SSI Facilitation - Application
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SSI Facilitation - Application


Revised October 9, 2014



Purpose: SSI facilitation is provided for ABD cash and TANF recipients.

This section includes information about:

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CLARIFYING INFORMATION

Clients who are age 65 or older, terminally ill (TERI cases), compassionate allowances, and those that meet presumptive listing criteria should be immediately referred to SSA. Do not submit an SSI application. SSA must process these claims directly.


Process Overview

The facilitation process includes the following activities:

  1. Preparing for the SSI application interview by reviewing available documents to learn about the person's medical, education, and employment history.
  2. Interviewing the person.
  3. Documenting personal observations of the individual’s appearance, speech, mobility, and activities of daily living.
  4. Preparing and submitting a TANF disability referral packet that:

a.    Contains all relevant medical evidence to support a claim of disability.

b.   Meets SSI evidentiary requirements.

  1. Verifying a signed IARA is on file with SSA for all ABD cash clients.
  2. Obtaining additional medical records when necessary.
  3. Completing SSI application forms and filing the application packet with SSA.

Preparing for the Interview

  1. Research available information to become familiar with the person's situation such as:
    1. Medical records.
    2. Social services assessment of Health, Education, and Employment.
    3. Case notes.
  2. Include information the person should bring to the interview in the appointment letter such as medical sources, completed activity of daily living forms, or a list of medications with:
    1. Name of medication.
    2. Dosage.
    3. Condition.
    4.  Who prescribed the medication.

Interview

  1. A face to face interview with the person is preferred and can be held:
    1. In the office.
    2. In a hospital or nursing home.
    3. When a face-to-face interview is not possible, conduct a telephone interview.
  2. During the interview gather information about the person including:
    1. A contact person or advocate, including the address and phone number. This is important for all individuals and essential for people who are homeless.
    2. Onset date of impairment.
    3. The date the individual became unable to work.
    4. Educational history.
    5. Sources of other information about the person's impairment.
  3. Record all sources of medical information. Use this information to complete the i3368PRO (Internet Adult Disability & Work History Report).
  4. Explore employment history for each type of job the person has held in the last 15 years. Use this information to complete the i3368PRO.
  5. Ensure there is a signed DSHS 18-235, Interim Assistance Reimbursement Authorization on file with SSA for each ABD cash client

 


Medical Records

  1. The diagnosis of disabling impairment must be made by an acceptable medical source within 5 years of the SSI application. Once the impairment has been established, SSA considers evidence from other treating providers. SSA defines acceptable sources of medical evidence as licensed:
    1. Physicians.
    2. Osteopaths.
    3. Psychologists.
    4. Psychiatrists.
    5. Optometrists for measurement of visual acuity and visual fields.
  2. DDDS uses the Medical Evidence of Record (MER) as the primary source of medical evidence to determine disability. This includes:
    1. Hospital and clinic records.
    2. Records from the treating physician.
    3. Evaluations by specialists.
    4. X-rays, lab tests, psychological testing. Include dates of any exams scheduled in the future.
  3. DDDS arranges consultative examinations with contracted Physicians and Psychologists (including transportation when requested) when medical evidence does not contain sufficient information to make a disability decision.
  4. Include the clear, objective medical evidence used to determine ABD Cash eligibility, and all available medical records with the application packet.
  5. For TANF clients, use Support Services through eJAS to purchase medical records and/or a general examination to obtain objective medical evidence for individuals when existing medical evidence is not adequate to determine if a person appears to meet SSA disability criteria.

An attorney requesting copies of medical records in DSHS’s records (ECR) is making a PUBLIC DISCLOSURE REQUEST. Refer all public disclosure requests to the designated public disclosure officer. The public disclosure officer will coordinate with the social worker to provide copies of records to attorneys per established confidentiality rules.

When an attorney representing a person that is receiving SSI Facilitation services makes a request for additional medical records to assist with the SSI appeal process, follow these procedures:

  1. Determine whether the additional medical evidence is needed to support the SSI application.
    1. If the records are already in the person’s electronic case record (ECR), forward the request to the public disclosure officer.
    2. If there is not enough information to determine if the medical evidence requested by the attorney is necessary to support the SSI application:

                                              i.        Deny the request, or

                                            ii.        Contact for the attorney for more information.

  1. If the records are necessary to support the person’s SSI application, and aren’t already in the ECR, request the records from the medical provider, document the action in ICMS, and coordinate with the public disclosure officer to provide copies of the medical evidence to the attorney.
  2. If the records aren’t necessary to support the person’s SSI application, send a written notice to the attorney stating the reason that the department has denied their request, and document the action taken in the ICMS notes.

