Transcript Healthy and Ready to Work - Syntiro

Making the Paperwork Work:
Expediting Program Eligibility
Celebrate the Paperwork:
It Means You Are Alive!
Patti Hackett, MEd
HRTW National Center, Natick, MA
9th AZ Transition Conference
September 2009
www.hrtw.org
•Did you drive here
Standup
•Did you sleep 8 hrs
or more last night
•Skipped breakfast
Breakfast
…..sit down
•Had coffee & donut
…sit down
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Exercise
Laugh
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•Would your sneakers said
you exercised this week?
•Do your sneakers lie?
•Did something make you
laugh yesterday?
•Haven’t laughed today
….sit down
Today’s Outcomes
By the end of 1 hour success
will look, sound and feel like:
• New knowledge of how to draft disability
documentation
• Ways to increase family involvement in their own
care
• Energized by working in a brain compatible
learning environment that you can model in your
work
www.hrtw.org
OVERVIEW
• About You & Me
• About HRTW
• Entitlement-Eligibility
• Essential Paperwork
• Just the Facts
• Resources
www.hrtw.org
You, Me, Looking for ?
•Affirm
• Ah ha!
•Squirm
•Disagree
www.hrtw.org
Who You Are?
Experts in the Room
About me!
Growing Up Ready
to try new things!
7
www.hrtw.org
Transition to Adulthood
www.hrtw.org
www.hrtw.org
www.hrtw.org
Knowledge
Skills
Abilities
what needs
to be
learned
teach it,
practice it,
master it
Automatic
response,
solution
orientated
Strengthen
Circle of
Support
www.hrtw.org
Prepare for the Difference: Entitlement to Eligibility
Methods
Requires
documentation
(need proof,
even if its obvious)
►So many different
definitions of disability.
►Who is considered
disabled ?
►Who is not?
And why does it matter?
►What is the difference
between disabled and
special health care
needs?
www.hrtw.org
Expediting Eligibility: Definition, Criteria & Rules
Adult Programs,
Services & Benefits
Methods
• Definition of disability
• Each agency is different
• Learn their rules/definitions
Documenting Disability - LEGAL RESOURCES
http://www.hrtw.org/tools/dis_info.html
-
ADA
DEVELOPMENTAL DISABILITY
EDUCATION: IDEA/IDEIA
HEALTH
REHABILTATION ACT 1973, Section 504
SEVERE DISABILITY
SOCIAL SECURITY
WORK
www.hrtw.org
Making the Paperwork Work!
Concise Documentation
• Review takes less time when
application and documentation is complete!
• Faster decision.
•Less stress for YOU!
Methods
Evidence matches “rules”
• Medical
• Functional: Social, physical, behavior, cognitive,
and decision making
• Other
www.hrtw.org
Take Home Messages
1. Paperwork is a reality
no positives in whining
2. Identify the shortcuts
put energy on solutions
3. Draft the paragraph, create the one pager
Trim down the care notebook
4. Families NEED to learn this
they get the denials and the stress
www.hrtw.org
Disability Criteria
3
Timeline
2
Documentation
www.hrtw.org
1
Definition
DISCUSSION
www.hrtw.org
Disability Criteria
www.hrtw.org
Just the Facts: Accessing Adult Services
It’s Moving from Entitlement to Eligibility
FORMAT
• Dispelling the Myths (SSI, VR, health insurance)
• The Intent of the Service
• Roles: Teachers,
•
Physicians, Care Coordinators
Families & Youth
www.hrtw.org
The Myth:
Just the Facts: SSI
All applications get denied first time around.
The Intent:
• Supplemental Security Income (SSI) 1972
Federal funded by general tax revenues (not Social Security taxes)
Designed to help aged, blind, and disabled people,
who have little or no income; and
Provides cash to meet basic needs for food,
clothing, and shelter (assets $2,000 single/$3,000 couple)
www.hrtw.org
Just the Facts: SSI
Insider Info:
• Applications will receive a timely impartial
review IF the complete paperwork is received.
• Medical and other evidence is not complete.
• Documentation doesn’t follow disability criteria.
* SSA staff receive raises in part based on
paperwork
flow.
