ODMH Expedited SSI and Medicaid Application Procedures Training Program Conducted by the Social Security Administration

1. ODMH Expedited SSI and Medicaid Application ProceduresTraining Program Conducted by the Social Security Administration and the Ohio Bureau of Disability DeterminationAugust 4, 2009

4. Types of Disability Programs Social Security benefits for workers Social Security benefits foradults disabled since childhood Social Security benefits for disabled widows Supplemental Security Income (SSI) for children and adults

5. To qualify, the disabled person must have a recent work history Special rules apply to younger persons who need less work to qualify Social Security Disability Insurance

8. Amount of Benefits Benefits are calculated based on your entire  work history If your Social Security  benefit amount is lower  than the full SSI payment,  you may be eligible to  receive both Social  Security and SSI

9. Benefits can be paid on the record of a disabled, retired or deceased parent to an unmarried child of any age if the child became disabled before the age of 22

10. Social Security Benefits for Adults Disabled Since Childhood Who Is a Child? Natural Legitimate Child Stepchild Legally Adopted Child Illegitimate Child Other

11. Social Security Benefits for Disabled Widows Requirements for Entitlement Legal Spouse of Deceased Worker Surviving Divorced Spouse Married 10 Years Age 50 But Not Yet 60 Disabled Within 7 Years of Workers Death Unmarried or remarriage occurred after age 50 and onset of disability

12. Medicare Coverage Automatic enrollment in Medicare after being entitled to disability benefits for 24 months Information about Medicare is sent several months before coverage starts NOTE: People who have permanent kidney  failure requiring dialysis or a transplant  or have amyotrophic lateral sclerosis  (Lou Gehrig�s disease) may qualify for  Medicare almost immediately

13. Spouse, if he or she is 62 or older Spouse, at any age if he or she is caring for a child of worker who is younger than age 16 or disabled Unmarried child, including an adopted child, or, in some cases, a stepchild or grandchild. The child must be under age 18 or under age 19 if in elementary or secondary school full time Unmarried child, age 18 or older, if he or she has a disability that started before age 22. (The child�s disability also must meet the definition of disability for adults) A divorced spouse if he or she was married to worker for at least 10 years, is not currently married and is at least age 62 NOTE: The money paid to a divorced spouse does not reduce your  benefit or any benefits due to your current spouse or children Benefits for Family Members

15. Resource limits � $2,000 for individual � $3,000 for couple We count � bank accounts (CDs, IRAs) � second car � stocks and bonds, 401Ks � liquid assets � property other than where you live SSI Benefits for Adults

16. SSI Benefits for Adults

17. Disability for All Adults (Over Age 18) Both Social Security and SSI Must have a physical or mental impairment (or combination of conditions) Inability to perform substantial work activity Disability must be expected to last 12 consecutive months or result in death We consider age, education and past work activity

18. The Application Process - Current A paperless process Application and disability report completed online at www.socialsecurity.gov, or during office/phone interview SSA creates Electronic Folder (EF) to house all forms and medical evidence EF transferred from SSA office to Ohio Bureau of Disability Determination (OBDD) for medical decision

19. The Application Process - Current OBDD requests medical evidence from providers Provider has paper records Scans records to make them electronic Using barcode fax records to BDD to convert to electronic Mail per instructions on BDD request letter Provider has electronic records Send records by uploading to Electronic Records Express secure website (ERE)

20. The Application Process � ProjectOverview SSA applications, forms and questionnaires submitted with medical evidence to local SSA office as a complete package (Refer to �Checklist�) Local office creates EF and adds all forms and evidence, begins development of non-medical eligibility factors, transfers EF to OBDD for medical decision OBDD requests any additional medical evidence from mental health provider

21. The Application Process � Project Overview Mental health provider submits evidence via fax gateway using barcode (866 755-6629) or ERE website OBDD makes medical eligibility determination SSA effectuates decision If approved SSA may contact mental health provider for any needed non-medical evidence

22. The Application Process � Project First Steps Initial contact between local SSA office and mental health provider to establish working relationship; then case by case� Applicant often unaware of status with SSA Obtain SSA-1696 at screening � allows for release of information Contact local SSA liaison to discuss current entitlement and potential eligibility SSA establishes protective filing for benefits based on contact

23. What You Can Complete Online Social Security Disability Benefits Complete the Internet Disability Application (SSA-16) online at: http://www.socialsecurity.gov/applyfordisability/ Complete the Adult Disability and Work History Report-PRO (Form SSA-3368) online at: https://secure.ssa.gov/apps6z/i3368PRO/main.html

24. What You Can Complete Online Supplemental Security Income (SSI)  Complete the Adult Disability and Work History Report-PRO (Form SSA-3368) online at: https://secure.ssa.gov/apps6z/i3368PRO/main.html Application for SSI (Form SSA-8000-BK) must be completed as a paper form

26. ODMH Expedited Pilot Project Forms Needed Hello My name is Carlos Walker, and I will talk to you about the forms that are needed in order to properly process the claim. Hello My name is Carlos Walker, and I will talk to you about the forms that are needed in order to properly process the claim.

