SSI Facilitation - Process
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SSI Facilitation - Process

Revised December 22, 2008

Purpose: Document all actions in ICMS (GA) or eJAS (TANF)

This section includes information about:


Process Overview

The SSI facilitation process is intended to make it easier for persons who are receiving GA or TANF to apply for SSI. We help the person complete the application forms and navigate the complex federal application system. The facilitation process includes the following activities:

  1. Identifying individuals who appear to meet SSA disability criteria using DSHS 14-332, Disability Assessment.

  2. Preparing for the interview by reviewing available documents to learn about the person's medical, education, and employment history.

  3. Interviewing the person.

  4. Writing your personal observations of the individual.

  5. Submitting a GAX request.

  6. Verifying a signed IARA is on file with SSA.

  7. Obtaining additional medical records when necessary.

  8. Completing SSI application forms and filing the application packet with SSA.


Case Staffing

Social Workers work closely with other professionals together to staff cases. The SSI Facilitator contributes to case staffing outcomes by:

  1. Obtaining medical evidence needed to decide GAX eligibility and to expedite the SSI application process for TANF and GAX clients (Refer to 3.5 Case Staffing in the WorkFirst Handbook for more information when working with TANF staffings),

  2. Assessing whether a person appears to meet SSI disability criteria,

  3. Developing treatment and referral plans and use DSHS 14-249, GA Case Plan to notify clients of required participation,

  4. Developing Individual Responsibility Plans, and

  5. Providing case management services to reduce a person's need for GA or TANF.


Preparing for the Interview

  1. Research available information to become familiar with the person's situation such as:

    1. Medical records,

    2. DSHS 14-050, Statement of Health, Education, and Employment, and

    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, and

    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. At the person’s home,

    3. In a hospital or nursing home,

    4. In a neutral location, or

    5. 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, and

    5. Sources of other information about the person's impairment.

  3. Obtain 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. Have each GA client sign and date DSHS 18-235, Interim Assistance Reimbursement Authorization or verify that a signed copy is on file with SSA.


Medical Records

  1. DDS 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, and

    4. X-rays, lab tests, psychological testing. Include dates of any exams scheduled in the future.

  2. SSA defines acceptable sources of medical evidence as licensed:

    1. Physicians,

    2. Osteopaths,

    3. Psychologists,

    4. Optometrists for measurement of visual acuity and visual fields, and

    5. In some cases a report from a Physician Assistant when countersigned by the supervising physician.

  3. DDS arranges consultative examinations (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 GA eligibility and all available medical records with the application packet.

  5. Purchase medical records and/or a general examination for GA clients when existing medical evidence is not adequate to determine if a person appears to meet SSA disability criteria. Use Social Services Payment System (SSPS) and follow the procedures in Medical Evidence Reimbursements when purchasing medical evidence.

  6. 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.

Attorney Requests for Medical Records

 


NOTE:

The SSIF is responsible for managing the medical evidence request process, making decisions about whether or not it is necessary to purchase medical records for the attorney, and handling associated correspondence. Under no circumstances should the Social Worker permit the attorney to generate correspondence on behalf of DSHS.

Attorney requests copies of medical records:

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. The attorney initiates the medical records requested to the SSI Facilitator. The request must include:

    1. A brief explanation of the reason for the request,

    2. A target date for receiving the records,

    3. Details about the records, including specific time frames and the name and address of the source, and

    4. A release of information naming the attorney and signed by the person as appropriate.

  2. The SSIF decides whether the request is complete and appropriate.

    1. The SSIF checks whether the requested records are in the person's file. If so, the SSIF forwards a copy of the records to the attorney.

    2. When the SSIF determines the records are not available from the person's file and accepts the attorney's request, the SSIF sends a request for records letter to the medical evidence provider, with a copy to the attorney.

  3. For most requests, it is expected that the medical evidence provider will send the records to DSHS. Within 10 calendar days of the date received or available in the Document Management System, the SSIF will forward the records to the attorney.

    1. When the attorney presents the request as urgent (for example, the client changed attorneys within the month that the SSI Hearing is scheduled) and the SSIF accepts the reason for the urgency, the SSIF sends a request for records letter to the source either:

      1. Requesting one copy of the records instructing the medical evidence provider to send the records directly to the attorney and billing DSHS. In such cases, the SSIF should require the attorney to provide a written statement that the attorney will provide copies of the records to DSHS within 3 weeks after receipt without cost to the department or client prior to authorizing the purchase of medical evidence, or

      2. Requesting and authorizing payment for two copies of the records, with one copy to be sent directly to the attorney.

Special report for SSI hearing:

The purpose of special reports is to clarify existing medical reports. Special reports are a supplement to medical evidence already obtained by DSHS and the consulting exams obtained by DDDS.

The medical provider provides verbal information to the attorney, followed by a written report or the medical provider appears at an administrative hearing to offer testimony in person.

Special reports must be pre-approved by the Social Worker.

See MEDICAL EVIDENCE REIMBURSEMENTS for payment rates and maximum payment.

When the attorney requests a 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 decides whether the request is complete and appropriate.

  3. The Social Worker communicates the decision to the attorney. If the request is approved, the Social Worker sends a 14-150 to the medical provider authorizing payment for the special report.

  4. After the service is provided, the Social Worker must receive a detailed billing listing the service provided and 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.

