NORTHROP GRUMMAN SYSTEMS CORPORATION
Moderator: Lucy Miller
06-12-13/1:00 p.m. EST
Confirmation # 92685905
Page 1
NORTHROP GRUMMAN SYSTEMS CORPORATION
Moderator: Lucy Miller
June 12, 2013
1:00 p.m. EST
Operator:
Good afternoon. My name is (Jessica) and I will be your conference operator
today. At this time, I would like to welcome everyone to the Understanding
IRWE conference call. All lines have been placed on mute to prevent any
background noise.
After the speaker’s remarks, there will be a question-and-answer session. If
you would like to ask a question during this time, simply press star then the
number 1 on your telephone keypad. If you would like to withdraw your
question, press the pound key. Thank you.
Lucy Miller, you may begin your conference.
Lucy Miller:
Thank you, (Jessica).
Good afternoon, everybody. I don’t know about where you're sitting, but here
in Louisville, Kentucky, it is an absolutely glorious summer day. It’s warm
and sunshiny with a lovely breeze. And here we all are sitting indoors,
typically in front of a computer screen, getting two hours of very intensive
training on IRWEs. So, anyway, we’ll try to make it as fun as we can but I'm
not going to make any promises.
This is probably one of the most technical trainings that I've done in a while.
If you scan the slides, you see it reads pretty much like the POMS and there's
a reason for that. I stuck very close for you to the POMS, everyone should
know what that is, right, Program Operating Manual System.
NORTHROP GRUMMAN SYSTEMS CORPORATION
Moderator: Lucy Miller
06-12-13/1:00 p.m. EST
Confirmation # 92685905
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That’s Social Security’s little rule book, but I stuck very close to the POMS
when developing these slides and it’s because I wanted to make sure that we
were capturing all of the information in an absolutely accurate manner.
Most of you listening to this call, you’ve been doing this job a while. You
know that when you're doing work incentives counseling, the devil is in the
details. And, boy, IRWE has a lot of detail that you probably aren't familiar
with.
This training assumes that you’ve already read the manual, the piece on the
SSI chapter on IRWEs and also the Title II chapter on IRWEs, and this
training picks up where the manual leads off.
So, we’re really going to dig in, we’re going to deal with a lot of detail, a lot
of regulatory information and I think some of what you're going to hear today
is going to be new, that you’ve never heard it before, enlightening, some of it
is going to be technical and hard to understand but we’ll do our very best to
weigh through it.
Now, there are 52 slides that we have to cover today and here’s what we’re
going to do. We’re going to get to slide 25 and then we actually kind of
change gears in the presentation, so I'm going to stop, we’re going to take
questions probably 10 minutes worth. This is a long presentation today so I'm
– I don’t want you to be here until, you know, 5 o’clock Eastern time.
So, we want to make sure that we sort of stay on track but we’ll stop and take
questions after that first half then we’ll get into the second half which really
digs into some very specific IRWE situations and then we’ll take the balance
of the questions at the end.
We many go a little bit over. That’s up to you as to whether or not you decide
that you want to hang up, you’ve had just about enough, or whether you want
to stay tuned in until the absolute, bitter end.
So, hopefully everybody’s read the manual, hopefully you’ve all got the
information that (Julie Schulz) sent you. You should have a PowerPoint
presentation. You should have a couple of handouts.
NORTHROP GRUMMAN SYSTEMS CORPORATION
Moderator: Lucy Miller
06-12-13/1:00 p.m. EST
Confirmation # 92685905
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One of them is an – a form in SSA-795 and we’ll talk about that when we get
to it in the presentation, the actual form that Social Security uses to document
an alleged IRWE, and they use it for lots of different things but that’s one
thing Social Security uses it for.
You also got a sort of spiffy, little collection of worksheets that comes straight
out of the POMS and they are worksheets that are provided to claims reps,
Social Security employees for use, if chosen, to develop and document
IRWEs.
It’s always handy to be able to look and see at the tools that Social Security
gives their own employees when it comes to work incentives because it really
helps you understand how they do things from the inside.
You also have a form that should not be new to you. It is a template for use in
requesting consideration of an IRWE. It’s out of the manual. It’s posted on
our Website and I think those are the three.
Now, I chose not to give you a separate document which would have been a
compilation of all the POMS citation on IRWEs. I hope you thank me for that
because I actually saved that as a Word document. And the SSDI or Title II
IRWE POMS, in and of themselves, were over 40 pages. So, that doesn’t
even count the citations in the SSI section.
I will give you the citations if you're one of those diehards who love to read
the POMS. That’s provided on the last slide so you're certainly willing and
able to go in and look that up yourself, but I did not provide that to you as a
Word document just because it’s very long and cumbersome.
All right. That’s the intro. Let’s get started.
All right. One of the things that – as just a little bit more intro, one of the
things that I noticed when I was researching the material to prepare this
presentation, the POMS has been updated a lot in the area of IRWEs over
about the last three to four years, and I really think that has a lot to do with us,
NORTHROP GRUMMAN SYSTEMS CORPORATION
Moderator: Lucy Miller
06-12-13/1:00 p.m. EST
Confirmation # 92685905
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with WIPA, with those of us who are helping beneficiaries claim impairment
related work expenses and document them.
I think when we all started this work, there wasn’t enough specificity in the
POMS. And so, as we kept presenting situations to Social Security, they
didn’t have enough regulation to provide guidance.
So, over the years, and particularly, really over the last three or four, the
POMS citations covering IRWE have really expanded. There are a lot more
detail. They are a lot more explanatory. They cover a lot more sort of odd,
little, obscure situations, but that all helps us to do our job. So, you're going
to see a lot of that.
All right. Let’s take a look at – it’s actually slide number two. When was
IRWE started? It actually was not part of the original legislation for either the
SSI program or Title II. It was not sort of invented or part of the rules until
December 1st of 1980.
And you all have seen the basic explanation of what IRWE is. It’s items or
services that a person with disability needs, because of their disability, OK, or
a medical condition, in order to walk.
And those types of expenses can be deducted from earned income when
Social Security is looking at wages to see, in the Title II program, if SGA,
substantial gainful activity, is in evidence and/or when you're looking at an
SSI recipient in trying to determine how much that cash payment should be
reduced based on countable earned income.
It’s one of the few work incentives that is applicable to both programs.
Remember, it is allowed under Title II and Title XVI. It just affects those
benefits a little bit differently because those benefits are so different.
On slide three, a working beneficiary may be eligible to claim IRWE under the following
conditions: number one, the individual would need to require some type of
assistance like services, medical devices, medication, something, because of a
physical or mental impairment and it needs to be something the individual
NORTHROP GRUMMAN SYSTEMS CORPORATION
Moderator: Lucy Miller
06-12-13/1:00 p.m. EST
Confirmation # 92685905
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requires in order to work, OK, whether or not such assistance is also needed to
enable the person to carry out normal daily functions.
Now, that’s a really important point, and if you have your highlighter handy,
it’s really important to highlight that because a lot of times there's
misunderstanding that people think, “Well, so I'm on seizure medication. I
take it every day. And so, that's not going to be an IRWE, right?”
Well, just because it’s medication that you need anyway, you needed it before
you went to work, that doesn’t mean that you don’t need it in order to work as
well. And so it’s really important that you understand it’s a very broad
definition.
All right. In order for the IRWE – the beneficiary to claim an IRWE, that also
is required that the beneficiary pays the cost of whatever the assistance is,
whether it’s services, medical devices, medication, whatever, in cash and it
cannot be, has not been and will not be, as the POMS speak here, reimbursed
by any source.
So, let’s say that I pay for something upfront, but subsequently, the insurance
covers and then reimburses me, no, that’s not going to work. It has to be
something I'm paying for out of my own pocket that is not reimbursable,
hasn’t been reimbursed, cannot be reimbursed, will not be, you get all the
tenses there.
And it also needs to be what Social Security says “in cash” but that doesn’t
mean it actually has to be cash. It can be a credit card, it can be a check, any
other kind of money. It just can't be in kind, like you can't swap your doctor
for medications with a – you know, a bushel of apples or services that, you
know, you're offering in exchange for the work. It has to be, you know,
something that’s cash, something that is real payment, not a service or an in
kind of situation.
And the payment has to be within reasonable limits and we’re going to spend
what will seem like probably an interminable amount of time describing what
Social Security means by “reasonable,” again, the devil is always in the
details. What does that word mean? But we’ll get there.
NORTHROP GRUMMAN SYSTEMS CORPORATION
Moderator: Lucy Miller
06-12-13/1:00 p.m. EST
Confirmation # 92685905
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So, it has to be paid out of your own pocket, not reimbursed by any other
source, has to be paid in cash, meaning not in kind. The payment has to be
within reasonable limits. And finally, you have to pay for that item or service
in a month in which the person is either working or in anticipation of work.
And that “anticipation of work” is kind of a change in the – in the wording but
it’s good, because it means that something that an individual purchases before
their job actually starts.
But because they expect to work, they anticipate working, they're preparing
for work, there's a way to actually claim expenses that incur – that were
incurred before the job actually began and pay began to be received. So, hang
on to that fact because it’s really important and certainly a tremendous
advantage to beneficiaries.
All right. Now, IRWEs are work. They're work for the beneficiary, they're
work for us, and they're work for Social Security employees. And anytime a
beneficiary alleges that there are impairment related work expenses, the
employee that you're dealing with at Social Security has some questions that
have to be answered, and here they are on slide number four.
Does the alleged IRWE correlate with some impairment that the individual
had that’s being treated by a health care provider? And again, we’ll spend a
long time talking about what that means, “correlating with some medical
condition that the beneficiary has.”
Now, does the person really require the item or service to work? So,
remember it has to be work-related. It can also be something you need
beyond work but it either has to be a connection between this item and service
and working,
And then had the person actually paid for the item or service? And certainly,
you know, is it – is it not being reimbursed? And then the final question and
this is something that those of us who don’t work for Social Security don’t
really think about, but there are some interesting sort of questions here, OK,
we have this expense, when is the expense deductible? And in some cases, if
NORTHROP GRUMMAN SYSTEMS CORPORATION
Moderator: Lucy Miller
06-12-13/1:00 p.m. EST
Confirmation # 92685905
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you have a big ticket item, how can you distribute the expense? And some
really interesting and complicated regulations arise around this.
So, lots of things that the claims rep needs to think about and document and
lots of questions that need to be answered before the expense can be approved.
All right. On slide number five, let’s start looking at these issues that Social
Security has to deal with and the first one is correlating that expense with
some type of impairment or medical condition that the beneficiary has.
Now, for those of us who are ancient and I – to count myself as one of that
number, and who have been doing that for like a long time, in the old days,
IRWEs were very narrowly interpreted like the expense had to be related to
the actual disability of record, a disability of record that Social Security had.
And this would’ve been a disability that DDS, Disability Determination
Services, quantified when the person was either applying for benefits or
during a subsequent medical review.
