Transcript New Opportunities for SOAR in South Dakota

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?
SOAR
 SOAR stands for SSI/SSDI Outreach, Access and Recovery
 For people who are experiencing or at-risk of 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
 22,863 persons experiencing or at risk for homelessness have
been approved on initial application
 65% approval rate overall, in an average of 94 days in 2014
 Compares to 10-15 percent for unassisted applications from
people who are homeless and 29 percent for all applicants
 Appeals can take a year or more; many people give up and do
not appeal
Top Ten States
 Served more than 8,400 persons
 82 percent approval rate on initial applications
 AR, KS, MD, NC, OK, OR, PA, TN, VA, WA
 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
Activity: Online Course Experience
Wows
Wishes
Activity
Reasons For The Work We Do
SOAR Fundamentals Agenda
 The Basics
 Getting Started
 Who is a SOAR applicant?
 Engaging the applicant
 State SOAR process
 SSA 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!
SOAR Fundamentals
The Basics
SOAR Has Broader Goals
Housing
Decrease in
incarcerations &
hospitalizations
Community
Investment
SOAR
Access to
treatment &
other
services
Employment
Opportunities
• Medical/
Treatment
providers
• Assessments/
evaluations
• Medical
records
You
• Federal
agency that
administers
SSI/SSDI
• Makes the
non-medical
decision
• Disability
Determination
Services
• State agency
under contract
to SSA
• Makes the
medical/
disability
determination
Medical
• Social Security
Administration
DDS
SSA
SOAR Partners
• SOAR
trained case
managers
are actively
involved
every step of
the process
SSI & SSDI: The Basics
Supplemental Security
Income (SSI)
Needs based; federal
benefit rate is $733 per
month (2015); provides
Medicaid in most states
Social Security Disability
Insurance (SSDI)
Amount depends on
earnings put into SSA
system; Medicare
generally provided after
2 years of eligibility
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
Definition of Disability
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
 Diagnostic tests
 Physical health evaluations
 Neuropsychological tests
 Specialty physical health
evaluations
 Psychological tests
 Neurological reports
 Laboratory results
 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 is the applicant unable to work?”
Medical Summary Report
 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 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
Getting Started
SOAR Fundamentals
The Challenge
 Limited resources
 Limited time
 A lot of people need our help
 Applications involving mental illness and co-occurring 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
Who is considered “homeless”?
 Moving from place to place throughout the month
 Living “doubled-up”
 Living in uninhabitable housing, outside or in shelters
Who is considered “at-risk for homelessness”?
 Living in unstable or non-permanent housing
 Exiting jails or prisons with no stable place to live
 Permanent housing for those recently experiencing homelessness with limited
income or relying on grant funding to sustain housing
 Youth transitioning out of foster care
Identifying SOAR Applicants
Make the Tool Work For You
 Identify individuals who most need your assistance
 Do not discourage anyone from applying for SSA benefits
 Plan for alternative service or referral
 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 filing dates
 When to contact SSA
 How to communicate with DDS
 Where to access records and assessments
Completing an Initial
SSI/SSDI Application
Protective Filing Date
 The date the applicant first contacts SSA indicating an intent to file SSI
and SSDI applications
Ways to set the protective filing date:
 Walk in to SSA without an appointment
 Call SSA to establish a date for an in-person or telephone interview
 Initiate the online disability application
 Stop once you reach the re-entry number screen
 Fax the SOAR Consent for Release of Information form to your local SSA
office
 Check with your SOAR State Team Lead to see if this is the process in your
community
SSA-1696: Appointment of
Representative
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/DDS
 Important to provide complete addresses on this form
 Neither the agency or the case manager is liable for the decision made
 It is NOT the same as the representative payee
 SOAR providers should mark “waiving fees from all sources” and both
Title II (RSDI) and Title XVI (SSI)
Requesting Medical Records
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
SSA-3368 : Adult Disability Report
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
SSA-8000: Application for SSI
SSA-8000: SSI Application
 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
SSA-16: SSDI Application
SSA-16: SSDI Application
 SSDI eligibility is generally 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
Medical Summary Report
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 a folder with sections
 Include a cover sheet
 Section for medical records
 Section for SSA/DDS Correspondence
 Have files prepared in advance
 Create a contact list for SSA reps, DDS adjudicators and medical
records providers
Medical Summary Report
Refresher
SOAR Fundamentals
Critical Components
 Serving as the appointed representative
 Collecting and submitting medical records
 Electronically submitting applications and medical evidence
whenever possible
 Collaborating with physicians for assessments and medical
information
 Collaborating with SSA and DDS
 Submitting a Medical Summary Report
The Importance of
the Medical Summary Report
 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 Interview Guide (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
 Observations about behavior and mannerisms
 Include diagnoses and impairment information
 Help the DDS examiner “see” the individual as you do!
