, carrying, etc.) may reduce a
person's ability to do past work and other work
Using the Blue Book Listings
http://www.ssa.gov/disability/professionals/bluebook/
AdultListings.htm
For each category of mental impairment:
General description of disorder
Section A – types of symptoms and impairments (diagnosis)
Section B – required “level of severity” (limitations in functioning)
Section C – medically documented history (longer period of
documentation)
To qualify, an individual must:
Meet A + B
Or C
Criteria “A” – Blue Book Listings
Psychiatric evaluations
Physical health
evaluations
Specialty physical
health evaluations
Neurological reports
Laboratory results
Diagnostic tests
Neuropsychological
tests
Psychological tests
Admission summaries
Discharge summaries
Criteria “B” – Blue Book Listing
Bio-psychosocial evaluation reports
Occupational therapy evaluation reports
Vocational evaluation reports
Psychiatric Rehabilitation Day Program notes
Supported housing progress notes
Functional descriptions
Medical Summary Report
Remember to Make the Link
Diagnosis
Part “A” of the Listing
Functional Limitations
Part “B” of the Listing
Why the applicant is unable to work.
The MSR helps illustrate the connection between A and B
The Secret to Approvals?
A + B = Approval
Co-Occurring Disorders
If substance use is deemed "material" to a person's
disability, benefits will be denied
Substance use is "material" when:
If
a person were clean and sober, the functional
impairment would not exist and the person would not
be disabled
The determination does NOT require sobriety
Use past periods of sobriety (hospital, jail,
treatment) to document symptoms that persisted
Medical Summary Report (MSR)
The MSR is a letter which describes the individual and
his/her functional limitations and struggles
Supports medical records submitted
Helps DDS “see” the person you are working with
Illustrates the connection between the applicant’s functional
limitations and the impairment
Answers the question: “Why can’t the applicant work?”
The MSR worksheet guides the case manager through
the sections of the written report
The letter, not the worksheet, is submitted to DDS
Medical Summary Report
Medical Summary Reports are considered medical
evidence if signed by a treating physician or
psychologist
Even without a physician’s signature it is important
for DDS’s determination of the applicant’s ability to
work
POLL QUESTION #3
Getting Started
The Challenge
Limited resources
Limited time
A lot of people need our help
Applications involving mental illness and cooccurring substance use disorders are complicated
The SOAR Applicant
Who can be helped by SOAR?
Adults who are experiencing, or at risk for, homelessness
And who have mental illness, co-occurring disorders or other
physical disabilities or conditions
Who is considered “homeless”?
Moving from place to place throughout the month
Living “doubled-up”
Living in uninhabitable housing, outside or in shelters
Living in unstable or non-permanent housing
Exiting jails or prisons and who have no stable place to live
Identifying SOAR Applicants
Using the Tool
Identify individuals who most need your
assistance
Do not discourage anyone from applying for
SSA benefits
Plan for alternative service or referral
Make the Tool Work For You
Consider adding your program acceptance
criteria
Use in conjunction with other assessment tools
Consult with colleagues or the SOAR TA Center
Engaging Applicants
Create and maintain a safe space for you and the
applicant
Keep your promises: Under promise and over deliver
Find out where the person spends his/her time
Develop ways to maintain contact, including someone to
contact should you need to reach the applicant
Ask open-ended questions
Be mindful of non-verbal communication
Our State or Local SOAR Process
Attention Local/State Leads!
The next few slides cover the standard SOAR process;
adapt these slides if your process differs from this
Add information about your local/state SOAR process
here
How to set protective filings dates
When to contact SSA
How to communicate with DDS
Where to access records and assessments
Getting Started: Completing an Initial
SSI/SSDI Application
Getting Started: Days 2 – 3
Complete and
have applicant
sign the SSA-1696
Appointment of
Representative form
SSA-1696: Appointment of
Representative
Permits communication with SSA and DDS about the applicant’s file
Case manager receives copies of all applicant communication from
SSA and DDS
The most important tool for working with someone who is
experiencing homelessness
“The Key to the City”
Neither the agency or the case manager is liable for the decision
made by DDS
It is NOT the same as the representative payee
SOAR providers should check “waiving fees from all sources”
Getting Started: Days 2 – 3
Request Letter
Agency Release
SSA-827
SSA-827: Authorization to Disclose
Information to SSA
Allows SSA and DDS to gather medical records and
information from medical records departments
SOAR providers - use along with Agency Release
Form when requesting medical records from every
source (HIPAA Compliant)
All forms should be signed by the applicant
Available online
Getting Started: Weeks 1 – 2
SSA-3368:
Disability
Report Adult
SSA 3368: Adult Disability Report
Gathers basic information about the applicant’s
work history, medical treatment and education
Helps DDS know which providers will have medical
evidence for the application
DDS
will request records from the medical sources listed
SOAR
case managers can indicate in Remarks which
records they will submit with the application
Complete online, use the paper version as a
worksheet
Getting Started: Weeks 3 – 4
SSA-8000:
Application for SSI
SSA-8000: SSI Application
Title XVI
Needs based so income and resources are counted
Longer application
The amount of pages may seem overwhelming but for
many, resources are so limited that many of the pages
will be blank
Don’t assume that the applicant does or does not have
resources
Can be completed in person, by phone or submitted
hard copy
Getting Started: Weeks 3-4
SSA-16: SSDI Application
SSA-16: SSDI Application
Title II
SSDI eligibility is based on work history
No resources and assets counted
Not necessary to establish need
Explores eligibility for other benefit programs
(Worker’s Compensation, VA benefits, etc.)
SSA prefers online submissions
Establishes protective filing date for SSI applications
Remember the ‘Remarks’ Section
Found on the SSA-8000, SSA-16 and SSA-3368
Indicate that this is a “SOAR” claim if the person is
experiencing or at risk of homelessness
Provide additional information that will clarify
responses to questions on the forms
Reference the question number in the comments
section along with the explanation
Getting Started: Weeks 5 – 8
Medical Summary Report (first and last pages)
Submitting the Application
Call the SSA SOAR Contact at least 1-2 weeks
before the 60-day deadline, or earlier, to request
an appointment to submit the completed application
24-48 hours before the SSA appointment, submit
the combined Disability Application (SSA-16) and
Disability Report (SSA-3368) online
Submit the completed application package using
the SOAR Checklist for Initial Claims as a cover
sheet
Submitting the Application
http://www.ssa.gov/applyfordisability/
SOAR Application Checklist
Reminder! A Complete SOAR Packet Includes:
1.
SOAR Checklist as a cover sheet for the completed application
package
2.
SSA-1696 Appointment of Representative form
3.
SSA-827 Authorization to Disclose Information to SSA
4.
SSA-8000 signed and dated by applicant
5.
MSR signed by the SOAR provider as well as the applicant’s
physician or psychologist
6.
Copies of all medical records in chronological order
7.
SSA-3368 and SSA-16 submitted on-line 24-48 hours before
turning in completed application package (Items 1-6)
Organizing Your Effort
Make a file for each applicant
Consider
Include
a cover sheet
Section
for medical records
Section
for SSA/DDS Correspondence
Have
a folder with sections
files prepared in advance
Create a contact list for SSA reps, DDS
adjudicators and medical records providers
QUESTION & ANSWER
Homework
Download the SOAR Fundamentals PowerPoint
Peruse the SOAR Leaders page
Password:
SOARWorks
Enroll in the SOAR Online Course
Bring your questions!
Connect With Us
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]
www.facebook.com/soarworks
@SOARWorks