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SOAR Fundamentals. Introductions. Local SOAR Leads Program Participants Please tell us: Your name and work location What are your plans/goals for using SOAR in your work? What do you need to learn today to get you there?. Logistics and Housekeeping. Take care of yourself
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Introductions • Local SOAR Leads • Program Participants Please tell us: • Your name and work location • What are your plans/goals for using SOAR in your work? • What do you need to learn today to get you there?
Logistics and Housekeeping • Take care of yourself • Restrooms and breaks • Ground rules • Cell phones • Ouch, Stretch, ELMO • Others? • Values and language • Parking Lot
SOAR • SOAR stands for SSI/SSDI Outreach, Access and Recovery • Focus is on people who are homeless or at risk for homelessness • Sponsored by the Substance Abuse and Mental Health Services Administration (SAMHSA) in collaboration with SSA since 2005 • All 50 states currently participate; no direct funding provided to states
Why is SSI/SSDI Important for Individuals? • SSA disability benefits can provide access to: • Income • Housing • Health Insurance • Treatment • Other supportive services • For people with disabilities, SSI/SSDI can be a critical step towards ending homelessness and promoting recovery
Why is Access to SSI/SSDI Important for States & Localities? • People experiencing homelessness are frequent users of expensive uncompensated health care • Can recoup cost of this care from Medicaid for up to 90 days retroactive to date of SSI eligibility • States and localities can recoup from SSA the cost of public assistance provided during the application process • SSI, SSDI and Medicaid bring federal dollars into states, localities and community programs
Changing Lives Since 2005 • 19,008 persons experiencing or at risk for homelessness have been approved on initial application • 65 percent approval rate overall • Compares to 10-15 percent for unassisted applications from people who are homeless and 29 percent for all applicants • Approvals were received in an average of 100 days in 2013 • Appeals can take a year or more; many people give up and do not appeal
Top Eight States • Served more than 4,000 persons • 89 percent approval rate on initial applications • Approval rates are highest in places where more SOAR critical components are implemented
SOAR Technical Assistance Center • SAMHSA funds the SOAR TA Center to support states and communities • Offers virtual and on-site technical assistance • SOAR TA Liaisons are responsible for SOAR in multiple states • Get to know your SOAR TA Liaison • Reach out for help or answers to questions about any aspect of SOAR
Online Course Experience Wows Wishes
Activity: Reasons for the Work We Do • This program is about: • Ending homelessness • Promoting recovery • Transforming lives • Discussion: • What brought you to this work?
SOAR Fundamentals Agenda • The Basics • Getting Started • Who is a SOAR applicant? • Engaging the applicant • State SOAR process • Forms • Medical Summary Report Refresher • TrackingOutcomes • Special Populations • Appeals • Now What?
SOAR Fundamentals Materials • PowerPoint slide handouts • Sample SSA Forms • MSR Worksheet • Sample Medical Summary Reports • Your State’s SOAR Process • Sample Application Packet • Any other materials that you want participants to have!
SOAR Partners • Social Security Administration (SSA) • Federal agency that administers SSI/SSDI • Makes the non-medical decision • Disability Determination Services (DDS) • State agency under contract to SSA • Makes the medical/disability determination • Medical/treatment providers • Assessments/evaluations • Medical records • You!
SSI & SSDI: The Basics • SSI: Supplemental Security Income; needs based; federal benefit rate is $721 per month in 2014; provides Medicaid in most states • SSDI: Social Security Disability Insurance; amount depends on earnings put into SSA system; Medicare generally provided after 2 years of eligibility • The disability determination process for both programs is the same
Criteria for Eligibility 1. Medically Determinable Physical or Mental impairment • Illness must either meet or be equivalent to the “listing” criteria used by DDS. Supporting information must be documented in medical records 2. Duration • The impairment tied to the illness(es) must have lasted OR be expected to last 12 months or more OR be expected to result in death 3. Functional Information • Applicants must demonstrate that significant functional impairment related to the illness(es) exists that impede their ability to work
Step 3 is Key! • Person can be found disabled at Step 3 and begin receiving benefits • If adequate evidence is presented that impairment meets the Listings and the applicant is unable to work • Connecting functional limitations to their inability to work with appropriate medical documentation is key
Documenting the Disability • Case managers need to collect medical records from all treatment sources • Applicant report • Collateral sources (friends, family, other service providers) • Common treatment providers • Two releases (agency and SSA-827) for each treatment source are signed so that the case manager can share these records with SSA and DDS • Used to meet the Listings • Organize your search!