Well, over the years, this interpretation has been broadened and that is a good
thing. So, now, it doesn’t just have to be an expense that relates to like your
original disabling condition but it can be related to any sort of impairment or
condition that you have as long as it’s something that’s quantifiable and that
you are receiving some type of treatment for.
So it doesn’t have to be primary disability, doesn’t even have to be something
that DDS marked down, it’s a – it’s a broader definition and that’s all good.
All right. The IRWE can correlate with any medically established impairment
or impairments being treated by a physician or health care provider. And
when Social Security is looking at all this, when the IRWE doesn’t seem to
correlate with either the DDS diagnosis or the medical records in the medical
file, then what Social Security will do is ask the beneficiary to provide
information from a treating physician or a health care provider that can
document that there is some connection between this expense that the person’s
incurred and that they want to deduct from wages and some medical condition
that you have.
NORTHROP GRUMMAN SYSTEMS CORPORATION
Moderator: Lucy Miller
06-12-13/1:00 p.m. EST
Confirmation # 92685905
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So, I know this sounds kind of complicated and it’s like, “Oh, Jiminy
Crickets! Now we have to go with doctors.” But you know what? This is all
good. This is much broader than the original definition of IRWE where, if
Social Security didn’t see it in the medical file that they have electronically
that they can look into, they weren’t going to approve it. And now, it’s a good
thing that it’s been expanded.
I mean even though it does create some work, OK, so we got to go to the
doctors, we may have to get some documentation, may have to get some
forms signed indicating that this really, truly is something being treated by a
physician, but it’s all good.
So, on slide number six, now you have to determine the needs. So, first thing
Social Security does, OK, documenting that – the expenses related to the
impairment, because remember, it’s all in the name, “impairment related work
expense,” all right?
So, documenting that it’s impairment related, got that first. Now, what is the
need for the IRWE? The person’s functional limitations, and this is right out
of POMS, require him or her to have assistance in the form of whatever it is
that this IRWE is, item, services, whatever, quote, “in order to work.”
OK, so you have to find a connection, have to prove a connection between this
expense that the individual is incurring and the work that they're doing, OK?
And, meaning something else, the alleged expense meets the statutory
definition of an IRWE which means that there's – it includes attendant care,
durable medical equipment, prosthesis, other equipments, similar items, it
goes on and on in the POMS.
So, it’s two things: it has to be something that the person needs in order to work and it has to
meet that statutory definition of an allowable expense, the IRWE, all right.
The expense has to pertain to the person with the disability, not another
person, and that sounds like really obvious, but you'd be surprised how often a
beneficiary might come up with an expense that is not exactly related to them
and requesting that that be disregarded. But it has to be an expense that is
directly pertained, incurred by, related to the beneficiary.
NORTHROP GRUMMAN SYSTEMS CORPORATION
Moderator: Lucy Miller
06-12-13/1:00 p.m. EST
Confirmation # 92685905
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And the impairment which requires the person with a disability to use that
item or service, we talked about on the slide before, have to, of course,
correlate with some type of medically established impairment or medical
condition or disability that the individual has.
Now, what is the procedure that – remember the third bullet? OK, so it’s it
has to correlate with the disability. It also has to be needed because of work.
And it has to be something that you paid for out-of-pocket. Well, this can get
a little tricky. Social Security has got a lot of questions that have to be
resolved here.
When they're looking at SGA, now remember that would be for a Title II
beneficiary, is the payment made in a month in which the person is working?
Now, there are exceptions, remember we talked about before, or an
anticipation of work, but there are some very specific guidelines that allow
certain expenses that were incurred before work to be deducted. So, they're
really looking to see is the payment made in a month the person with the
disability is working.
For determinations of SSI countable earned income, is the payment made in a
month earned income is received? And remember, those are different things.
You could work let’s say at the end of a month you got hired, but let’s say you
don’t get paid for a week or two after you get hired, the expense has to be
incurred in a month in which there was actual pay or there's no way to deduct
it. You know how SSI works, it’s very literal, month by month by month.
And we’ll cover that more as we get – go along, so don’t worry if that seemed
a little fuzzy.
Now, does the payment pertain to an item that is used or a service that is
received in a month in which this person with a disability is working? And
that’s related to that top bullet. Then the question becomes, is the payment
within reasonable limits? And we’ll go over what they mean by “reasonable.”
And is the payment actually made by the person with the disability? So let’s
dig further. How do they figure this all out?
NORTHROP GRUMMAN SYSTEMS CORPORATION
Moderator: Lucy Miller
06-12-13/1:00 p.m. EST
Confirmation # 92685905
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All right. The process of documenting IRWEs is time-consuming and
definitely involves effort. It involves effort on your part, it involves effort on
the beneficiary’s part, it involves effort on the Social Security employees’
part.
The beneficiary needs to provide proof that he or she paid – actually paid, not
with billed, but paid for the expense, for the item. Most of the time, Social
Security will require that the beneficiary sign a verifying statement on a
special form. It’s called an “SSA-795.”
And if you're not familiar with this form, it’s a generic form that Social
Security uses to sort of document anything important that a beneficiary
alleges, OK. It’s not just an IRWE form, it’s sort of a verification of a
statement made by the beneficiary.
And I provided you, as one of the handouts, with an example of an SSA-795
already filled out, ready for the beneficiary to sign. And I don’t see any
reason for you not to go ahead and use these forms.
I'm kind of copying some procedures that are used in the BOND program, if
you’ve heard that, because BOND EWICS really do a lot of work similar to
what a claims rep would do. And BOND EWICS, in particular, use SSA-795s
often to capture a statement that at beneficiary is making to make – to describe
something that they're alleging and then the beneficiary signs it.
And that's sort of – you know, puts everything in formality. It’s like, “OK,
I'm sort of swearing that this is the case.” And then with the 795, you would
need to attach copies of documents that prove the expense was paid.
Now, not just that the expense was incurred, not a bill. A bill does not work.
It needs to be either a cancel check or a receipt or a statement from the
provider like the medical provider or the pharmacy that shows that payment
was received, OK.
So, it’s a common confusion. When I was actually doing direct services in the
BOND program recently, I had a beneficiary with lots and lots of IRWEs, and
she kept sending me the bills. And I kept telling her, “No, no. I have to see
NORTHROP GRUMMAN SYSTEMS CORPORATION
Moderator: Lucy Miller
06-12-13/1:00 p.m. EST
Confirmation # 92685905
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that the bill was paid.” Social Security won't accept the bill. It has to be a
receipt or proof of payment, that payment was received.
Now, the deduction for the IRWE is not allowable to the extent that the
beneficiary has been, could be or will be reimbursed for such expense by any
source. So, to the extent that Medicare is going to pay or private insurance is
going to pay or mom’s going to pay you back or (inaudible) is going to pay
you back or any reimbursement for that expense, it’s not allowable.
So, it’s only the portion of the expense that the individual paid for themselves
out of their own pocket and that is not going to be reimbursed by anyone at
anytime.
And I had to leave the POMS language in here because I sort of got a giggle
out of it, you know, this whole timeframe. It hasn’t been, it will not, it can't
be, you know, reimbursed by any other source because it shows you how
seriously they take this and you have to prove – you have to prove – the
beneficiary has to prove that you're not going to get paid back for any of it.
All right. Determining if the IRWE cost is, quote, “reasonable,” and you
would think that such a simple word like reasonable would be something we
would all understand. No. Social Security goes on for citation after citation,
bullet after bullet, describing what they mean by that word “reasonable.”
Well, they’re going to determine that the amount is within reasonable limits if
it’s no more than that, quote, “prevailing charge” for the same item or service.
When we do training and we teach IRWE, a lot of times we kind of talk about
the usual and customary cost, same thing, prevailing charge, usual and
customary. It’s kind of what the charge is usually in the normal circumstances
in your community.
Now, the prevailing charges are those that fall within a range of charges that
are most frequently or widely used in the local community of the beneficiary
for a particular item or service. And, you know, different providers of things
charge different amounts.
NORTHROP GRUMMAN SYSTEMS CORPORATION
Moderator: Lucy Miller
06-12-13/1:00 p.m. EST
Confirmation # 92685905
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So, there will typically be a top of the range and a bottom of the range, and the
top of the range establishes the standard or normal cost that can be accepted as
within reasonable limits for a given item or service.
Now, if Social Security decides that the cost the beneficiary paid is
“unreasonable,” meaning that it is outside the range of prevailing charges,
then they’re going to allow the full cost of the beneficiary paid as the early.
They’re only going to approve that standard or normal cost.
Now, that will be the top of the range but, you know, if you paid $50 billion,
you know, for a wheel chair and the usual cost is $2,000, I’m sorry, you’re
only going to get reimbursed for what is considered that usual customary
standard or normal cost in the local community.
Now, I, personally, have never experienced a determination where Social
Security said the cost was unreasonable. Well, that’s not true. A long time
ago, I had a beneficiary who had intellectual impairment and lived in a rural
community. And this individual literally took the little rural cab to and from
his job every day, and it was expensive, OK.
And the claims rep – this was a long time ago when IRWE was, you know, I
don’t want to say new, but I don’t think that claims rep had a lot of
experience, she that the cost was unreasonable because it was expensive. And
fortunately, that is not the definition of “reasonable.”
“Reasonable” does not equal “cheap,” OK? Some reasonable expenses are
high, OK, taking a cab to and from work, even a little rural Kentucky was a
little costly. But it was the usual customary prevailing cost. It’s not like the
cab driver was gouging the beneficiary that I was working with. He was
charging that individual the usual community rate that he charged everyone.
And we simply had to make a statement to that effect. The cab driver was
very kind and offered some verification of that and pointed out in the POMS
that, you know, “reasonable” doesn’t equal “cheap,” OK, just means usual and
customary and the claims rep was very gracious and said, “No problem.
We’ll allow that.”
NORTHROP GRUMMAN SYSTEMS CORPORATION
Moderator: Lucy Miller
06-12-13/1:00 p.m. EST
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OK. Onto slide number 10, so if Social Security has answered that first group
of questions, and remember go back to that first slide with, is this a medically
determinable item? OK, does it correlate to your disability? Is it related to
work? OK, that’s number two. Is it paid for by the beneficiary and not
reimbursed and is it reasonable? OK, so those are the first three.
Now, we got to figure out, OK, so it’s in IRWE, all right. We’re saying, “It’s
in IRWE. It’s accepted. We approve it.” Now, how do we deduct it? And
how is this all figured out? And it seems like this would be so easy. But
when you start reading the POMS and you start thinking about all of the
bizarre circumstances under which an expense could be paid, you'll realize it’s
a lot more complicated than you think.
So, services are deductable if the services are received while the person is
working. Deductions for services may be made even though a person must
leave work temporarily to receive the service, OK.
The costs of any services received before the person begins working are not
deductable. Now notice the word “services,” OK, you can deduct the cost of
certain durable goods that you purchased prior to work beginning (inaudible)
actually starting the job, but not services. So that is a very important
distinction.
Now, I wanted you to make a note of that on your slides. Services would be
things like, you know, medical appointments, chiropractor services, physical
therapy, mental health treatment, those are services. Durable goods are
things, OK, and its services that are really restricted to being purchased only
after the person’s job has begun. All right.