Medical examinations at the SSI administrative hearing level (new evaluations):

The Social Worker should not routinely authorize and reimburse for evaluations when a person reaches the SSI hearing level. For situations when further evaluation is necessary, complete the DSHS 17-118. Request for Expenditure Approval. You must state a clear and convincing reason for the medical evaluation and an itemized description of the services and cost. The 17-118 is then sent to headquarters staff. If approved, payment would be authorized with SSPS code 96224.

Whether the attorney is requesting additional medical records, a special report, or a new medical examination, the SSIF is responsible for managing the medical evidence request process, making decisions about whether or not it is necessary to purchase medical records for the attorney, and handling associated correspondence.


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.

EXAMPLE

DSHS receives a request for a Special Report from an attorney. The request is in writing and includes a brief summary of the case, a list of the records the attorney currently has, and a statement that the medical evidence in the record does not sufficiently address the functional limitations resulting from the person's closed head injury (CHI) that occurred before the person lost her job. The request indicates that without the Special Report the Administrative Law Judge would make a decision based on incomplete evidence, and that the specified neurologist would analyze existing records and provide a written summary of functional limitations. The time requested is 2 hours. The SSIF follows up with a phone call to discuss the request, and concludes that the request is appropriate.

Personal Observation

  1. A personal observation of the individual is one of the most important pieces of the SSI application packet. The SSI Facilitator is the eyes and ears of the DDS adjudicator. Personal observations:

    1. Help the DDS adjudicator form a complete picture of the person,

    2. Point out areas of impairment that may not be fully covered by medical evidence, and

    3. May be the difference between a SSI approval and denial.

  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, and

    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.

  5. 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 approval of GAX or 90 days of referral of a TANF person.

  4. 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 GAU 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 DDS 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, and

  4. Notifies DDS of any updated information.


Facilitation of a Non-U.S. Citizen / Naturalization Referral

1.      Because the rules for which non-United States (non-U.S.) citizens are eligible for Social Security benefits are very complex, refer all persons who are non-U.S. citizens and appear to meet SSA disability criteria directly to the local Social Security Administration office before providing facilitation services.  This applies to both GA and TANF recipients.  For GA recipients, open the SSI Facilitation screen in ICMS.

2.      When SSA accepts an application from the GA recipient:

a.      Verify with the local SSA office that an SSI application was filed,

b.      For GA recipients, request GAX certification and verify with the SSA office that they have a DSHS 18-235, Interim Assistance Reimbursement Authorization on file,

c.      Document in case notes and update screens in ICMS, and

c.      Provide the necessary accommodation and SSI Facilitation services to assist the recipient with the application process.

  1.  When the SSA office rejects an application for or does not allow a person who is a qualified alien (as defined in WAC 388-424-0001) to apply because of citizenship status AND the person has lived in the United States for at least four years:

a.      It is strongly advised that the person be brought in for a face to face interview.   Talk to them about the advantages of becoming a U.S. citizen.  Citizenship gives them the right to apply for federal benefits, vote and makes traveling abroad easier.  Never tell the person that they must become a U.S. Citizen.

b.      Urge them to see one of the naturalization agencies.  Explain that the service is free.  Tell them that the agency can help them decide if they should apply for citizenship.  If they decide to pursue citizenship, tell them about the services that the agency can provide.  For example, help getting the disability waiver when their disability prevents them from taking the citizenship test.  Or the agency can set up citizenship training to help them prepare for the test.  If they have legal issues that would keep them from applying, the agency can refer them to an immigration attorney who will help them work through the problem.

c.       If the person is capable of contacting and following through with the naturalization agency give them the Naturalization Letter, DSHS 14-495 with a list of the local naturalization agencies attached.   The list can be found at:   NATURALIZATION REFERRAL LIST

d.      If the person needs help contacting the naturalization agency, call one of the local naturalization agencies and make an appointment for them.  Ask the them if they need help getting to the appointment and if there is someone else you need to contact such as a friend or relative to help them keep the appointment. Give them the information on the Naturalization Appointment Letter, DSHS 14-496.  The naturalization agencies can be found at: NATURALIZATION REFERRAL LIST.

e.      Explain that they need to take the letters with them.  The agency will copy the letters for their files and notify the social worker that the person was seen, whether they will apply for citizenship and if not, why not.

f.        On the SSI Facilitation screen in ICMS, enter “SSI/SSA denied-Non Citizen (SN)” as the closing reason code.  A date field will open.  Enter the date that you made the naturalization referral.

g.      Open the Naturalization Screen.  The permanent residency date, four (4) year date and the date of referral will auto-populate the screen.  Put the date the person makes contact with the agency in the Date of Contact box.  The provider can be chosen from a drop-down menu listing all the naturalization agencies.  The agency will inform the social worker if the person makes contact.   The social worker needs to maintain contact with the agency to find out if the person will apply for citizenship and the reasons if not applying.

h.      Continue tracking the case through the recipient and the naturalization agency.

  1. When a person who is a non-U.S. citizen reports SSI approval, inform them that unless they naturalize they will only receive SSI for seven years from the date they entered the U.S. if:

a.      They entered as a refugee, asylee, Cuban/Haitian entrant, Amerasian, victim of trafficking, or

b.      They have had deportation/removal withheld.

 

Links

Social Security:

DSHS: (Note: you may receive a "page not found" error if you do not work for DSHS)

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Modification Date: December 22, 2008
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