27. Application for SSI (SSA-8000-BK) Pays benefits to disabled adults and children who have limited income and resources. Also pays benefits to people 65 and older without disabilities who meet financial limits

28. Application for SSDI (SSA-16-BK) Pays benefits to disabled individuals and certain family members if they have worked long enough and paid Social Security taxes

29. Authorization to Disclose Information (SSA-827) Used to obtain medical and other information needed to determine whether or not a claimant is disabled. SSA and its affiliated State disability determination services use Form SSA-827, "Authorization to Disclose Information to the Social Security Administration (SSA)" to obtain medical and other information needed to determine whether or not a claimant is disabled. Its efficient handling and widespread acceptance is critical to the success of the disability programs. SSA and its affiliated State disability determination services use Form SSA-827, "Authorization to Disclose Information to the Social Security Administration (SSA)" to obtain medical and other information needed to determine whether or not a claimant is disabled. Its efficient handling and widespread acceptance is critical to the success of the disability programs.

30. Disability Report (SSA-3368BK) Provide information about claimant and their medical condition, healthcare providers, medications, education, and job skills. If completed online, indicate date of completion and confirmation # The Disability Report Form (SSA-3368) for Adults is an important part of your application for disability benefits. On the Disability Report Form, you will provide information about yourself and your medical condition, your health care providers, medications, education, and job skills.The Disability Report Form (SSA-3368) for Adults is an important part of your application for disability benefits. On the Disability Report Form, you will provide information about yourself and your medical condition, your health care providers, medications, education, and job skills.

31. Work History (SSA-3369) Needed for the disability determination. Work experience is a vocational factor that helps determine what jobs an individual can do. If completed online, indicate date of completion and confirmation #

32. Online Disability Report (i3368 PRO) The iPRO gathers all of the same information you�re used to putting on a paper 3368 and 3369 The iPRO gathers all of the same information you�re used to putting on a paper 3368 and 3369. Like the paper version, you can stop and come back to it later on (you don�t have to finish it in one sitting); and like the paper 3368, you can complete the sections out of order � if you�re in the habit of asking about the work history before the medical sources, for instance, that�s okay � you don�t have to complete the section in order. But the online version has some bells and whistles that the paper forms do not. For one thing, there are helpful examples and instructions imbedded throughout the application, just a click away. Also, if your browser accepts cookies, then your computer will store responses. Over time, you�ll build a bank of medical sources, medication names, and so on, and find yourself typing less and less. And best of all, when you�re done, you submit the form to Social Security electronically � we instantaneously receive your report The iPRO gathers all of the same information you�re used to putting on a paper 3368 and 3369. Like the paper version, you can stop and come back to it later on (you don�t have to finish it in one sitting); and like the paper 3368, you can complete the sections out of order � if you�re in the habit of asking about the work history before the medical sources, for instance, that�s okay � you don�t have to complete the section in order. But the online version has some bells and whistles that the paper forms do not. For one thing, there are helpful examples and instructions imbedded throughout the application, just a click away. Also, if your browser accepts cookies, then your computer will store responses. Over time, you�ll build a bank of medical sources, medication names, and so on, and find yourself typing less and less. And best of all, when you�re done, you submit the form to Social Security electronically � we instantaneously receive your report

33. Appointment of Authorized Representative (SSA-1696-U4) A representative can help with: completing forms; going with you to your local Social Security office; interpreting for you;  gathering and giving information; taking you to medical examinations, tests, or to your local Social Security office; receiving mail for you at his or her address. Representatives are usually attorneys, but need not be. Representatives must abide by standards of conduct which the Social Security Administration (SSA) has published. In addition, most representatives will not charge a fee, unless they win your case. In any event, a representative cannot charge a fee until SSA approves that fee. If you do not know the name of a representative in your area, your local SSA office can provide a list of representatives for you to choose from. At the hearing level, representatives are involved in approximately 70 percent of our cases. If you decide to have a representative, you must sign and submit to SSA a written statement appointing him or her to represent you in your dealings with SSA. Use Form SSA-1696 (Appointment of Representative) for this purpose.Representatives are usually attorneys, but need not be. Representatives must abide by standards of conduct which the Social Security Administration (SSA) has published. In addition, most representatives will not charge a fee, unless they win your case. In any event, a representative cannot charge a fee until SSA approves that fee. If you do not know the name of a representative in your area, your local SSA office can provide a list of representatives for you to choose from. At the hearing level, representatives are involved in approximately 70 percent of our cases. If you decide to have a representative, you must sign and submit to SSA a written statement appointing him or her to represent you in your dealings with SSA. Use Form SSA-1696 (Appointment of Representative) for this purpose.