Now, look at the second bullet. Items, those are things needed in order to
work our deductible, whether the item is purchased before or after the person
begins working, if the person needs the item in order to work.
So, Social Security needs to make that distinction right off, so what are we
looking at here, is it service or is it an item? Because they’re going to treat
those two things differently and that you'd never thought of that. All right.
NORTHROP GRUMMAN SYSTEMS CORPORATION
Moderator: Lucy Miller
06-12-13/1:00 p.m. EST
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On slide 11, let’s look at things that are recurring monthly expenses. Now we
love this kind of IRWE because they’re easy, OK. Things that happen every
month, the same, (da da da da da). So, this could be medical prescription copays that are happening every month. It could be a flat fee for some type of
service that the individual receives every single month.
And when you have these kinds of recurring monthly services, therapies,
medical services, attendant care, whatever, they occur every month, generally,
the total amount that the cost of this service is paid by the beneficiary and that
includes sales tax. That’s kind of nice to know.
So, that will be the deductible amount as long as the cost is, quote,
“reasonable.” Remember that doesn’t mean “cheap.” Such costs are
deductable only if the services are received while the person is working.
Remember, services can’t be deducted until work began.
Now, in the case of durable equipment, respirators, wheel chairs, you know, I
don’t – whatever else it is, stuff, things, the recurring cost is ordinarily paid
over a period of time under some type of installment purchase plan, right?
In addition to the cost of the purchased item, Social Security does allow
interest and other normal charges like sales tax that the beneficiary pays on
the purchase to be deductible.
So think about, you know, if you’re renting durable equipment, and so it’s a
recurring monthly expense or you’re leasing something or you have a time
system where you’re paying – you’re actually purchasing the item but you
have a payment plan over time, those would be recurring monthly expenses
and those are deductibles.
So again, Social Security makes a distinction between the way they look at
services and the way they look at items, things. It’s important to make that
distinction.
Now, what do you do about, we’re on slide 12 now, recurring non-monthly
expenses, like, “What the heck is that, Lucy?” Well, you know, sometimes a
person with a disability is going to make pay for an expense that is an IRWE
NORTHROP GRUMMAN SYSTEMS CORPORATION
Moderator: Lucy Miller
06-12-13/1:00 p.m. EST
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like less frequently than monthly. For example, it might be some sort of
quarterly charge. It’s a little odd. But as I said, the POMS are full of detail
and this is one and, you know, this is something you might encounter.
So here’s what the POMS says, “These expenses can either be deducted
entirely in the month in which the payment is made or allocated over the
month in the payment period whichever the person chooses.”
And there is actually instruction in the POMS that says, “Claims reps, you
need to be helping the beneficiary make a proper selection and we should be
looking at whichever way is most advantageous for the beneficiary, which
would provide the higher payment amount, in the case of SSI, or which would
have the greatest impact on an SGA determination if it’s a Title II, OK?
So, you have some choices here. This impacts our counseling. We would
want to be working with beneficiaries and helping them see, OK, you can do it
this way or you can do it this way. And we would want to be making
recommendations to the person about which way, in their unique
circumstances, would be the most advantageous financially.
OK, slide 13. Non-recurring expenses, these are one-time expenses that a
person may make for an item or a service. So, it’s like a one-time cost. Nonrecurring expenses may be deducted entirely in one month or maybe prorated
over a 12-consecutive month period whichever the person chooses.
And the beneficiary again, should consider which method will provide more
benefits including the amount of the SSI cash payment or which one is most
beneficial when Social Security is looking at countable wages for an SGA
determination.
So, this is pretty awesome. You can take these one-time expenses. And
normally, we’re looking at like pretty big ticket expenses, big things, big
expenses, that you pay one time. You get it over with but you can prorate the
amount of this expense over quite a period of time.
All right. That leads to a common type of payment which is on slide 14, down
payments. So, let’s say that you are purchasing, I don’t know, something
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really expensive. I’ll tell you the most expensive item that I ever helped a
beneficiary purchase was a Segway.
Hopefully, you’re all familiar with what that is. It’s sort of a weird form of
conveyance, two wheels that kind of looks like a scooter that’s just got two
wheels. And it was very expensive. And that individual purchased the
Segway by making a down payment and then taking the balance and
spreading it out with – what do you call it – just like monthly payments or,
you know, paying over time.
Now, a down payment on an early may be deducted entirely in one month if
you choose or spread over a 12-consecutive month period, again, whichever
the beneficiary chooses and whichever would be most advantageous. And
that’s our job, to help the person figure out.
Now, when the down payment is spread out over a 12-month period, Social
Security actually has to do some math. All right. So sit down, get ready,
we’re going to do some math.
They have to determine the total payment made over a 12-consecutive month
period beginning with the month of the down payment. So, that’s the down
payment plus the regular monthly payments that are made during that period
and you have to divide to total equally over a 12-month period.
And then beginning with the 13th month, they deduct the regular monthly
payment amount only. If the regular monthly payment extends for less than
12 months, Social Security allocates the total amount payable, the down
payment plus monthly payments over a shorter period. And at that point,
everyone’s eyes have rolled back in their head and they’re like, “What?”
All right, here’s an example. Look on page 15. We’ll give you two examples
(inaudible) even because this stuff makes your head spin. All right.
(Carl). (Carl) purchases a scooter to enhance his mobility on his new job. He
pays a $500 down payment and then makes monthly installment payments of
$200 a month for nine months. Social Security calculates the IRWE
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deduction in the following manner. OK, get ready, get your calculator, all
right, here we go.
They’re going to take the $500 down payment. They’re going to add that to
the total amount of installment payments. And remember, that can include
interest and sales tax, total amount, OK. So, (Carl), I made it – made it easy
(inaudible) numbers, $200 for nine months, so the installment amount is a
total of $1,800. We add that to the $500 for a total of $2,300. And that’s the
total amount that’s coming out of (Carl’s) pocket for the scooter over time,
OK?
Now, they’re going to take the total cost in the scooter. They’re going to
divide it by 10 months. That is the month of the down payment and the
number of months that (Carl) is going to actually be making those payments
over time, the installment payments. So, the month of down payment plus 9 is
10, OK?
Now, you’re going to take the $2,300, divide it by 10, and that is equals $230.
So, Social Security will take $230 in IRWE expense each month for 10
months. That’s pretty awesome.
Now, (Carl) could choose to do it another way. He could adjust the actual
down payment in one month and then deduct the actual installment payment
each month afterward, if he chose. And you would probably want to run the
numbers and see which way is better and it might be six to 1 1/2 dozen of the
other, OK?
But you do have some options. See, it’s not – it’s not that bad. So once you
look at the examples, it’s not that bad. All right. Now, look at another
example.
On page 16 or slide 16, (Joan). (Joan) starts working in October of 2011. At
which time she purchases special equipment at a cost of $4,800, whatever that
is, OK? So, she pays $1,200 down and a balance of $3,600 plus interest of
$540 is to be paid in 36 installments. Oh, my gosh, three years of a payment
and $115 a month beginning in November 2011.
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So here’s what they do, all right, go back to the steps again. All right, we’re
going to take the down payment. That’s $1,200. And we’re going to add that
to the total amount of monthly installment payments which is, remember,
$115 times 36, all right, that’s $1,265. So what that means is (Joan) is going
to pay $2,465 total for this adaptive equipment, special equipment, whatever it
is she’s bought, OK?
Now, Social Security is going to divide the first year cost of $2,465 by 12, all
right. So that’s $205.42. They’re going to deduct this amount for the first 12
months of employment, October 2011 through September 2012. After
September of 2012, Social Security is going to revert to the regular monthly
payment of $115.
So, the down payment – go back to step one, the down payment is added to 11
monthly installments, not all 36, just 11, because it’s only that first year, just
12 months, the month of the down payment and then 11 monthly installment
payments, OK, and that is going to give you higher IRWE deduction for that
first year. I hope everybody gets that.
Once the down payment has been extended, has been deducted, then they
move back to the IRWE being at the regular $115 level. It really isn’t rocket
science but you are going to have to probably open the slides, get your
calculator, and really kind of map it out. So, hopefully that helps a little bit.
All right. Slide 17, what do we do about leases or rentals? Well, it’s pretty
simple. I love rentals or leases because it’s typically a set amount. It’s a
recurring expense every single month for some period of time and it’s the
actual monthly charge, OK.
Now, sometimes, like if you’re paying a rental fee every week instead of
every month, Social Security’s going to have to convert that because, you
know if you're just looking at weekly, it’s going to make a mess. So they’re
going to have to divide the total amount by the number of weeks and come up
with a monthly amount to make it – to make it fair.
Now, as with all other costs, rental or lease payments are subject to the
reasonable limits position. So an amount that doesn’t exceed whatever the
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usual, customary, standard, normal, whatever charge is going to be considered
reasonable. Hopefully, your beneficiary is not being gouged, OK. And if so,
hopefully, Social Security would catch that and perhaps you could renegotiate.
But rentals or leases are easy, easy, easy. OK.
Now, what does Social Security do when there is an IRWE, and we’re on slide
18, that is purchased before work began? Now remember, couple of slides
back we talked about the difference between the way they handle services and
the way they handle items.
And this issue comes right back up here because, through this IRWEs, it really
has to occur within a month in which work was performed and – or paid for in
the case of SSI. But an item – a big ticket item, a durable item can be
purchased in advance.
So, durable items are things that can be used repeatedly. These include, but
are not limited to, medical devices like wheel chairs, braces, prosthesis, work
related equipment like typing aid, electronic visual aids, residential
modifications, non-medical appliances, service animals, well I’ve never really
thought about that as being a durable item but I guess it is, and vehicle
modifications, so things, OK, that can be reused repeatedly.
So, the expense has to be either a monthly or recurring payment or a one-time,
non-recurring payment or down payment, but it may not be made for rented or
leased item and it must be made some time in the 11 months preceding the
month in which work begins, and a person must be disabled and receiving
disability benefits when the payment is made, all right.
Payments made prior to the established onset date, you guys should all know
what that is, it shows on the (BBQR), are not deductible, OK. So it has to be
an expense that occurred after onset, so – but it doesn’t – it can occur during
the five-month waiting period. I guess I should have made that point.
So, it doesn’t have to be a month in which a check is received, but it has to be
a month in which the individual is considered to be disabled. So that would
be month of onset and beyond. And you’ll see the onset that date on the
(BBQR) so that’s a verifiable thing.
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All right, slide 19. So, how do we decide to how much is deducted for a nonrecurring expense? Well, when an item is paid for like one time during the 11
months preceding the month that work started, social Security is going to
allocate the payment over a 12-month beginning with the month of payment.
Now, they’re only going to deduct that part of the payment which is
apportioned to the month that work began and following months. And I know
that reads like, “Great, hang in there.” I’m going to show you an example.
The total deductible account may be deducted in one month, if the individual
chooses, or allocated over a 12-consecutive month period, whichever one the
beneficiary selects. And again, this is a counseling issue for us because we
should be helping with that.
