Sponsored by: Substance Abuse and Mental Health Services Administration

Sponsored by:Substance Abuse and Mental Health Services Administration

U.S. Department of Health and Human Services April 2014

SOAR FundamentalsPart II

SSI/SSDI OUTREACH, ACCESS, AND RECOVERYSAMHSA SOAR TECHNICAL ASSISTANCE CENTER

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, Children, Justice Involved Persons SSA 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 activityDiagnosis

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 (SSA-1696) 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

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?

Income Parent/household income

Resources 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 determination2. Reconsideration3. Administrative

Hearing4. Appeals Council

Review5. 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 make a favorable decision based on the evidence in the case record 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

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

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!

Visit the SOAR website at

http://soarworks.prainc.com

Or contact:SAMHSA SOAR TA Center

Policy Research Associates, Inc.

Delmar, NY(518) 439 – 7415

soar@prainc.comFacebook: SOARWorksTwitter: @soarworks

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