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www.hrtw.org
Patti Hackett, MEdHRTW Co-Director, Bangor, ME
PacRim Conference, Honolulu, HIApril 14, 2008
Healthy & Ready to Work, to Live and to Participate!
“Celebrate the Paperwork: It Means You Are Alive!
Making the Paperwork Work: Expediting Program Eligibility
www.hrtw.org
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
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
Who You Are?
Experts in the Room
About me!
www.hrtw.org
Just the Facts: Key Benefits
• “Celebrate the Paperwork: It Means You Are Alive!
• Making the Paperwork Work: Expediting Program Eligibility
www.hrtw.org
Take Home Messages
1.Paperwork is a reality no positives in whining
2. Indentify the shortcuts put energy on solutions
3. Draft the paragraph, create the one pager
Trim done the care notebook
4. Families NEED to learn this they get the denials and the stress
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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
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SKILLS FOR YOUTH
1.Practice filling in forms (Home & School)
2. Cheat sheet: portable medical summary
3. Tracking to avoid forgetting
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Just the Facts: Key Benefits
OVERVIEW
• SSI
• Voc Rehab
• Maintaining Private Health Insurance
www.hrtw.org
Just the Facts: Accessing Adult ServicesIt’s Moving from Entitlement to Eligibility
FORMAT
• Dispelling the Myths
• The Intent of the Service
• Roles: Teachers,
• Physicians, Care Coordinators
Families & Youth
www.hrtw.org
Just the Facts: SSI
The Myth:
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)
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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
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)
Just the Facts: SSI – Disability Criteria
www.hrtw.org
Just the Facts: SSI - Listings
1. Musculoskeletal System2. Special Senses and Speech3. Respiratory System4. Cardiovascular System5. Digestive System6. Genito-Urinary System7. Hemic and Lymphatic System8. Skin9. Endocrine System10.Multiple Body Systems11.Neurological12.Mental Disorders13.Neoplastic Diseases Malignant14.Immune System
www.ssa.gov
search BLUE BOOK
www.hrtw.org
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
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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
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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.
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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
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Just the Facts: VR
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
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Just the Facts: VR
TRAINING• Supported Employment • Short-Term, Vocational Training • College or University-based education
EMPLOYMENT SUPPORT• Job Coaching • On-the-Job Training
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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.
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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
Handouts: Private Health Insurance
Maine Health Insurance Statute – up to age 25 Chapter 33:§2742-A. Extension of coverage for dependent children Effective August 23, 2006
Dependent child; definition. A. Is unmarried;
B. Has no dependent of the child's own;
C. Is a resident of this State or is enrolled as a full-time student at an accredited public or private institution of higher education; and
D. Is not provided coverage under any other individual or group health insurance policy or health maintenance organization contract or under a federal or state government program.
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Handouts: Private Health Insurance
Requires
An insurer may require, as a condition of eligibility for continued coverage in accordance with this section, that a covered person seeking continued coverage for a dependent child provide written documentation on an annual basis that the dependent child meets or continues to meet the requirements
Celebrate Annual Documentation!
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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 before submitting
4. Come ready (paperwork completed) the day of “intake”
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Resources - 04
HRTW Portal - Laws that Affect CYSHCNhttp://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
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Just the Facts: SSI -- Resources
SSA websitewww.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
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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
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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
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www.hdwg.org/catalyst/index.php
State-at-a-GlanceChartbook onCoverage and Financingof Care for Children andYouth with Special Needs
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www.hdwg.org/catalyst/index.php
State-at-a-GlanceChartbook onCoverage and Financingof Care for Children andYouth with Special Needs