All right. So let’s figure out how this works. When an item is paid for in
installments, we’re on slide 20, determine the total amount of the installment
payment including the down payment made for the particular item during the
11 months preceding the month that work began. This total amount is
considered paid in the month of the first payment for that item within this 11month period.
Now, Social Security is going to allocate the total of these payments –
installment and down payment if any over a 12-month period beginning with
the month of the first payment, but never earlier than 11 months before the
work that month began.
And they’re only going to deduct that part of the total which is a portion to the
month that work begins and the following months. Now, you can deduct it in
one month or allocate over 12-month. We’ve kind of beat that with a stick,
whichever is chosen.
And here’s an example. It’s all in the examples because when you read these
rules, you (inaudible) pass out and I did the same thing. You read them and
it’s like, “What?” You have to look at the examples. So save the slides.
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And these examples are also in the POMS, so if you’re more comfortable with
using the POMS, that’s fine too. All right, let’s look at (Jim), slide 21. He
purchases an item in June of ’12, four months before his job begins in
October.
He begins monthly payments of $240 at that time. He will have paid a total of
$960 preceding the month work started. This amount is considered paid in the
first month of payment, the fourth month before the month work begins, so
the total deductible amount is $640.
All right, so what are they going to do? They’re going to take the $960,
they’re going to divide it by 12 and they’re going to multiple it by eight
months of work, all right, 10 of 12 through May of ’13, right? That’s the
month before – you know, it’s 12-month period but you’re not going to get
credit for stuff that you paid in advance, OK?
This amount may be deducted at one time or allocated over 12-month
consecutive period whichever (Jim) chooses beginning with the first month of
work for purposes of determining SGA or the first month when a paycheck is
received for the purposes of determining SSI – accountable income.
Remember, they’re different.
The monthly payments of $240 that (Jim) continues to make while working
will also be deductible in accordance with the instructions for recurring
expenses, OK? So some of the stuff that he paid before work begin is going
to be rolled into the IRWE, and beyond that then the installment payments,
just the regular monthly payments will be permitted.
I know it sounds complicated but the first time you have a case like this, go
back and look at your site. Stop, go through the steps, you can figure it out
and if you need help, you know your friendly neighborhood technical
assistance liaison is available.
On next slide 22, let’s look at an example of items purchased before
employment begins, a one-time purchase, these are easier. (Missy) purchased
an item in February of 2012, seven months before her job started in
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September. It is paid with a one-time payment of $300, that’s a very
expensive thing.
The total deductible amount will be $125, that’s 300 divided by 12 multiplied
by five, right? She – within that year, she’s only working for five months –
September, October, November, December, January, OK? So that’s how it
works.
(Jordan), next bullet, purchased an item three months before the work began
and paid for the item with a one-time payment of $600. The deductible
amount will be $450. You take the $600, you divide it by 12 and then you
multiply it by the nine months in that year that Jordan worked, OK? You can
do this. It’s not rocket science but you just have to sit down and really think
about it and you kind of have to map it out.
OK, let’s look at slide 23. If the IRWE payment is made before earned
income received, there is a way around this. So if an SSI recipient starts
working and makes an IRWE payment in one month but does not receive
earned income until the following months, Social Security will deduct or
begin allocating the payment amount in the first month in which earned
income is received, so that’s kind of nice.
So look at the example, a person with a disability begins working on August
24th and make an IRWE on August 31st but don’t receive their first paycheck
until September 7th, Social Security is going to be nice and they’re going to
go ahead and deduct that first payment from earned income that is received in
September, so you don’t lose credit for that which is nice.
So you can even make an IRWE payment after earned income is received and
after work stops. So this is a weird situation. Slide 24, if a person with a
disability who gets SSI makes an IRWE payment in the month after he or she
left work and received earned income and the payment is for an impairmentrelated item or service that was used while working, Social Security can
deduct – should deduct the payment amount from the earned income received
in the last month of work.
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So just because you’ve actually paid for something after your last paycheck,
after you stopped working, that does mean it wouldn't be allowed as a
deduction. Keep your receipts, submit that to Social Security, and based on
the rule, that should be deducted from that last month in which earned income
was received. That’s all good.
So what about an IRWE payment made when earned income received after
work stops, so again, some weird SSI rules. If a person – if an SSI recipient is
no longer working but does receive earned income and makes an IRWE
payment – because that could happen like you could quit and then get a final
paycheck.
The IRWE – Social Security will deduct the payment amount for – from
earned income in the month of non-work only if the income received is for
work activity, not things like a silent partner when you got a silent partner,
and the work activity is performed in a period when the person requires the
impairment-related item or service.
So with Social Security with SSI, you’ve got some issues about, you know,
how they count income and retrospective monthly accounting and things like
that, but definitely, there are some ways that you can have an IRWE that was
paid in the month before work deducted and an IRWE that was actually paid
after work stopped also be deducted. It depends on the circumstance, so don’t
forget that.
All right, (Jessica) has probably passed out from listening to this because it’s
just so boring for the poll operators but I’m showing that it’s about five (till), I
did good, halfway through. Let’s do like 10 minutes or so with questions. So
hopefully, we wouldn't get deluged with questions. So (Jessica), if you would
open the lines for questions that would be wonderful. (Jessica)?
Operator:
At this time, I would like to remind everyone, in order to ask a question,
please press star then the number 1 on your telephone keypad. We’ll pause
for just a moment to compile the Q&A roster.
Your first question comes from (Susana Shawley). Your line is open.
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Lucy Miller:
Hi.
(Susana Shawley): Hi, Lucy. I wanted to ask, can you talk about the difference between service
and items again?
Lucy Miller:
Sure. A service would be something that is not durable, that’s not a thing.
OK, it’s something that someone does for you. So it would be like a doctor’s
appointment, a therapist service, going to the chiropractor. Some people
literally need things like massage therapy. So it’s – you know, it can be a
doctor’s appointment, therapist’s appointment. It’s something someone does
for you, OK?
An item is a thing, OK? It’s an inanimate object. It’s something that you
need like a wheelchair or crutches or a hearing aid or, you know, special
glasses. I mean, you know, it’s a thing. Does that help a little bit?
(Susana Shawley): Yes, ma’am. Thank you.
Lucy Miller:
OK. Next question?
Operator:
Again, if you would like to ask a question, please press star then the number 1
on your telephone keypad.
Your next question comes from (Diane Rodriguez). Your line is open.
Lucy Miller:
Hi, (Diane).
(Diane Rodriguez):
Lucy Miller:
Hi, Lucy. (Inaudible).
I have.
(Diane Rodriguez): Wonderful. I have a client and she’s – she’s adorable. She has a van. It’s
already been purchased but she has hand controls. Something happened to the
hand controls, we’re now raising money to have the hand controls. With that,
it’s going to take $2,000 (inaudible) going to – we’re raising money
throughout the community.
Lucy Miller:
OK.
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(Diane Rodriguez):
Lucy Miller:
Her and her husband are putting $500 as part of their contribution…
OK.
(Diane Rodriguez): … for this, but this is only to see what is happening with hand controls.
Its clock…
Lucy Miller:
It’s diagnostic.
(Diane Rodriguez):
Lucy Miller:
Diagnostic, right, it’s expensive.
(Diane Rodriguez):
Lucy Miller:
Right.
And pay a mechanic to diagnose the problem and then hopefully fix the
problem.
(Diane Rodriguez):
Lucy Miller:
Yes.
She would have to take it to a shop, right?
(Diane Rodriguez):
Lucy Miller:
Yes.
But can she use all that?
Well…
(CROSSTALK)
(Diane Rodriguez):
Lucy Miller:
That – there is a question and I’ll tell you why, we’re going to look at
transportation really closely in the second half.
(Diane Rodriguez):
Lucy Miller:
… on the hand controls.
OK.
What Social Security – I’m – but I’m going to try to answer it now. Social
Security, when you have an adapted vehicle like she has and you have a job,
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Social Security allows you to actually deduct the cost of mileage, the federal
mileage rate to and from your job each day.
That mileage rate is high because it not only is supposed to cover the cost of
gas. It is supposed to cover the cost of repairs to your vehicle. So that’s
where the quandary would come in. Is she already working?
(Diane Rodriguez): She had work lined up but she can't get to it because she has no
transportation.
Lucy Miller:
Then I think you submit the request to have the $500 at least that she is paying
out of her pocket approved as an IRWE and it would be a non-recurring
expense which was incurred in the month before she actually went to work.
And I would be interested to see what the claims rep would do. I think you
could sell it. I think that needs a criterion.
(Diane Rodriguez):
Lucy Miller:
OK, thank you.
Try it.
(Diane Rodriguez):
I will, I will.
Lucy Miller:
Next question?
Operator:
Your next question comes from (Shanna Savilan). Your line is open.
Lucy Miller:
Well, hi, (Shanna).
(Shanna Savilan): Hi, Lucy. I was just wondering if – I work with mental health.
Lucy Miller:
OK.
(Shanna Savilan): And I was wondering if their services here at the treatment center and
prescriptions like shots are covered.
Lucy Miller:
You bet, it is.
(Shanna Savilan): OK.
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Lucy Miller:
That’s a very common IRWE now. But remember, it has to be something that
the beneficiary pays out of pocket.
(Shanna Savilan): Out of pocket.
Lucy Miller:
So not that you’re billing the Medicare or Medicaid.
(Shanna Savilan): OK.
Lucy Miller:
It’s their share.
(Shanna Savilan): And then you, guys, are copays?
Lucy Miller:
Yes, yes.
(Shanna Savilan): OK.
Lucy Miller:
Copays and prescription copays, absolutely.
(Shanna Savilan): What about copays for the doctor visits?
Lucy Miller:
Yes, psychiatrist, absolutely.
(Shanna Savilan): OK.
Lucy Miller:
Absolutely, definitely necessary. Whether the person work or not, but
certainly without that service, a person with a severe and chronic mental
illness would certainly not be successful on employment.
(Shanna Savilan): OK.
Lucy Miller:
So, yes, that would be approved.
(Shanna Savilan): Thank you.
Operator:
Your next question comes from (Susana Shawley) and (Lisa Lee). Your line
is open.
Lucy Miller:
They’re doubling up on me.
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(Susana Shawley): Well, I’ll go. And my question was in regards to how do you make a
prescription drug correlate with the – with the disability that’s on file because
I’ve been told – so I think it’s missed maybe by the claims person. I had a
person that had obesity and then they were taking medications for diabetes
and high blood pressure and they – and the IRWE was not approved because I
don’t know – they said it didn’t have anything to do with obesity and then I’m
like, if it does?
Lucy Miller:
Well, really, the rules have definitely relaxed. So you may have encountered
a claims rep that isn’t quite current. And the rules, if you read the slides and if
you read the POMS, it’s very clear. It’s simply needs to be an item or service
that the person needs because of a medical condition that is being treated by a
physician.
