US Department of Health and Human Services April 2014 SOAR Fundamentals Part II SSISSDI Outreach Access and Recovery SAMHSA SOAR Technical Assistance Center Welcome ID: 780829
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Sponsored by:Substance Abuse and Mental Health Services AdministrationU.S. Department of Health and Human Services April 2014
SOAR Fundamentals
Part II
SSI/SSDI Outreach, Access, and Recovery
SAMHSA SOAR Technical Assistance Center
Slide2WelcomePamela Heine, MSW, LSWSenior Project Associate
SAMHSA SOAR Technical Assistance Center Policy Research Associates, Inc.
Slide3LogisticsRecordingDownloading materialsPoll questionsChat questions
Live Q&A
Slide4ReviewSOAR Leadership Academy Webinar Series:4/10- SOAR Fundamentals Overview:New OpportunitiesSOAR Online Course
Local ImplementationIntro to the SOAR Fundamentals
training
4/17- SOAR Fundamentals: Part I
The Basics
Getting Started
Slide5PreviewContinuation of SOAR Fundamentals RefresherMedical Summary ReportTracking OutcomesSpecial Populations Veterans, Children, Justice Involved PersonsSSA Appeals ProcessNext Steps
Poll and Chat QuestionsQ&A
Slide6Poll Question #1
Slide7Medical Summary Report Refresher
Slide8The Importance of the Medical Summary ReportCritical 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
Slide9Tips for WritingCollect medical records after Releases of Information are signedGo through medical records and organize in chronological orderSet aside several hours at a time to begin writing the report with no interruptions
Sit down with all information -- medical
records, i
ntake packet, completed MSR worksheet (personal, medical, employment and substance use history) and any current mental status exams
Slide10Components of the MSRReference SectionIntroductionPersonal HistoryDiagnostic and Treatment Information
Link to Functional Impairment
SummaryContact Information
Slide11Introduction SectionDemographicsPhysical description – hygiene, grooming, dress, make-up, any unique characteristics
Include diagnoses and impairment information
Help the DDS
examiner “see” the individual as
you do!
Slide12Diagnoses and TreatmentPsychiatric and physicalChronological treatment history
Specific quotes from the applicant or record that illustrate diagnosis
Observations of behavior
Durational issues
Current mental status exam
Slide13Link to Functional ImpairmentCritical 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
Slide14Make the LinkThe MSR is the link that connects the diagnosis to the limitations that the applicant experiencesBeing 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?
Slide15Medical Summary Report WorksheetTool for gathering information needed to write the MSROpen-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!
Slide16Summary and Contact InformationTies all information together for a concise picture of the individual
Contact – names and numbersCo-signed by case manager, treating physician/psychologist
Slide17MSR Samples & SupportVisit the SOAR website for MSR samples and abbreviated versionsThe SOAR TA Center will review redacted MSR letters and provide feedback upon request
Slide18Worth the EffortThe overall process of applying for benefits is time-consumingPutting 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
Slide19Tracking Outcomes
Slide20Poll Question #2
Slide21Online Application Tracking (OAT)https://soartrack.prainc.comA web-based program that allows case managers to keep track of their outcomesFreeEasy to useAccessible from any web browser
Nothing to downloadOn a secure server
HIPAA compliant No personal identifying information is collected
Slide22Registration
Slide23Outcomes in OATOutcomes for initial applications & appealsApproval ratesTime to decision
Critical componentsOptional outcomes
HousingEmployment
Medicaid and other public benefit reimbursements
Slide24Applicant Identification (ID)No personally identifiable informationAlpha-numeric IDFirst 2 letters of first nameLast 2 digits of the birth yearFirst 2 letters of last name
Last 4 digits of the Social Security NumberCase workers should record Applicant ID in the case file for cross reference
Slide25Example: Summary Report
Slide26Special Populations
Slide27Special PopulationsVeteransChildren
Justice-Involved Persons
Slide28Veterans and SSA BenefitsThe 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
V
eterans without
VA health care
SSA has special provisions for expediting disability applications for Wounded Warriors, that also apply to appeals
Slide29VA Staff and SOARStaff 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 (SSA-1696) or Representative Payee (SSA-11
),
but can
be listed as a contact who knows the Veteran
Slide30How Do Children Qualify for SSI?Four main criteria considered:DisabilityA 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
monthsHow 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
?
Income
Parent/household income
Resources
Parent/household resources
Citizenship/Immigration status
Slide31Justice – Involved PersonsWarrants (other than escape) should not hinder a person from applying or receiving paymentA person can apply for benefits while incarcerated
Prior history of incarceration alone does not make someone eligible for benefits
Slide32Engagement Tips for People in Correctional SettingsJails and prisons have distinct culturesAnticipate how this culture or “code” affects behavior and functioning in prison
Expand skills to engage individuals in this culture
Life experience affects engagementEngagement involves creating a safe space
Slide33SSA Appeals Process
Slide34Poll Question #3
Slide35SSA Appeals ProcessInitial determinationReconsideration
Administrative HearingAppeals Council Review
Federal Court Review
Slide36Appeal Onlinehttp://www.socialsecurity.gov/pgm/appeal.html
Slide37ReconsiderationFirst 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
Slide38ReconsiderationDDS takes an entirely new look at the case and makes a new determination on a person’s disabilityNew 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
Slide39What 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
Slide40Appeal vs. New ApplicationStarting 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!
Slide41Know the Reason(s) for DenialRequest 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
Slide42Administrative HearingAdministrative Law Judge (ALJ) HearingIf denied at Reconsideration or you are in a prototype state
File appeal online within 60 days of
decisionReview the claim, including the evidence used to deny the claim
Submit new evidence if applicable
Plan
to attend the hearing
Slide43On the Record (OTR) ReviewA written request asking that the ALJ make a favorable decision based on the evidence in the case recordA 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
You are requesting a decision based on new evidence that has become available since the DDS denial
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
Slide44Now What?
Slide45Next StepsGet started on your first applicationReach out to your colleagues, local leads and the SAMHSA SOAR TA Center for assistanceKeep in close communication with your SSA and DDS representatives
Attend local SOAR steering committee meetings
Track your outcomes in OAT
Slide46Your State SOAR TeamAttention Local Leads! Add your information below:State Team Lead contact information
Local Lead(s) contact information
Slide47SOAR Leaders Pagehttp://soarworks.prainc.comLeaders OnlyPassword: SOARWorksCase sensitive
Leaders TabMaterials for SOAR Fundamentals trainings
Trainers TabMaterials for 2-day trainings
Slide48POLL QUESTION #4
Slide49POLL QUESTION #5
Slide50CHAT QUESTIONS
Slide51Homework!Download the SOAR Fundamentals PowerPointPeruse the SOAR Leaders pageEnroll in the SOAR Online CourseContact the SOAR TA Center with any questions!
Slide52Visit the SOAR website at http://soarworks.prainc.comOr contact:
SAMHSA SOAR TA Center
Policy Research Associates, Inc.Delmar, NY
(518) 439 – 7415
soar@prainc.com
Facebook:
SOARWorks
Twitter: @soarworks
For More Information