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Transcript of Sponsored by: Substance Abuse and Mental Health Services Administration
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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
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Welcome
Pamela Heine, MSW, LSW
Senior Project Associate
SAMHSA SOAR Technical Assistance Center
Policy Research Associates, Inc.
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Logistics
Recording Downloading materials Poll questions Chat questions Live Q&A
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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
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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
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POLL QUESTION #1
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Medical Summary Report Refresher
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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
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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
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Components of the MSR
Reference Section Introduction Personal History Diagnostic and Treatment Information Link to Functional Impairment Summary Contact Information
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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!
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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
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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
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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?
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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!
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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
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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
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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
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Tracking Outcomes
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POLL QUESTION #2
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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
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Registration
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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
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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
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Example: Summary Report
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Special Populations
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Special Populations
Veterans
Children
Justice-Involved Persons
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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
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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
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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
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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
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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
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SSA Appeals Process
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POLL QUESTION #3
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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
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Appeal Online
http://www.socialsecurity.gov/pgm/appeal.html
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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
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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
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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
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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!
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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
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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
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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
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Now What?
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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
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Your State SOAR Team
Attention Local Leads!
Add your information below:
State Team Lead contact information
Local Lead(s) contact information
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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
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POLL QUESTION #4
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POLL QUESTION #5
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CHAT QUESTIONS
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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!
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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]: SOARWorksTwitter: @soarworks
For More Information