So things like, you know, high blood pressure, a cholesterol drug, things like
that are definitely related to obesity which is a medical condition, you would
need to get a statement from the doctor that this person sees and…
(Susana Shawley): (Inaudible) if I had a lot of 795 form so you’re saying after that then a doctor
would have to make a statement.
Lucy Miller:
Doctor statement, yes, the doctor statement. Actually, Social Security has a
special form that they are supposed to mail to the medical professional or give
to the beneficiary to give to the professional. But a simple statement in
writing from the medical professional should suffice. And if it’s denied, try
again. If it’s denied again, you need to appeal the determination, that’s a
wrongful denial.
(Susana Shawley): OK, appeal the determination…
Lucy Miller:
Yes. Anything that affects the payment amount like SSI or that would affect
an SGA determination is an appealable decision. So when a claims rep denies
a request for an IRWE, that is an appealable determination subject to all of the
appeal rights that Social Security affords anyone. So there has to be a
reconsideration, if it didn’t pass, it has to go before (inaudible), OK? There is
due process.
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(Susana Shawley): OK. And then you mentioned something – I don’t remember the whole
wording but you said like reasonable – the cost has to be reasonable. Well, I
have someone that their payments are like $4,000 for their medication. Is that
like non-reasonable? Would they be like, “No, we can't give that for that”?
Lucy Miller:
Well remember, reasonable doesn’t mean cheap. Reasonable means,-- it
doesn’t mean cheap. It means usual and customary – usual and customary.
So if that is the price of the drug that is charged to all customers in your
community, it is reasonable.
(Susana Shawley): OK.
Lucy Miller:
It’s expensive but it’s reasonable, meaning it’s normal, it’s customary, it’s the
usual price, OK?
(Susana Shawley): All right, thank you.
Operator:
Your next question comes from (David Mons). Your line is open.
Lucy Miller:
Hi, (David).
(David Mons):
Hi, Lucy. I probably asked you this question before but (inaudible).
Medicare Part B Premium as a recurring monthly expense?
Lucy Miller:
No.
(David Mons):
If it’s not reimbursed by any other source and the consumer, you know, in
order to purchase the medical services related to disability and needed in order
to work.
Lucy Miller:
Yes, you’ve told me, I’m on your side on this one. Unfortunately, that’s not
the side that Social Security is on. Medicate Part – Medicare Premiums are
specifically stated, as a matter of fact, all insurance premiums are specifically
stated as not allowable as IRWEs.
(David Mons):
OK, all medical premiums?
Lucy Miller:
All premiums, yes, insurance premiums.
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(David Mons):
OK.
Lucy Miller:
Yes, sorry.
(David Mons):
Thank you.
Lucy Miller:
Next question?
Operator:
Your next question comes from (Douglas Mattie). Your line is open.
(Douglas Mattie): Yes, hi, Lucy. My question relates to herbal supplements and my
understanding is they do – herbal supplements do have to be prescribed by a
physician in relate to the individual disability in order to be approved as an
IRWE.
Lucy Miller:
Yes. Again, this would tie back to correlating the expense with a medical
condition that the individual is receiving treatment for. So I would just be
prepared to provide a statement to Social Security from the doctor indicating
what the herbal supplements…
(Douglas Mattie): Go ahead.
Lucy Miller:
I think that herbal supplements are for – and that – that they’re necessary for
whatever condition. Now, having said that, everyone is going to laugh but
I’m going to tell you this, the POMS clearly states that you may not be
reimbursed as an IRWE for any item or service which is illegal by federal law.
So medical marijuana is not an IRWE, (some said that) herbal supplement,
just made me think of that, (Douglas), so, you know, if you’ve got somebody
with the medical marijuana, that’s fine, but they will not allow that as an
IRWE because it is not in accordance with federal law.
(Douglas Mattie): Great, thank you.
Lucy Miller:
You’re welcome. Next question?
Operator:
Your next question comes from (Richard Friskin). Your line is open.
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Lucy Miller:
I knew you’d ask me a question, (Richard).
(Richard Friskin): Hello, Lucy. How are you doing?
Lucy Miller:
Good.
(Richard Friskin): I just kind of – well, I have this situation, a person with a mental disability
who also has high blood pressure.
Lucy Miller:
Yes.
(Richard Friskin): And takes high blood pressure medication as just a matter, of course, to keep
his blood pressure under control but his real disability for SSDI purposes is
mental illness. Now, can he deduct the cost of the blood pressure medication
as well?
Lucy Miller:
Well, let’s talk about that. What would happen to him if he stopped taking his
blood pressure medicine?
(Richard Friskin): Well, if he stops taking his blood pressure medicine, in time, he would
probably not be able to work.
Lucy Miller:
My husband – yes.
(Richard Friskin): But in the current run, it’s probably not going to make any difference.
Lucy Miller:
Well, my husband has high blood pressure and if he doesn’t take his medicine
within several days, he is unable to function. So what you have to do on a
case like this, this is related to a medical condition.
It would – may not be in the medical record that Social Security has, it may
not be part of the medical determination that DDS performed, but it is still a
medical condition. So you would need – you know, be prepared to get a
statement from the treating physician saying, you know, this is medication
that I prescribed for this individual to be able to function, you know, day-today including work. If this individual did not take high blood pressure
medicine, they would not be able to work long term.
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So, you know, be prepared for a claims rep to say, you know, because again,
the broadening of correlating with the medical condition, that is fairly new
and so you’re going to encounter claims rep who aren’t current and you just
have to push back politely and say, “Well, well, wait, wait, the POMS does
says this,” and then you’ll have to be prepared to document then need for that
medication and the fact that it is a condition that is being treated by a
physician, high blood pressure.
(Richard Friskin): OK. You know…
Lucy Miller:
It’s a serious condition.
(Richard Friskin): Yes, yes. OK, thanks.
Lucy Miller:
Anyone else?
Operator:
There are no further questions at this time.
Lucy Miller:
Awesome. OK, well, let’s jump back in and what we’re going to do now is
look at some very specific situations where – certainly where those of us who
do technical support, e get lots and lots of questions and it shows you how
Social Security interprets the IRWE rules in very specific instances.
So if you’re on slide 26, you’ll see five areas that I specifically picked out.
Now, I want to warn you that there are lots of other areas that I could have
included here, we just didn’t have the time, so I just left them out. They were
– I tried to choose things that are common that we see, not things that are
really obscure.
So here’s what we’re going to look at. We’re going to look at routine drugs
and medical services which is really the question that (Richard) just asked
about, well this is the drug I take anyway, we’ll look at that.
Transportation, already got a question about that. Attendant care and there are
some rules in the attendant care section that you, guys, are not going to like.
We’re going to look at residential modifications and then we’re going to look
at service animals.
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So just to remind you, you know, these five areas are not the only areas that
have very specific rules spelled out in the POMS. So all right, let’s take a
look. Routine drugs and medical services, now, payments for routine drugs,
over-the-counter drugs and routine medical services are deductible only if
such drugs and services are prescribed and they’re necessary for the control of
the disabling condition and it enables the person with the disability to work,
OK?
So (Richard)’s example of someone who is taking high blood pressure
medicine, certainly, we can make a case that will certainly they are prescribed,
OK? You don’t just go buy that over the counter. Certainly, it is necessary to
control with disabling condition or medical condition. Without that
medication, there could be some very severe circumstances that occur.
And, you know, again, this would occur under the treatment of a medical
professional, so it really seems to fit. It’s OK that you’re taking these drugs
anyway. You can get these drugs approved as IRWE but only whatever piece
you are paying for out of your own pockets, right? That’s very important
point.
Now, routine refers to the regularly prescribed type of medical treatment or
therapy followed for the impairment, so that could be controlled, refers to
reducing or eliminating symptoms or slowing down progression of the
disease.
So examples would include anticonvulsant drugs, blood level monitoring,
radiation treatment, antidepressant medications, corrective surgery, anything
like that, so things that you get on a regular basis but which are necessary for
you to stay healthy and be able to work.
So again, be prepared for a claims rep maybe to not be as current and to say,
I’m sorry, if the drug isn’t directly related to the original disability that you
have on DDS (future) determination, we’re going to say, no, you’re going to
have to appeal that determination and go get some verification from the
physician.
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All right, on the next slide 28, payments for drugs or medical services for
minor physical or mental problems not resulting in any significant loss of
function are not deductible. So some examples would be the yearly routine
physical exam which I just went in for my annual wellness exam today, a
wellness exam like that, that’s not going to be allowable.
I take over-the-counter allergy medicine. Unless that is a part of my
disability, a real medical condition that causes me significant problems,
they’re not going to allow my little bottle of Allegra, OK? I also take (Alesse)
because I run all the time and I’m an old lady so I get sore, OK? That’s not
something that Social Security would let me deduct.
Now, if I had arthritis, I had arthritis and (Alesse) was part of the medical
treatment that my doctor was suggesting for me or prescribing, I could
probably deduct that, OK? But a healthy lady who just overdoes it like I do in
the garden or running, they’re not going to allow that.
All right, things like basic glasses, I wear glasses too, I probably buy a pair of
readers every week because I lose them, guess what, that’s not going to be
counted as an IRWE, all right?
And there on slide 28 for (Douglas), I guess – I think it was (Douglas), the
cost of premiums for health and/or life insurance is specifically named in the
POMS is not allowable.
Prescription drugs that are a violation of federal law cannot be deducted as an
IRWE even if allowed by state law and certainly nothing that is illegal, no
medicine or item or service that is illegal by federal law would be allowed.
You know, I have to tell a story because this is very unusual. I had someone
called me about a beneficiary whose out of pocket expenses for prescription
painkillers was thousands of dollars a month.
This person was not receiving those drugs properly, OK? This person
probably had – well, definitely had an addiction problem, all right? Guess
what, that’s not an IRWE, all right? Even though this individual was still
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working, he has this expense, the expense was so suspicious, I mean it was
bizarre.
So you need to be careful about the kinds of things that people want to pass
off as IRWE. Sometimes these things are – they’re not just going to be
allowed, OK, very odd things. All right, so that’s routine drugs.
All right, next, transportation, this is probably something where there are so
many misunderstandings about what is and is not deductible. I read
(PS&NA)s where people say, “Oh, well, all your transportation costs are
deductible as an IRWE.”
No, no, no. There are very specific rules and if the transportation cost is not
related to your disability, it’s not going to be deductible. I have transportation
cost. You know, all of us do. But, you know, to be an IRWE, it has to be
specifically meeting certain rules.
So on slide 29 here, a beneficiary may have deductible transportation cost if
his or her impairments require structural or operational modification to a
vehicle in order to drive (inaudible) to work.
The modification must be critical to the operation or use of the vehicle and
must be directly related to the person’s impairment. The cost of the
modification but not the cost of the vehicle may be deducted as an IRWE.
Now, the maintenance and repair cost for the impairment-related modification
may also be deducted as an IRWE but not the cost for maintenance and repair
of the automobile or van. Now, this is why I indicated to the earlier question
poster that I think getting the repairs to the vehicle will probably be OK.
A mileage allowance for the trip to and from work is also deductible. That is
only for modified vehicles. So, you know, be very careful that you’re not
promising every single person that their transportation cost will be allowed as
an IRWE.