34. Physician/Medical Statement (SSA-787) This form is used to determine if we should pay this person directly or if he or she needs a representative payee to handle the funds

35. Mental Status Questionnaire Appearance and Behavior Flow of Conversation and Thought Affect and Mood Anxiety Issues Substance Abuse History Mental Content Bodily Concerns Sensory and Cognitive Functioning Intellectual and Memory Functioning Insight and Judgment

36. Daily Activities Questionnaires Living Arrangements Sleeping Habits Personal Care Meals/Eating Habits Shopping Social Contacts Concentration and Memory Treatment (Medications)

37. Medical Records and Other Pertinent Information Psychiatric Assessments Psychiatric/Nursing Notes Progress Notes Hospitalization/Crisis Shelter information IEP Claimant�s Statement Other Pertinent Information

38. Additional Forms Request for Representative Payee provides financial management for the Social Security and SSI payments of our beneficiaries who are incapable of managing their Social Security or SSI payments. Generally, we look for family or friends to serve in this capacity. When friends and family are not able to serve as payee, Social Security looks for qualified organizations to be a representative payee.

39. Additional Forms (cont.) Advance Notice of Representative Payee

41. Definition of Disability Inability to engage in Substantial Gainful Activity (work) Due to a Medically Determinable Impairment (mental/physical) Expected to or having lasted for no less than 12 months or Expected to result in death

42. Application filed at SSA-FO Forwarded to DDS for Medical Development & Decision Assigned to DCA � Primary Point of Contact Obtains & analyzes supporting medical & non-medical evidence

43. Sequential Evaluation5 Step Evaluation Process SGA Severe Impairment Meets/Medically Equals Listing Severity Return to Past Work Ability to Perform Other Work

44. Listing of Impairments Medical evaluation criteria ensures program consistency May be accessed at: www.socialsecurity.gov/ disability/professionals/bluebook

45. MENTAL LISTINGS 12.02 Organic Mental Disorders 12.03 Schizophrenia, other Psychotic Disorders 12.04 Affective Disorders 12.05 Mental Retardation

46. MENTAL LISTINGS 12.06 Anxiety Related Disorders 12.07 Somatoform Disorders 12.08 Personality Disorders 12.09 Substance Addiction Disorders 12.10 Autism and other PDD

47. Drug and Alcohol Use Details of Drug and Alcohol use are needed, including: Frequency of use When last use occurred Periods of sobriety Functional limitations when using Functional limitations when sober

48. A Criteria--Substantiates the particular mental disorder. It contains a composite of the medical criteria usually used to establish the presence of that impairment. LISTING STRUCTURE

49. Examples of A Criteria Medically documented persistence, either continuous or intermittent, of one/more of the criteria in the listings, examples include: Delusions/Hallucinations Incoherence, loosening of associations, illogical thinking, or poverty of content of speech if associated with the following: Blunt, Flat, or Inappropriate affect Emotional withdrawal and/or isolation

50. LISTING STRUCTURE B Criteria--Assesses the severity of the impairment. It is expressed in terms of functional limitations

51. THE B &C CRITERIA 1. Activities of Daily Living 2. Social Functioning 3. Concentration, Persistence or Pace Episodes of Decompensation Document episodes of decompensation, including duration

52. THE FIVE CONTEXTS USED TO 1. Effectiveness or Quality 2. Independence 3. Appropriateness 4. Sustainability 5. Longitudinal History

53. Effects of Medication

54. Acceptable Medical Sources Psychiatrists

55. Other Good Sources of Information MH Counselors/Therapists Hospitals/ Clinics Rehabilitation Centers Schools

56. GENERAL DOCUMENTATION REQUIREMENTS FOR MENTAL CLAIMS 1. History

57. Completing ODMH forms Mental Status Questionnaire Ensure all information is consistent with the medical evidence in file If inconsistencies exist, explain them Daily Activities Questionnaire Ensure that the claimant�s day to day functioning is fully described Where problems exist in functioning, be sure to describe problems in detail

58. ODMH Checklist In addition to SSA forms BDD needs as much medical and functional evidence as possible to make a fair and accurate decision. Evidence can be given to the SSA office upon filing Evidence can be faxed to BDD using a barcode after the case is transferred from SSA to BDD.

59. Final Determination Adjudicator must consult with and have decision signed by physician/ psychologist prior to finalizing

60. Notification By Mail Appeal Rights DDS Accountability

61. Questions?

62. Expedited SSI ProcessEvaluation Plan

63. Design Four Evaluation Components Satisfaction with Training Expedited SSI Tracking Form Implementation Factors Satisfaction with Technical Support

64. Additional Tracking Surveys In the near future you will also be sent some �draft� Expedited SSI tracking forms and another survey to give comments on to make sure we are capturing the critical elements of the Expedited SSI process. THANK YOU

65. Satisfaction with Training We are utilizing Survey Monkey for the Evaluation surveys. Upon completion of the training, you will be forwarded a link to a website that houses the Satisfaction Survey.