Documenting the Disability • If medical records are not current, case managers may need to arrange for assessments to be done • Mental status exams must be done within 90 days of submitting application • DDS requires that the applicant has a diagnosis from a doctor (MD/PhD/EdD)
Make the Link to Work • The question DDS must answer is: “Can the person work and earn SGA?” • Disability must meet the criteria in the “Listings” • Must make the link between a person’s illness, his/her inability to function in a work setting
Functional Information • For mental illnesses, the applicant must demonstrate functional impairments that meet the Listings • Document all four areas • Activities of daily living • Social functioning • Concentration, persistence and pace • Repeated episodes of decompensation • Must demonstrate marked functional impairments in at least twoareas
Functional Information • For physical impairments, the application must demonstrate significant limitations in meeting physical, mental, sensory and other requirements of work • A limited ability to perform certain physical demands of work activity (e.g. sitting, standing, walking, lifting, carrying, etc.) may reduce a person's ability to do past work and other work
Using the Blue Book Listings • http://www.ssa.gov/disability/professionals/bluebook/ AdultListings.htm • For each category of mental impairment: • General description of disorder • Section A – types of symptoms and impairments (diagnosis) • Section B – required “level of severity” (limitations in functioning) • Section C – medically documented history (longer period of documentation) • To qualify, an individual must: • Meet A + B • Or C
Criteria “A” – Blue Book Listings • Psychiatric evaluations • Physical health evaluations • Specialty physical health evaluations • Neurological reports • Laboratory results • Diagnostic tests • Neuropsychological tests • Psychological tests • Admission summaries • Discharge summaries
Criteria “B” – Blue Book Listing • Bio-psychosocial evaluation reports • Occupational therapy evaluation reports • Vocational evaluation reports • Psychiatric Rehabilitation Day Program notes • Supported housing progress notes • Functional descriptions • Medical Summary Report
The Secret to Approvals? A + B = Approval
Co-Occurring Disorders • If substance use is deemed "material" to a person's disability, benefits will be denied • Substance use is "material" when: • If a person were clean and sober, the functional impairment would not exist and the person would not be disabled • The determination does NOT require sobriety • Use past periods of sobriety (hospital, jail, treatment) to document symptoms that persisted
Medical Summary Report (MSR) • The MSR is a letter which describes the individual and his/her functional limitations and struggles • Supports medical records submitted • Helps DDS “see” the person you are working with • Illustrates the connection between the applicant’s functional limitations and the impairment • Answers the question: “Why can’t the applicant work?” • The MSR worksheet guides the case manager through the sections of the written report • The letter, not the worksheet, is submitted to DDS
Medical Summary Report • Medical Summary Reports are considered medical evidence if signed by a treating physician or psychologist • Even without a physician’s signature it is important for DDS’s determination of the applicant’s ability to work
The Challenge • Limited resources • Limited time • A lot of people need our help • Applications involving mental illness and co-occurring substance use disorders are complicated
The SOAR Applicant Who can be helped by SOAR? • Adults who are experiencing, or at risk for, homelessness • And who have mental illness, co-occurring disorders or other physical disabilities or conditions Who is considered “homeless”? • Moving from place to place throughout the month • Living “doubled-up” • Living in uninhabitable housing, outside or in shelters • Living in unstable or non-permanent housing • Exiting jails or prisons and who have no stable place to live
Using the Tool • Identify individuals who most need your assistance • Do not discourage anyone from applying for SSA benefits • Plan for alternative service or referral
Make the Tool Work For You • Consider adding your program acceptance criteria • Use in conjunction with other assessment tools • Consult with colleagues or the SOAR TA Center
Engaging Applicants • Create and maintain a safe space for you and the applicant • Keep your promises: Under promise and over deliver • Find out where the person spends his/her time • Develop ways to maintain contact, including someone to contact should you need to reach the applicant • Ask open-ended questions • Be mindful of non-verbal communication
Our State or Local SOAR Process • Attention Local/State Leads! • The next few slides cover the standard SOAR process; adapt these slides if your process differs from this • Add information about your local/state SOAR process here • How to set protective filings dates • When to contact SSA • How to communicate with DDS • Where to access records and assessments
Getting Started: Days 2 – 3 Complete and have applicant sign the SSA-1696 Appointment of Representative form
SSA-1696: Appointment of Representative • Permits communication with SSA and DDS about the applicant’s file • Case manager receives copies of all applicant communication from SSA and DDS • The most important tool for working with someone who is experiencing homelessness • “The Key to the City” • Neither the agency or the case manager is liable for the decision made by DDS • It is NOT the same as the representative payee • SOAR providers should check “waiving fees from all sources”
Getting Started: Days 2 – 3 Request Letter Agency Release SSA-827
SSA-827: Authorization to Disclose Information to SSA • Allows SSA and DDS to gather medical records and information from medical records departments • SOAR providers - use along with Agency Release Form when requesting medical records from every source (HIPAA Compliant) • All forms should be signed by the applicant • Available online
Getting Started: Weeks 1 – 2 SSA-3368: Disability Report Adult
SSA 3368: Adult Disability Report • Gathers basic information about the applicant’s work history, medical treatment and education • Helps DDS know which providers will have medical evidence for the application • DDS will request records from the medical sources listed • SOAR case managers can indicate in Remarks which records they will submit with the application • Complete online, use the paper version as a worksheet
Getting Started: Weeks 3 – 4 SSA-8000: Application for SSI