If you’re driving a vehicle that has been modified to accommodate your
disability, that’s a no-brainer and you can claim mileage. Now, they use the
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federal mileage rates and you can Google that and find it online but it’s also
posted in the POMS.
All right, nest slide. Determining transportation cost since I’ve just kind of
went ahead here, the Social Security uses the IRS standard, OK, you can find
those items provided to POMS here for you. That was handy of me. And you
need to look at the type of car that the person is driving because there are
different mileage rates allowed for different types of cars.
And now, Social Security is going to determine the daily mileage to and from
work and then they’re going to multiply that by the appropriate mileage rate to
obtain the daily mileage cost and then they will multiply that by the numbers
of days that you work in a month.
So beneficiary really should keep a log, which days did you work so that you
have an accurate counting of which days you actually drove to and from your
job site.
All right, slide 31, what do you do if you have a non-modified vehicle? Well,
if a beneficiary’s impairment prevents him or her from taking available public
transportation and he or she must drive a regular car to and from work then it
would be allowed as an IRWE and you would use the mileage allowance.
Now, let me give you an example that I read about that might be the situation.
Let’s say that you have someone with a very, very severe anxiety disorder and
that anxiety disorder manifests itself around other people or, you know,
around like taking public transportation, getting on a bus.
It might be very likely that a person would be totally unable to take public
transportation because of a disability and it might be for a variety of reasons
and therefore they really have to drive themselves.
You could certainly request an IRWE for the mileage in that case. Be
prepared to have the kind of fight for it because this is a rather obscure
citation and you probably have to print this off in a (POD) original
determination which probably would be a denial and you’d have to be
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prepared to prove that the disability that an individual has prohibits him from
taking public transportation.
Now, if public transportation is not available, that’s not the problem, all right?
It’s not like you live in the country, OK? It’s – you can't take public
transportation that otherwise is available, all right?
Now, no separate amount can be deducted for maintenance and repair of the
automobile or van because those costs are rolled – so those costs are rolled
into the mileage cost. And a physician, a VR counselor or somebody else who
would be qualified would have to verify that the person is unable to use
available public transportation. I personally have never been involved in a
case like this so I don’t have any personal experience with what would
happen.
The POMS is clear, I mean the slide comes right out of POMS but I can see
that you might have to really cite for this one because my guess is that a
claims rep would turn it down. So it’d be interesting to hear from anyone that
has had this work.
All right, so on page 32 or slide 32, some examples of unmodified vehicle cost
is an IRWE. So let’s say a person uses the wheelchair and public
transportation is not equipped for luxury use and the person I guess would not
have a modified vehicle.
The person cannot manage getting on and off public transportation, say that
there was a physical impairment perhaps that prohibited travel from home to
the bus stop, the person uses a service animal that’s not permitted non-public
transit, that would be very unusual, or the person is not mobility trained to use
public transportation or the nature of the impairment precludes travel on
public transportation like person with a respiratory illness requires air-treated
environment or something like that.
Or let’s say the person could not negotiate public transportation due to the
nature of the impairment. Those are some examples. And again, these come
right out of the POMS. I didn’t make these up.
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So these are examples that are cited in the POMS so if you have a beneficiary
with one of these situations and they are driving themselves to and from work,
I’d say, give it a try. You could certainly provide documentation from the
POMS.
Remember, you’d have to get some professional doctor, VR counselor or
qualified mental retardation professional or somebody to say, you know, this
is a true therapist, somebody like that, to say, this person cannot use public
transportation and here is why.
All right, page 33 or slide 33, other transportation situation. If the individual’s
disability prevents them from being able to take up available public
transportation and they have to use driver’s assistance, taxis, other (height)
vehicles then these amounts that are paid to the driver should be deducted as
an IRWE. Again, the person has to pay them out of pocket. It can't be
reimbursed and expense has to be reasonable.
If the person’s own vehicle is used in this process, Social Security will also
deduct a mileage allowance. And the inability to use available public
transportation, the need for driver’s assistance or the use of taxi cab has to be
verified by some professional, an appropriate professional, a doctor, VR
counselor, medical provider, therapist, somebody with some credential, OK?
So it’s a little bit broader than a lot of people think but it certainly isn’t every
type of transportation is allowed as a deduction.
How does Social Security evaluate a transportation situation? That’s slide 34.
Evaluation of the transportation cost really is based on two things – the
availability of public transportation in the person’s community and the
person’s capacity to drive a vehicle to work. And here are several examples.
Let’s say that the beneficiary you’re working with works until 9:00 until 3:00,
a public bus runs until 11 and then stops until 5 a.m. the next morning.
Although the person could take the bus to work, he wouldn’t be able to take
the bus home.
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And I’ve actually had people in this situation who work nighttime jobs. I had
some people that did shelf-stocking at military commissaries and they always
work at night and they always got out at like 3 or 4 in the morning. There was
absolutely no way to get those folks home using the bus. There was no bus,
OK?
So public transportation is not available, if the individuals are not capable of
learning to drive, you’re going to have to figure something out like a cab or
paying someone else to drive them home and that would be an IRWE.
Example two, let’s say that person was in a neighborhood where there is bus
service but the place of work is not within walking distance of a bus stop.
That happens a lot. If you’ve got someone with a physical disability and there
is a long walk either from the home to the bus stop where you catch the bus to
go to work or long walk where the bus stop would let you off, you know, the
idea is not to incapacitate people by causing them to have to do these several
walks if they’re incapable of doing.
It’s you have to present that to Social Security and say, this is just impossible
for this person. And in that case, the person can either pay a cab or take
(fared) transit, something like that and that would be allowable as an IRWE.
On 35, if public transportation is not available and the beneficiary is unable to
drive a vehicle to work due to the nature of the impairment and not simply,
because he or she is not licensed, OK, but not just that you don’t have a
license, you aren’t able to get a license or unable to drive.
The following travel expenses may be deducted. Certainly the cost of a trip to
and from work by taxi cab and I personally have gotten that done many times
or the cost of paying another person to drive the person with the disability to
and from work, and in most cases, that for me has been either a coworker with
jobs arranged on numerous occasions or in some cases, if a family and boy,
there are some really weird rules around that, it wasn’t that a good segue
because look at slide 36.
Now, you’re not going to like these rules. And these rules are new. Until
several months ago, there were some allusions in the POMS to transportation
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provided by a family member and how that was probably not going to be
allowed as an IRWE except under very, very specific circumstances.
But they actually revised the POMS recently and I don’t think I have that date
with me but fairly recently within the last year or so, to make the rules about
providing transportation exactly like the rules for providing attendant care.
And so they really have tightened this up and this is not a happy change for us
but it simply is what it is.
So if the transportation is provided by a family member, first of all, who is –
what is the family member? For the purpose of this provision, a family
member is anyone who is related to the person with a disability by blood,
marriage or adoption whether or not that person lives with the beneficiary,
OK? So blood relative, adoptive relative, married, OK, any of those, you’re
considered a family member.
Payment, if a person with a disability pays a family member to provide
transportation, such payment will generally not be deductible as an IRWE
unless, and get ready, you’re not going to like this, it is established that the
family member has been otherwise employed and suffers an economic loss by
reducing the number of work hours or terminating employment in order to
perform such service and – and, which means both things have to occur – the
payment is made to the family member in cash. Payment in kind is not
deductible.
Well, so if you have a mom driving a severely disabled son or daughter, that’s
not going to count. Unless you can prove to Social Security that mom literally
had to give up a job – sorry, I’m coughing a little bit, I’m going to go drink a
water. Sorry about that. Allergies, my goodness, (inaudible) is worse.
So now, you have to prove that the family member has suffered an economic
loss by now providing this transportation service and the circumstances under
which you’re going to be able to do that are pretty limited.
So this makes it very difficult to claim transportation provided by a family
member as an IRWE and I’m sorry about this because it is a very common
situation and I’m still thinking some circumstance is quite valid, but this is the
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current rule and it’s very clearly stated in the POMS now. It’s an
(unequivocal).
All right, so the documentation, the transportation services to and from work
have been rendered and the payment in cash has been provided, that would
have to produce to prove that the transportation provided by a family member
was an IRWE.
Evidence of – that the payment was made, meaning canceled checks, OK, and
information which establishes prior ongoing employment of the family
member before the issue of transportation became relevant and the statement
that establishes how the family member suffers an economic loss by doing this
transportation.
This isn’t going to be easy. It’s going to be very rare that now, you’re going
to be able to get a transportation IRWE-approved when the transportation is
provided by a family member. And then I’m sorry about that, I really wish
Social Security hadn’t gone down this particular path but for now, these are
the regulations.
All right, similarly, this is a great segue, onto slide 38, we’re going to go into
attendant care. The rules that apply to attendant care provided by a family
member are the same. So we’ll get there.
But first of all, what is attendant care? That’s those forms of assistance which
helps a person with the disability meets his or her essential needs at home or
at work so that would be things like bathing, clothing, dressing, cooking,
eating, things like that.
And attendant care services can include services provided to help a person
with the disability perform the functions of a job such as like a reader, if
you’re blind, or a job coach, and its definition – the definition is applicable
only to those services which can be shown to be needed to enable the person
with the disability to work, but that would be sort of considered attendant care
at the job site. So that’s the definition.
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Payments made for attendant care services are deductible as an IRWE if the
services are needed in the work setting or in assisting the person in traveling
to and from the work, and those are fairly easy to document for Social
Security.
Payments of attendant care at work or to and from work are deductible when
the cost is paid by the person and not provided by the employer or reimbursed
by any other source. So you shouldn’t have too much trouble claiming this
sort of stuff as long as it wasn’t provided by a family member.
Then attendant care at home, and I have successfully accommodated this or
gotten this approved. So payments paid for attendant care services that are
rendered in the home are deductible only when the services relate to the
person getting ready to go to work or to assistance that’s required after the
workday and the way it kind of reads is to help the beneficiary acclimate
themselves back to the home environment.
And generally, no more than two hours in the morning and/or evening will be
approved but they do have a special provision that says, if you can prove that
more than two hours is needed in the morning or in the afternoon that you can
certainly describe that and document it and it’s possible to have more than two
hours approved.
Some examples of this type of attendant care would be, let’s say that you pay
an attendant to come in and kind of get you up in the morning, help you bathe,
help you get dressed, get you a breakfast, get you on the door to door van
service.
That time, if you’re paying for that service out of pocket, as long as what the
person is doing is getting you ready to go to work then the cost of that is
definitely allowable as an IRWE and I have gotten this allowed on more than
one occasion. So this is not that obscure, OK?
You can also again add some time at the end of the day to get the person – you
know, an attendant has to be at the home maybe to help a person with a
developmental disability, get off the van, back in the house, get the afternoon
snack, you know, get things going again, and you need to be careful about
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how much time you’re actually requesting on that other end, and be prepared
to justify it. But this is allowable and it’s not the obscure, so don’t be afraid to
request this.