www.hrtw.org
Just the Facts: SSI – Disability Criteria
An individual is "disabled" if he or she has a
medically determinable physical or mental
impairment
• Can be expected to result in death
• Has lasted or can be expected to last for a
continuous period of not less than 12 months
• Child - Marked & severe functional limitations
• Adults -Inability to engage in any
substantial gainful activity (2007-$900/mo)
www.hrtw.org
Just the Facts: SSI - Listings
1. Musculoskeletal System
2. Special Senses and Speech
3. Respiratory System
4. Cardiovascular System
5. Digestive System
6. Genito-Urinary System
7. Hemic and Lymphatic System
8. Skin
9. Endocrine System
10.Multiple Body Systems
11.Neurological
12.Mental Disorders
13.Neoplastic Diseases Malignant
14.Immune System
www.hrtw.org
www.ssa.gov
search
BLUE BOOK
Just the Facts: SSI
111.07 Cerebral palsy with:
A. Motor dysfunction meeting the requirements of 101.02
or 111.06; or
B. Less severe motor dysfunction
(but more than slight) and 1 of the following:
1. IQ of 70 or less; or
2. Seizure disorder, with at least one major motor
seizure in the year prior to application; or
3. Significant interference with communication due to
speech, hearing, or visual defect; or
4. Significant
emotional disorder
www.hrtw.org
Just the Facts: SSI
Disability Criteria for Children: Domains
- Acquiring and Using Information;
- Attending and Completing Tasks;
- Interacting and Relating with Others;
- Moving About and Manipulating Objects;
- Caring for Yourself; and
- Health and Physical Well-being
www.hrtw.org
Just the Facts: SSI
CHILDREN - Meets or Equals
Functionally = "listed impairment”
• Marked limitations in 2 of these domains
interferes seriously with the child's ability to
independently initiate, sustain, or complete
activities.
• Extreme limitation in 1 domain,
interferes very seriously with these abilities.
www.hrtw.org
Just the Facts: SSI
Disability Criteria for Adults
• Meets the Listing - one of the Listings by
comparing it to the specific requirements in the
Listings.
• Meets or Equals - impairment(s) is equal in
severity and duration to a listed impairment.
• Residual Functional Capacity - disability is
severe, but does not meet or equal a listed
impairment
www.hrtw.org
TIPS: Navigating & Documenting
1. Prepare the medical and other evidence
2. Know the eligibility requirement
3. Prepare the application
- Ask for review by others before submitting
4. Come ready (paperwork completed)
the day of “intake”
www.hrtw.org
DISCUSSION
www.hrtw.org
Just the Facts: Vocational Rehabilitation
The Myth:
- They purposely delay applications.
- They only serve people who are easy to place.
The Intent:
To assist and empower eligible individuals with
disabilities to achieve and maintain meaningful
employment
www.hrtw.org
Just the Facts: VR
TRAINING
• Supported Employment
• Short-Term, Vocational Training
• College or University-based education
EMPLOYMENT SUPPORT
• Job Coaching
• On-the-Job Training
www.hrtw.org
Just the Facts: VR
Physicians, Care Coordinators
- Help gather medical & other evidence for
disability determination
Families & Youth
- Portable Medical Summary-ICD9 codes
- 1st appt have ALL paperwork completed.
- Be part of the solution, be proactive.
www.hrtw.org
Handouts: VR
Documenting Disability
- Sample Letter from Physician
• Families need to learn how to draft letter
• Medical Team reviews/edits
• Youth learn the rules and regs.
www.hrtw.org
TIPS: Navigating & Documenting
1. Prepare the medical and other evidence
2. Know the eligibility requirement
3. Prepare the application
- Ask for review by others before submitting
4. Come ready (paperwork completed)
the day of “intake”
www.hrtw.org
DISCUSSION
www.hrtw.org
Just the Facts: Private Health Insurance
The Myth:
• My disabled child will not age out of my health
care insurance.
• All young adults are covered by Medicaid so
why should we continue the private coverage
The Intent:
• It’s a state mandated benefit.
www.hrtw.org
Maintaining Health Insurance
AZ
Mandates:
Private Insurance
- Extended the age of dependent coverage
N
- Adult disabled dependent coverage
Y
- Qualified Medical Child Support Order
(QMCSO)
- Divorce Decree, Support - Adult Disabled Children
Y
Y
Public Insurance
- Medicaid automatic with SSI
www.hrtw.org
Y
Extended Coverage – Family Plan
CONTINUATION OF COVERAGE POST 18 (18 states )
with/without disabilities. Unmarried, childless young adult, most
require student status
Up to age 24 — DE, IN, SD*
Up to age 25 — CO, ID, ME, MD, MT, NM, RI, TX, VA , WA, WV
Up to age 26 — CT, MA, NH, UT
Up to age 30 — FL, NJ, SD
*employer option
PA - Students in National Guard called to duty, maintain coverage
until education is completed regardless of age
www.hrtw.org
Extended Coverage – Family Plan
Adult Disabled Dependent Child
state mandate (40 states)
AZ, AR, CA, CT, FT, GA, HI, ID, IL, IN, LA, ME,
MD, MA, MI, MN, MS, MO, MT, NE, NV, NH, NJ,
NM, NY, NC, ND, OH, OR, RI, SC, SD, TN, TX,
UT, VA, VT, WA, WI and WY
www.hrtw.org
Handouts: Private Health Insurance
Adult Disabled Dependent
• AZ Rev. Stat. Ann. Sections 20-826
(F) - 1342.01, -1407)
• Coverage for dependent children cannot be
terminated while a person is incapable of selfsustaining employment due to mental
retardation or physical handicap and chiefly
dependent on the insured.
www.hrtw.org
Handouts: Private Health Insurance - 411
Extension of Policy for Dependent
Child with a Disability
Employee 1. FORM - continuation of coverage
2. FORM - Attending physician statement of
mental retardation or physical handicap.