Personal History
 Childhood and family information
 Brief overview of their background
 Past trauma that may relate to current diagnoses and functioning
 Education
 What was the last grade they completed? Did they have any struggles
in school?
 Employment history
 Describe their past jobs – include how long they stayed at each job,
the tasks they performed, any struggles they had at work, and why
they left
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
Interview Guide
 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
 Use the MSR Template to organize and write the MSR
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
 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
SOAR Fundamentals
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
SOAR Fundamentals
Special Populations
 Veterans
 Children
 Transition Age Youth
 Justice-Involved Persons
Importance of SSI/SSDI for Veterans
 SSA disability benefits can provide access to:
 Income: Veterans can receive SSI/SSDI in conjunction with, or as an
alternative to, VA disability benefits
 Health insurance: Veterans can use the Medicaid and Medicare health
benefits that coms with SSI/SSDI to supplement VA health services
 For Veterans with disabilities, SSI/SSDI can increase income & housing
stability, and reduce their future risk of homelessness
 Opportunity for staff serving Veterans to help with both SSA and VA
disability benefits
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
 Disabling condition does not need to be related to military service
 Those denied for VA benefits may still be eligible for SSI/SSDI
 Veterans can access SSA benefits while they are waiting for VA benefits
 There is no partial disability with Social Security
VHA Memorandum on SOAR
 Applies to federal VA staff
 Staff are encouraged to participate in SOAR training and assist with
SSI/SSDI applications
 May disclose VA records to SSA if Veteran signs the 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 (SSA-1696) or Representative
Payee (SSA-11)
 Can be listed as a contact who knows the Veteran
SSA Fast Track Programs: Veterans
100% Permanent and Total Veterans Initiative
 Expedites SSI/SSDI applications from Veterans who have 100% P&T
rating from the VA
 Does not guarantee SSI/SSDI approval
Wounded Warriors
 Veterans who received disabling mental or physical health injuries
while on active duty on or after October 1, 2001
 The injury does not need to have occurred during combat operations
How Do Children Qualify for SSI?
Four main criteria considered:
1. Disability
 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?
2. Income: Parent/household income
3. Resources: Parent/household resources
4. Citizenship/Immigration status
Transition Age Youth
 Often categorized as ages 18 – 24
 Due to a lack of extensive work history, other sources become very
important:
 School records
 Collateral sources
 Comparison to average youth (developmental and decision making abilities)
 Age 18 Redetermination
 Young adults who were eligible for SSI as a child will be evaluated to determine if
they qualify under the adult definition of disability
 Youth aging out of foster care
 SSA will accept an application 90 days prior to their exit from care
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
SOAR Fundamentals
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:
 Alabama, Alaska, California (Los Angeles North & WB), Colorado,
Louisiana, Michigan, Missouri, New Hampshire, New York, & Pennsylvania
 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:
 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:
 The loss of the earlier protective filing date and potential loss of
months of back benefits
 Requesting reconsideration:
 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 to 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
 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?
SOAR Fundamentals
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
Visit the SOAR Website Often!
https://soarworks.prainc.com
Connect With Us
Your State Team Lead
Your SOAR TA Center Liaison
[email protected]
www.facebook.com/soarworks
@SOARWorks
http://soarworks.prainc.com/blog