Now, again, you’ve got the issue of attendant care by a family member and
that’s the next slide, same exact rules of transportation, OK? So a family
member, same definition, anyone related to a person with the disability by
blood, marriage or adoption, it has nothing to do with whether the person lives
with the beneficiary or not and it’s all about you have to pay for the service, it
has to be paid right out of your own pocket in cash, not in kind, you have to be
able to document that you actually paid the money to the individual and the
family member has to document that he was otherwise employed and suffers
an economic loss by reducing the number of hours of work, you know, on and
on and on.
So the likelihood that you can prove this is some high, I mean it really kind of
decreases the ability to claim attendant care provided by a family member as
an IRWE. It’s just these are the rules for right now, so I know they’re not the
most advantageous, but there’s something to be aware of.
All right, documentation, this is the same thing, slide 42.
You have to provide documentation that that actual money was paid, OK.
You have to put like a canceled check or something like that. Not a bill, it has
to be proof.
Information have to be provided that establishes the prior ongoing
employment of the family member before the attended care issue was raised,
and there has to be a statement that establishes how the family member
suffered an economic loss by providing the attendant care. This is a real pain,
but it is the rule for now.
All right. Let’s go on to happier subjects. How about residential
modifications?
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These are really – this is really interesting. You can get the cost of residential
modifications approved as an IRWE. There are some different rules that
apply to people who weren’t outside the home as opposed to inside.
Basically, if you work outside of your home, you work away from home,
which is what most of us do, and you need to make changes to the outside of
your residence, residence that allows you to get to your means of
transportation or getting from the means of transportation, you know, to the
door, whatever, you can take those costs and you can claim them as IRWEs.
That can be things like you have to install a ramp, you have to have exterior
railings or pathways, things like that.
So you have to document the social security, you know, why you needed
those things. But I think it wouldn’t be too difficult.
Changes that modify the interior architecture are not going to be allowed, OK.
It’s really about things that you had to do to the exterior of your home to
enable you to actually get out and get to a job. So it’s something to be aware
of.
All right. Now what if you work at home? Well, you may need to make some
modifications to the interior of your home in order to create a working space,
but really it’s very limited. Social security is only going to allow things that
you did to accommodate that – or modifications specifically to your
workspace. So maybe you created a home office, you had to enlarge a
doorway so that you could get in there.
Maybe it was a room you didn’t use before. Maybe you had to – I don’t know
– purchase a special desk or a special chair or things like that. You can claim
that. But it’s not going to allow you to claim changes to your bathroom, your
kitchen, anything like that. It really is going to be very much focused on what
did you need to do to create a home office that is – that accommodates your
disability. And you’re going to have to be willing and able to document that
and make a case.
Now it’s interesting if you could also deduct these if you’re self-employed.
These might be business expenses. So any such cost deducted as business
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expenses are not also allowed to be deductible as IRWE. But, you know, that
makes total sense because if you’re deducting it as a business expense, it’s
reducing your net earnings from self-employment anyway and they’re not
going to allow you to double, you know, up that deduction. You can’t take it
twice. You can take it once.
There’s also some interesting rules. These are fairly new that have been put
into the system that govern tele-work modification. So what this is saying is
that an employer can set-up special tele-work programs to accommodate the
needs of employees with disabilities who really do need to work from home,
and this allows the cost and maintenance of equipment necessary for telework to be deducted as an IRWE.
The most common situation in which this occurs is when beneficiaries go to
work for probably the largest tele-work company in the country, and that’s
NTI, I think, is what it’s called. And it allows you to take things like highspeed Internet, a second phone line, computer maintenance which, to me, this
is really quite generous because although these are certainly things that would
be necessary to work to be a telecommuter, I incur these expenses as well. If
it is specifically set-up for companies that hire people with disabilities and
accommodate them, then this can be claimed.
So if you have any questions about that, contact your tech liaison because we
do have letters even from Social Security National Headquarters that describe
this particular way to exclude certain equipment and cost for tele-workers and
telecommuters.
All right. Service animal, slide 46.
Expenses that are paid by a person in – to own a guide dog or other service
animal are deductible as an IRWE if the animal enables the person to
overcome functional limitations in order to work, and the expenses would be
pretty broad, you know, animal, the training, the food, the licenses, vet items,
things like that. You’d need to submit a lot of documentation. You need to
justify why the animal is necessary to overcome functional limitations in order
to work.
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And if it were me, I would probably also want a statement from a
professional. If you’re maybe a blind individual who is using the service
animal, you might want your blind vocational rehabilitation counselor, blind
services counselor to add some power to that.
Expect if you’re not blind to get a denial and you may have to appeal and
really make a case as to why this service animal is necessary because of the
disability you have and the type of work you’re doing. And try to be specific
about how the service animal helps you overcome functional limitations that
you would otherwise encounter at work.
And I think for a person who is blind, that is a type of situation that the claims
reps would be very accustomed to. It’s non-blind disabilities with service
animals that you might encounter a little resistance. And I think if you
document your case that the likelihood of that is not as great.
OK. So how do we document IRWEs? This slide 47, this is really important,
and this is really practical information. And I hope if you kind of lolled off a
little bit because of all those technical stuff, kind of wake back up, pay
attention because this is the step that really is our job day-to-day.
When you have a Title II beneficiary, ideally, the good thing to do would be
to probe for the use of IRWEs, the potential of IRWEs immediately upon
employment and to provide some documentation to social security that
IRWEs are at play or potentially at play right away. How do you do that?
You do that by using the SSA-820 or 821, the Work Activity Report.
That report is designed specifically to dredge up any indication that subsidy or
IRWE would be at play. And if you’re not helping beneficiaries, complete the
820s and the 821s, you’re going to create a lot of trouble for yourself because
they often don’t understand what the questions that are being posed on that
form are getting at and they try to rush to the form and they sort of don’t pay
attention or don’t actually answer the questions accurately. It’s really
important that you use the 821 to show Social Security immediately that a
potential IRWE is at play, OK.
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06-12-13/1:00 p.m. EST
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You can certainly, when you’re ready to document them after the trial work
period because remember you can’t use IRWEs to reduce countable income
during the trial work period. It doesn’t work for that. I mean, they don’t care.
It’s only after the TWP when Social Security is looking to see if SGA is an
evidence that they want to really probe for those IRWEs. But you need to
document them on the 820 and 821 immediately so it doesn’t just look like,
“Oh, I’ve gotten to the end of the TWP. I’m going to pull IRWEs out of my
hat.”
Now, those IRWEs have been at play since the beginning, you need to
document them and make sure the beneficiary is keeping, keeping, keeping
the receipts. Any – you know, they don’t think about that until later, and then
it’s like, “Oh, no, I don’t have the receipts.” From the very beginning, that is
what is preferable.
If you can catch the beneficiary right when work begins, saving those receipts,
sending the documentation in on the 821. At the end of the trial work period,
when the SGA determination is being made, filling out a 795, the SSA-795,
attaching the documentation and getting it into Social Security so those
IRWEs can be looked at when an SGA determination is being made.
Now remember you can’t use IRWEs to reduce income in the TWP, but you
still want to retain all that documentation to prove that Social Security at these
costs have been incurred. They’re going to evaluate the IRWEs during the
SGA determination. Any allowable expenses that meet all the requirements
we’ve talked two hours about will be deducted from gross wages to determine
how much counts.
Now, guys, if the person is only earning 700 bucks a month or 800 bucks a
month, go ahead and document potential IRWEs on the 821, but there’s no
point in sending receipts to Social Security. If the person’s wages are clearly
under SGA, there is no point in going to all of the work of having to send in
the documentation.
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I still think it’s important to notify Social Security that IRWEs are at play.
You do that with the 821, but there is no need to go any further than that. All
right.
Now, IRWEs are deducted after subsidy or special conditions are evaluated
and applied, and that’s based on the POMS. That’s the rule. And the IRWE
determinations, any and all of them, are subject to the appeals process. So if
you feel strongly or the beneficiary feels strongly that an expense is an IRWE
and it’s denied, appeal, appeal.
What’s the worst that can happen? You can go through reconsideration and
get told no again. But in a lot of cases, you’ll win.
Now if you’re going to appeal, do your homework before you go through all
that trouble and put the beneficiary through that. Touch bases with your tech
liaison. Make sure you’re in the right, OK? Don’t embarrass yourself, and
then we can help prepare you, give you information about what all would need
to be documented and sent in to aid in the appeal.
What do you need to do to document IRWEs for SSI? Well, in the SSI
program, IRWEs affect the actual payment amount, so you want to get those
in immediately. You don’t have a nine-month grace period, OK? All IRWEs
should be reported immediately when worked again and you need to do that.
Use the Notice of Change in Earnings status. That is a form we recommend
that you use to inform Social Security that you’re working.
There is place on that form where you can say, “I have IRWEs. I think I have
IRWEs.” OK. So you’re trying to raise that red flag. You should probably
go ahead and complete the 795. Remember that’s the documentation of an
allocation of a beneficiary and keep those receipts month by month by month,
and be prepared to document that or submit that to Social Security when
requested.
Typically, what they want to do, they’re going to want to estimate IRWEs on
a monthly basis so that you don’t have this constant barrage of letters. They
also want to do that with your wages, remember. So if your IRWEs vary a
little bit, they’re going to want to estimate that at the same amount every
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month to probably better off estimating a little – a little low on your IRWEs so
that Social Security actually ends up owing the beneficiary money at the
annual redetermination rather than the other way around. So keep all those
receipts.
And normally, Social Security only wants to see those at the annual
redetermination time, but field offices vary. So follow whichever instruction
you are provided by the claims rep you are working with. So just something
to remember.
The IRWE and PASS. IRWEs are not deductible from earned income if the
income used for the purchase of the expense is also deducted as part of a
PASS for the same period. OK? Any portion of attainment for an item or
service paid with income that is not deducted as part of the PASS can be
deducted as an IRWE, but you don’t get the double deduction here.
So if you’re setting income aside to purchase your segue, you can’t also then
claim that as an IRWE to reduce how much income counts, you know, against
your SSI. Put in the PASS. Anything the PASS doesn’t cover you can claim
as an IRWE. Obviously, this would be for SSI recipients.
And on slide 50, there’s an example. If – let’s say that you’re a concurrent
beneficiary, you’re working with them and the person purchases – I don’t
know – something that they need to achieve their designated occupational
goal, it cost $600. Let’s say the beneficiary pays the bill with $500 out of the
PASS account but adds another $100 of other income for the purposes of
determining SSI countable income, a $100 would be deductible.
But it would only work if the person had earned income, right? So if a person
is not working, you can’t have an impairment-related work expense, right? So
for the purposes of Title II, SSDI CDB (DWI), the entire $600 would be
deductible as an IRWE because you can take the same expense and claim in
terms on the SSI side and the Title II side simultaneously.
But if you have a PASS, in addition, then it comes out of PASS first if it’s
what’s written in the PASS plan. And only what balance you’re paying
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06-12-13/1:00 p.m. EST
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outside the PASS for the SSI side would count. And again, only if the person
is working, remember what the rules are.