2. In all situations, the medical evidence provider will send the records directly to DSHS.


NOTE: Don’t authorize or pay for copies of records to be sent directly to an attorney under any circumstances.

Special report for SSI hearing and Medical examinations at the SSI administrative hearing level

Special reports Medical examinations at the SSI administrative hearing level must be pre-approved by State Headquarters.

See MEDICAL EVIDENCE REIMBURSEMENTS for payment rates and maximum payment.

When the attorney requests an evaluation or special report by a medical provider to be used when the client is in the Social Security hearing process, follow this procedure:

  1. The Social Worker receives a written request from the attorney, which includes the following information:
    1. Reason that the report is necessary, including a summary of the exhibits in the record.
    2. Description of the consequence if the request is not approved.
    3. Name and contact information of the medical provider.
    4. An attached written time estimate from the medical provider who will be preparing the report.
  2. The SSIF submits an expenditure request form 17-118 by either fax (360) 725-4905 or by email to HQ ETR coordinator Jennifer Peterson.
  3. The Social Worker communicates the decision to the attorney. If the 17-118 is approved, the Social Worker sends a 14-150 to the medical provider along with the request for the special report.
  4. After the service is provided, the Social Worker must receive a detailed billing listing the service provided, the amount of time spent providing the service, and a copy of any records created as a result of this service. If approved, payment would be authorized with SSPS code 96224.

EXAMPLE

The SSIF receives a phone call from an attorney asking DSHS to pay for copies of medical record from the local community hospital. The attorney asks for the complete medical records (e.g. "all records" or "all history") and says that they are for "preparing the case for hearing." The SSIF asks specifically why the records are needed, if all or part of them were included in the DDDS or CSO records, and asks for what dates the records are incomplete. The attorney responds by saying he just wants to make sure he has everything. The SSIF denies the request because the need for the records has not been clearly demonstrated.


Personal Observation

  1. A personal observation of the individual is an important piece of the SSI application packet. The SSI Facilitator is the eyes and ears of the DDDS adjudicator.
  2. Focus on writing an objective description of the person's appearance and behavior during a face-to-face interview and avoid value judgments or subjective analysis. Be specific and quantify responses.
  3. Some areas to consider when writing your personal observations:
    1. Deficits in hygiene or grooming.
    2. Difficulty using legs, arms, hands, or shifting position to alleviate pain.
    3. Unusual speech patterns.
    4. Difficulty with long or short term memory.
    5. Unusual surroundings if interviewing the person in their home.
  4. Photographs may be helpful in depicting a person's situation or physical condition. Only take or use photographs with the individual's permission.

Include your personal observation statement within the i3368PRO. (Sign and date the personal observation statement and include it in the application packet if unable to access the i3368 PRO).


Application

  1. Complete a SSA 16 and SSA 8001 form in all cases when the individual is filing for a disability payment through SSA. Complete the medical/work history for the person by completing the i3368PRO.
  2. Refer to Forms Used in Facilitation for a description of documents used.
  3. Send the SSI application forms to the local SSA District Office (SSADO) within 60 calendar days of ABD cash approval.
  4. Send the SSI application forms to the local SSA District Office (SSADO) within  90 days of referral of a TANF person.
  5. Verify that the SSADO has received the application packet.

The initial SSI application packet includes the SSA Cover letter, original Interim Assistance Reimbursement Authorization, copies of available medical records, SSA 8001-F5, SSA 16-F6, completion of the i3368PRO on the Internet, activities of daily living forms, SSA-827s, personal observation statement, and a return envelope.


SSA Teleservice

Individuals may also apply for SSI by calling the SSA Teleservice at 1-800-772-1213 for an appointment or CSO staff may call and arrange a telephone appointment for the person.

  1. SSA sends a starter kit to the person.
  2. The person or facilitator sends the completed starter kit to the SSA District Office prior to the telephone interview with SSA.
  3. The facilitator may assist the person with the telephone interview.
  4. Notify SSA when the individual is unable to keep a scheduled telephone interview and assist the person with rescheduling the appointment.
  5. For all ABD cash recipients, verify DSHS 18-235, Interim Assistance Reimbursement Authorization is on file with SSA.

Case Transfers

When a person transfers from one CSO to another, the SSI facilitator in the receiving CSO:

  1. Notifies DDDS and SSA of the person's new address and phone number.
  2. Contacts the individual by telephone or schedules an interview to update the person's information.
  3. Inputs new information in the ICMS record.
  4. Notifies DDDS of any updated information.

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Modification Date: October 9, 2014