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Making the Paperwork Work: Expediting Program Eligibility Celebrate the Paperwork: It Means You Are Alive!. Patti Hackett, MEd HRTW National Center, Natick, MA 9 th AZ Transition Conference September 2009. Today’s Outcomes. By the end of 1 hour success

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Patti Hackett, MEd HRTW National Center, Natick, MA 9 th AZ Transition Conference

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Making the Paperwork Work:

Expediting Program Eligibility

Celebrate the Paperwork:

It Means You Are Alive!

Patti Hackett, MEd

HRTW National Center, Natick, MA

9th AZ Transition Conference

September 2009


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


  • O V E R V I E W

  • About You & Me

  • About HRTW

  • Entitlement-Eligibility

  • Essential Paperwork

  • Just the Facts

  • Resources


You, Me, Looking for ?

  • Affirm

  • Ah ha!

  • Squirm

  • Disagree

Who You Are?

Experts in the Room

About me!


Growing Up Ready

to try new things!


Transition to Adulthood


www.hrtw.org


Prepare for the Difference: Entitlement to Eligibility

  • So many different definitions of disability.

  • Who is considered disabled ?

  • Who is not?

  • And why does it matter?

  • What is the difference between disabled and special health care needs?

Methods


Expediting Eligibility: Definition, Criteria & Rules

  • Adult Programs, Services & Benefits

  • Definition of disability

  • Each agency is different

  • Learn their rules/definitions

  • Documenting Disability - LEGAL RESOURCES

  • http://www.hrtw.org/tools/dis_info.html

  • - ADA

  • - DEVELOPMENTAL DISABILITY

  • - EDUCATION: IDEA/IDEIA

  • - HEALTH

  • - REHABILTATION ACT 1973, Section 504

  • - SEVERE DISABILITY

  • - SOCIAL SECURITY

  • WORK

Methods


Making the Paperwork Work!

  • Concise Documentation

  • Review takes less time when

  • application and documentation is complete!

  • Faster decision.

  • Less stress for YOU!

  • Evidence matches “rules”

  • Medical

  • Functional: Social, physical, behavior, cognitive,

  • and decision making

  • Other

Methods


Take Home Messages

  • Paperwork is a reality

    no positives in whining

    2. Identify the shortcuts

    put energy on solutions

    3. Draft the paragraph, create the one pager

    Trim down the care notebook

    4. Families NEED to learn this

    they get the denials and the stress


Disability Criteria

3

2

1


D I S C U S S I O N


Disability Criteria


Just the Facts: Accessing Adult ServicesIt’s Moving from Entitlement to Eligibility

format

  • Dispelling the Myths (SSI, VR, health insurance)

  • The Intent of the Service

  • Roles: Teachers,

  • Physicians, Care Coordinators

    Families & Youth


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)


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.


Just the Facts: SSI – Disability Criteria

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 - Listings

www.ssa.gov

search

BLUE BOOK

  • Musculoskeletal System

  • Special Senses and Speech

  • Respiratory System

  • Cardiovascular System

  • Digestive System

  • Genito-Urinary System

  • Hemic and Lymphatic System

  • Skin

  • Endocrine System

  • Multiple Body Systems

  • Neurological

  • Mental Disorders

  • Neoplastic Diseases Malignant

  • Immune System


Just the Facts: SSI

111.07 Cerebral palsywith:

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


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


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.


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


TIPS: Navigating & Documenting

1. Prepare the medical and other evidence

2. Know the eligibility requirement

3. Prepare the application

- Ask for review by others before submitting

4. Come ready (paperwork completed)

the day of “intake”


D I S C U S S I O N


Just the Facts: Vocational Rehabilitation

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


Just the Facts: VR

TRAINING

  • Supported Employment

  • Short-Term, Vocational Training

  • College or University-based education

    EMPLOYMENT SUPPORT

  • Job Coaching

  • On-the-Job Training


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.


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.


TIPS: Navigating & Documenting

1. Prepare the medical and other evidence

2. Know the eligibility requirement

3. Prepare the application

- Ask for review by others before submitting

4. Come ready (paperwork completed)

the day of “intake”


D I S C U S S I O N


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.


Maintaining Health Insurance


Extended Coverage – Family Plan

CONTINUATION OF COVERAGE POST 18 (18 states ) with/without disabilities. Unmarried, childless young adult, most require student status

Up to age 24 — DE, IN, SD*

Up to age 25 — CO, ID, ME, MD, MT, NM, RI, TX, VA , WA, WV

Up to age 26 — CT, MA, NH, UT

Up to age 30 — FL, NJ, SD

*employer option

PA - Students in National Guard called to duty, maintain coverage until education is completed regardless of age


Extended Coverage – Family Plan

Adult Disabled Dependent Child

state mandate (40 states)

AZ, AR, CA, CT, FT, GA, HI, ID, IL, IN, LA, ME,

MD, MA, MI, MN, MS, MO, MT, NE, NV, NH, NJ,

NM, NY, NC, ND, OH, OR, RI, SC, SD, TN, TX,

UT, VA, VT, WA, WI and WY


Handouts: Private Health Insurance

Adult Disabled Dependent

  • AZ Rev. Stat. Ann. Sections 20-826 (F) - 1342.01, -1407)

  • Coverage for dependent children cannot be terminated while a person is incapable of self-sustaining employment due to mental retardation or physical handicap and chiefly dependent on the insured.


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.


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


TIPS: Navigating & Documenting

1. Prepare the medical and other evidence

2. Know the eligibility requirement

3. Prepare the application

- Ask for review by others before submitting

4. Come ready (paperwork completed)

the day of “intake”


TIPS: Creative Health Insurance

Ex #2

ex #1, 3rd wife


D I S C U S S I O N


SKILLS FOR YOUTH

  • Practice filling in forms (Home & School)

    2. Cheat sheet: portable medical summary

    3. Tracking to avoid forgetting


D I S C U S S I O N


Survival Tips: Why NOT try some

  • 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 17thprep relax bath

    4. Three way call


TIPS: Navigating & Documenting

1. Prepare the medical and other evidence

2. Know the eligibility requirement

3. Prepare the application

- Ask for review by others before submitting

4. Come ready (paperwork completed)

the day of “intake”


Patti Hackett, MEd

Co-Director, HRTW Center

pattihackett@hrtw.org

pattihackett@yahoo.com


Resources - 04

HRTW Portal - Laws that Affect CYSHCN

http://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


Just the Facts: SSI -- Resources

SSA website

www.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


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


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


What would you do,

if you thought you could not fail?


www.familyvillage.wisc.edu

www.familyvillage.wisc.edu/


www.fvkasa.org


??? NYLN

www.nyln.org/


www.ncwd-youth.info/index.html


www.familyvoices.org


www11.georgetown.edu/research/gucchd/nccc


infanthearing.org


Medicalhomeinfo.org


www.hdwg.org/catalyst/index.php

State-at-a-Glance Chartbookon

Coverage and Financing

of Carefor Children and Youth with Special Needs


http://www.championsinc.org


www.hrtw.org


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