Self-employment, on page 51, if you haven't taken the class on selfemployment that we offer, I encourage you to do so because it offers a lot
more in-depth information about how to claim impairment-related work
expenses for people who are self-employed.
In most situations, something that would qualify as an IRWE would also
qualify as a business expense, not always but some things do. If an expense
could be taken both ways, you always want to deduct it as a business expense
first because what that does is reduce your countable income for tax purposes
and for SGA purposes or for the purposes of determining how much your SSI
cash payment is.
Now some things that would qualify as IRWEs are not going to pass muster as
a business expense. And unreimbursed medical expense probably is in that
category unless you have a massive amount of unreimbursed medical
expenses. So that type of thing you would want to claim as an IRWE.
But let’s say you’re paying for home office modifications to accommodate
your disability or you’re paying an attendant to help you conduct your
business, those kinds of expenses are clearly IRS-allowable business expense.
You’d want to take them through your profit and loss statement, not claim
them as IRWEs. Only save for IRWEs anything that would not count at the
business expense. In most cases, it’s more advantageous to deduct the IRWE
as a business expense instead of deducting it as an IRWE.
So, OK, we’ve got that one covered.
So let’s see. For more information, can you believe that we’re at the last
slide? And I still have 10 minutes left.
These are the POMS – I’ve listed the POMS citations that you should read if
you are just a die-hard on this issue and you want every last scrap of
information about IRWEs and the questions that you had about IRWEs
weren’t answered by this training. The D.I. POMS are voluminous. You’ll
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06-12-13/1:00 p.m. EST
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see there it’s D.I. 10520.001 through 10520.065. That is literally 40 pages. I
printed it. So it’s helpful, it’s useful, but it’s long.
Now the SSI citations are much shorter. Basically, in the SSI program, they
just adopt the same citations as our (NDI) with a couple of additional citations
because in the SSI program, of course, IRWE is putting the calculation sheet
so it allows you to keep more of your SSI cash payment when you go to work.
And, of course, in the D.I. program, it doesn’t work that way. They’re applied
during an SGA determination, which is really, really different.
So there you have it. I mean, I think it’s sort of everything you ever wanted to
know about IRWEs and probably a whole bunch of stuff you didn’t want to
know. But you’ll see it’s a lot more to it than what it is in your manual. And
honestly, we’ve had some discussions as a team.
I think we’re going to have to rewrite that unit next year or the year after to
include more information because what’s in your manual right now really isn't
very adequate for you, experienced people in particular, to do your job. So,
hopefully, you found this helpful.
So, (Jessica), we have come to the end. So let’s take more questions if anyone
has any.
Operator:
At this time, I would like to remind everyone in order to ask a question, please
press star then the number 1 on your telephone keypad. We’ll pause for just a
moment to compile the Q&A roster.
Your first question comes from (Patty Hackman). Your line is open.
Lucy Miller:
Hi, (Patty).
Operator:
Ms. (Hackman), your line is open.
Your next question comes from (Lisa O’Connor). Your line is open.
(Lisa O’Connor): Hi, Lucy, (Lisa O’Connor).
Lucy Miller:
Hi, (Lisa). How are you?
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(Lisa O’Connor): I’m good. How are you?
Lucy Miller:
Very well, good.
(Lisa O’Connor): On slide 34, talking about transportation IRWEs…
Lucy Miller:
OK.
(Lisa O’Connor): …and cab, would that transportation only be to and from a bus stop?
Lucy Miller:
No, to and from work. To and from the actual job, yes.
(Lisa O’Connor): OK, because we’re charging somebody with a physical disability…
Lucy Miller:
Yes.
(Lisa O’Connor): …being able to walk to the bus stop.
Lucy Miller:
Right. Oh, that would be so cumbersome. Oh, my god. Getting a cab just to
take you to and from the bus, no, no. It is allowed to and from the actual
jobsite.
(Lisa O’Connor): OK, Lucy. Thanks.
Lucy Miller:
You’re welcome.
(Lisa O’Connor): Take care.
Lucy Miller:
You, too.
Operator:
Again if you would like to ask a question, please press star then the number 1
on your telephone keypad. Your next question comes from the (Debbie
Jackal). Your line is open.
Lucy Miller:
Hi, (Betty).
(Debbie Jackal): Hi, Lucy. Just a couple of questions. You had touch based a little bit on
allergies and looking at them as kind of a minor medical issue.
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06-12-13/1:00 p.m. EST
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Lucy Miller:
Yes.
(Debbie Jackal): Is this something where an individual is – has to take like an EpiPen for bee
stings or if they have to see the doctor on a regular basis for allergy shots.
Would that be more complex or more of a substantial medical issue that
actually counts?
Lucy Miller:
I think you should – I think you should try it. I think where you’re going to
fall down on this is making the connection between this treatment that the
person is receiving for allergies and the need for that in order to work.
(Debbie Jackal): OK.
Lucy Miller:
However, let’s say you’re a groundkeeper. Heaven forbid, this would not be a
very good for you and you had a severe allergy to bees, maybe that wouldn’t
be…
(Debbie Jackal): Yes.
Lucy Miller:
…that the job said, and so you had to carry EpiPens and you would be in dire
fear of getting stung every day. And you’d be around pollen and grass and
you’d have to, you know, really take extra allergy medicine. I think in that
case, you could – you could possibly make a case. But I think what they’re
trying to weed out are people like me. I mean, I have mild seasonal
allergies…
(Debbie Jackal): Yes.
Lucy Miller:
…and I take, you know, Allegra or Zyrtec as needed. Yes, I mean, but it
really – I don’t need that because of my job. I work in an office.
(Debbie Jackal): Right.
Lucy Miller:
But…
(Debbie Jackal): OK.
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Lucy Miller:
I think it really – it’s all about making the connection, selling it to the claims
rep.
(Debbie Jackal): OK.
Lucy Miller:
Why is this necessary for the person to be successful in employment?
(Debbie Jackal): OK.
Lucy Miller:
Make them (inaudible).
(Debbie Jackal): Next question is on attendant care. If an individual has like a personal care
worker that comes in to help them with just activities of daily living such as
cooking, cleaning, doing laundry, none of that was listed in what you talked
about. So is that because it doesn’t necessarily connect to the individual
getting ready for work or…
Lucy Miller:
Yes.
(Debbie Jackal): …coming from and transitioning…
Lucy Miller:
Yes, exactly.
(Debbie Jackal): OK.
Lucy Miller:
The POMS actually states the things you just listed has not…
(Debbie Jackal): OK.
Lucy Miller:
…I mean, it actually says, “The care attendant does these things that’s not we
don’t allow that. It’s these things that are allowable activities as attendant
care that are deductible.”
(Debbie Jackal): OK, great. Thank you very much, Lucy.
Lucy Miller:
Welcome.
Operator:
Your next question comes from (Lisa O’Connor). Your line is now open.
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Lucy Miller:
(Inaudible), (Lisa).
(Lisa O’Connor): Oh, no, I had already actually asked and we’re good.
Lucy Miller:
That’s all right.
Operator:
Your next question comes from (Cliff) (inaudible). Your line is now open.
Lucy Miller:
Well, (Cliff), how are you?
(Cliff):
Well, I’m walking, Lucy, so I’m doing pretty good. Going back to the
transportation situation, of course, in our rural area, we don’t have any public
transportation to offer. I’m having a young man who is bound to a wheelchair
working in a location and is having – he’s having some family, but he’s also
having friends come in.
I’ve been trying to get him to maybe do a documentation of his mileage and
stuff with the friends and things to help him for gas, mileage and things.
Could we possibly maybe use that? I mean…
Lucy Miller:
Oh, yes.
(Cliff):
…the family won’t probably going to be able to do.
Lucy Miller:
Yes, I have successfully done that on more than one occasion.
(Cliff):
OK.
Lucy Miller:
What you’re going to have to do is prove – OK, so there is no public
transportation.
(Cliff):
None.
Lucy Miller:
No public transportation. So you would have to make a case that this
individual, because of the disability, is unable to drive a vehicle, OK.
(Cliff):
Right.
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Lucy Miller:
Certainly, using the wheelchair would probably require modified vehicle, so
you could make that case. The family member thing, that’s going to get pretty
sticky so I wouldn’t go there, but if it’s a friend or a coworker, he would need
to actually – money would need to (inaudible). He has to pay…
(Cliff):
Right.
Lucy Miller:
…that individual for the cost, the mileage cost of that transportation,
document it clearly that the money, you know, cash can’t be in kind. You
have to show the transfer of money.
(Cliff):
Right.
Lucy Miller:
And you have to document, which days the friend actually provide a
transportation. And I would even keep a log and have the friend sign it, so it’s
like…
(Cliff):
Actually, I was – I was...
Lucy Miller:
Yes.
(Cliff):
…going with the log…
Lucy Miller:
Yes.
(Cliff):
…daily log…
Lucy Miller:
Yes.
(Cliff):
…plus a receipt book when he paid…
Lucy Miller:
Yes.
(Cliff):
… the amount that was due for that particular…
Lucy Miller:
Yes.
(Cliff):
…service a week or…
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06-12-13/1:00 p.m. EST
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Lucy Miller:
Yes.
(Cliff):
…every two weeks or whatever they wanted to do…
Lucy Miller:
Yes.
(Cliff):
…and actually do a receipt back and forth…
Lucy Miller:
Yes.
(Cliff):
…with him in case paid in cash.
Lucy Miller:
Yes. And I have successfully claimed this on numerous occasions. My
background like (inaudible) is working with people with developmental
disabilities, and a lot of people with intellectual impairments who really
weren’t able to learn to drive – they just weren’t.
And in a rural community, like yours, what options do you have? You got the
cab or you got paying friends or co-workers or neighbors, somebody to drive
you to and from your job. And I’ve successfully gotten that approved as an
IRWE many, many times. So, yes, (inaudible).
(Cliff):
Well, I think we discussed this once before as the family thing and…
Lucy Miller:
Yes.
(Cliff):
…you know, from what you (inaudible) that’s…
Lucy Miller:
Family thing is a mess, yes.
(Cliff):
…that’s still be way too sticky, so…
Lucy Miller:
Yes, I agree. I agree.
(Cliff):
…I think, you know, those family were providing the manual services…
Lucy Miller:
Yes.
(Cliff):
…to him, but he does have friends that do it, too. So…
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Lucy Miller:
That’s awesome. That will – that would be much easier to get approved.
(Cliff):
OK. Thank you, Ms. Lucy.
Lucy Miller:
You’re welcome.
Operator:
Again, if you would like to ask a question, please press star then the number 1
on your telephone keypad. There are no further questions at this time.
Lucy Miller:
That’s awesome. We got done right on time. Well, I hope you guys found
this really helpful.
I actually enjoyed writing these slides, doing the research. I learned some
stuff. They have really changed the rules a lot. So anyway, I’m just delighted
that you all were able to participate. I hope that this was helpful, and we’ll
hear your voices on the next call.
Take care. Bye-bye.
Operator:
This concludes today’s conference call.
END