3. Both forms submitted to the employer for
review and signature before forwarding
to the claim office.
www.hrtw.org
Just the Facts: Private Health Insurance
Physicians, Care Coordinators
- More than letter from God
- Discuss before age 17, 26
Families & Youth
- Transition of Care Notebook
to concise thin files and sample documentation
- Don’t wait to be informed – get the forms early
www.hrtw.org
TIPS: Navigating & Documenting
1. Prepare the medical and other evidence
2. Know the eligibility requirement
3. Prepare the application
- Ask for review by others before submitting
4. Come ready (paperwork completed)
the day of “intake”
www.hrtw.org
TIPS: Creative Health Insurance
Ex #2
ex #1, 3rd wife
www.hrtw.org
DISCUSSION
www.hrtw.org
SKILLS FOR YOUTH
1. Practice filling in forms (Home & School)
2. Cheat sheet: portable medical summary
3. Tracking to avoid forgetting
www.hrtw.org
www.hrtw.org
DISCUSSION
www.hrtw.org
Survival Tips: Why NOT try some
1. No is just the first answer
until additional information is provided
2. Speak their language, terms
Compliment, address by name
3. Scheduled stress day-deal w/ forms, bills.
- Open mail on the 15th
- Take action on 17th prep relax bath
4. Three way call
www.hrtw.org
TIPS: Navigating & Documenting
1. Prepare the medical and other evidence
2. Know the eligibility requirement
3. Prepare the application
- Ask for review by others before submitting
4. Come ready (paperwork completed)
the day of “intake”
www.hrtw.org
Knowledge
Skills
Abilities
what needs
to be
learned
teach it,
practice it,
master it
Automatic
response,
solution
orientated
Strengthen
Circle of
Support
www.hrtw.org
Patti Hackett, MEd
Co-Director, HRTW Center
[email protected]
[email protected]
www.hrtw.org
Resources - 04
HRTW Portal - Laws that Affect CYSHCN
http://www.hrtw.org/tools/laws_leg.html
• The Term Special Health Care Needs or
Disability
• Disability Rights Portals
• Education Issues
• Employment & Disability
• Equal Opportunity Access (504, 508 & ADA)
• Family Medical Leave Act
• HRSA/MCHB – Title V Legislation
• Health Insurance Benefits
• SSI/SSDI
www.hrtw.org
Just the Facts: SSI -- Resources
SSA website
www.ssa.gov/ssi
Benefit Eligibility Screening Tool (BEST)
On-line tool - eligible for benefits from any of the
programs Social Security administers.
https://secure.ssa.gov/apps7/best/benefits/
Understanding Supplemental Security Income, 2007
http://www.socialsecurity.gov/ssi/text-understanding-ssi.htm
www.hrtw.org
Just the Facts: SSI -- Resources
www.ssa.gov
search BLUE BOOK
Disability Evaluation Under Social Security
http://www.ssa.gov/disability/professionals/bluebook/
Listing of Impairments - Childhood Listings
www.ssa.gov/disability/professionals/bluebook/ChildhoodListings.htm
Listing of Impairments - Adult Listings
www.ssa.gov/disability/professionals/bluebook/AdultListings.htm
www.hrtw.org
Just the Facts: SSI -- Resources
Ultimate Social Security Disability Guide
http://www.ultimatedisabilityguide.com/index.html
Understanding the GRID Rules
http://www.ultimatedisabilityguide.com/grid_rules.html
FORMS-Residual Functional Capacity (mental) (physical)
http://www.ultimatedisabilityguide.com/rfc_forms.html
www.hrtw.org
What
would
you do,
if you
thought
you could
not fail?
www.hrtw.org
www.familyvillage.wisc.edu
www.familyvillage.wisc.edu/
www.hrtw.org
www.fvkasa.org
www.hrtw.org
???www.nyln.org/
NYLN
www.hrtw.org
www.ncwd-youth.info/index.html
www.hrtw.org
Got Data?
Data Resource Center National Survey for CSHCN
www.cshcndata.org
Nov.
2007
www.hrtw.org
www.familyvoices.org
www.hrtw.org
www11.georgetown.edu/research/gucchd/nccc
www.hrtw.org
infanthearing.org
www.hrtw.org
Medicalhomeinfo.org
www.hrtw.org
www.hdwg.org/catalyst/index.php
State-at-a-Glance Chartbook on
Coverage and Financing
of Care for Children and Youth
with Special Needs
www.hrtw.org
http://www.championsinc.org
www.hrtw.org
www.hrtw.org
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