DISABILITY
BENEFITS
PROJECT
SSI COALITION E- NEWSLETTER
February, 2009
BRIEF NOTES
1. ARRA
2 SSR On Childhood
Disability
3 Occupational
Advisory Panel
4 QDD Process
5 IRS Publications on
Taxes 2008
6 Health Information
Network
7 OIG on Claims
Processing Time
HEALTH CARE
UPDATES
Next SSI Coalition Meeting-March 14, 2009
Legal Assistance Corporation of Central Massachusetts
405 Main Street, 4th Floor, Worcester, MA
508-752-3718; 1-800-649-3718
The American Recovery and Reinvestment
Act of 2009
On February 17, 2009, the President signed H.R. 111-5, the American Recovery
and Reinvestment Act of 2009 (the “Act”). The Act includes provisions for
stimulus payments to SSA beneficiaries, supplemental appropriations for SSA
and health information technology, and the extension of E-Verify.
State Grant Awards
Under ARRA
Supplemental Appropriations
MassHealth Budget
Summery FY10
MassHealth Copayments The Act appropriates $1 billion to SSA's Limitation of Administrative Expenses,
to be used by September 30, 2010. From this amount:
Increased
Annual Change to
Federal Standard
• $500 million is available until expended for necessary expenses of the
Maintenance Allowance replacement of the National Computer Center (NCC) and the information
Marriage Equality Law technology costs associated with such Center; and
Individual Mandate
DID YOU KNOW?
Resolving MassHealth
Customer Service
Issues
FEDERAL COURT
DECISIONS
• $500 million is allocated for processing disability and retirement workloads,
including information technology acquisitions and research in support of such
activities.
• Up to $40 million of the workload appropriation can be used for health
information and technology to facilitate the adoption of electronic medical
records in disability claims and to carry out SSI demonstration projects and
research.
Appeals Courts
NTU v. SSA, OIG
Nelms v Astrue
Vasquez v. Astrue
Brownawell v Astrue
The Act provides SSA's Office of Inspector General $2 million for oversight and
audit of programs, grants, and projects.
District Courts
• The Act directs the Secretary of the Treasury to provide a one-time economic
recovery payment of $250 to adults who were eligible for benefits from one of
the four following Federal benefit programs: Social Security, Railroad
Whitzell v. Astrue
Martin v. Astrue
Economic Recovery Payments to Certain Individuals
Conley v. Astrue
Fletcher v. Astrue
Laskey v. Astrue
Retirement, Veterans Disability, and Supplemental Security Income (SSI). For
SSI, disabled children would also receive the payment but SSI recipients who
reside in Medicaid-funded treatment facilities would not.
ADMINISTRATIVE
• The Act limits recovery payments to those individuals who were eligible for
DECISIONS
DRB Remand. DAA
Childhood Disability
Standard
SS Listing 112.11
REGULATORY
ACTIVITY
FR: Musculoskeletal
Listings Extended
Amendment to FR: EVerify
FR: Clarification of
Evidentiary Standard
NPR: Written Protective
Filing
NPR: Technical
Revisions to SSI
Income/Resources
benefits under one of the four programs for any of the 3 months prior to the
month of enactment (November 2008, December 2008, January 2009).
• The Act provides that if a Social Security or SSI beneficiary has a
representative payee, the recovery payment would be paid to the payee.
• No more than one $250 recovery payment may be made to an individual.
• The recovery payment would be made only to individuals whose address of
record is in one of the 50 States, the District of Columbia , Puerto Rico, Guam,
the United States Virgin Islands, American Samoa , or the Northern Mariana
Islands.
• The Act directs the Secretary of the Treasury to commence disbursing
recovery payments at the earliest practicable date but in no event later than
120 days after the date of enactment. In no case would a special payment be
made after December 31, 2010. The payment, once made, would be
unaffected by any subsequent redetermination concerning entitlement to Social
Security or SSI benefits during the three-month eligibility window.
EMs
• The Act provides that an individual would not receive the recovery payment if
his or her Social Security or SSI benefits have been suspended because he or
Payments to SSI
beneficiaries under the she is in prison, a fugitive felon, a probation or parole violator, no longer
lawfully present in the United States , or his or her benefits have been
ARRA
Conditional Benefits
suspended under the administrative sanctions provision. In addition, the
Liquid Resource Limits recovery payment would not be made if the individual dies before certification
of the payment.
HALLEX
Critical Cases Work Up • The $250 recovery payment would not be taken into account as income or
POMS
Interviewing Payee
Applicants
INTERNET
RESOURCES
taken into account for resources for the month of receipt and the following 9
months, for purposes of determining the eligibility for SSI Federal benefits or
federally funded State or local assistance.
• The Act protects the recovery payment under the assignment and
garnishment provisions of the four Federal benefit programs. However, the
Department of Treasury can reduce the special payment to offset an existing
delinquent Federal debt or arrears in alimony payments.
Contact Us
• The Act appropriates to SSA the funds necessary to make the one-time
If you have any
recovery payment, including $90 million for administrative expenses related to
questions or
comments about this making the payments.
newsletter, contact
Health Information Technology (HIT)
Linda Landry,
llandry@dlc-ma.org or
Svetlana Uimenkova, • The Act codifies the Office of the National Coordinator for HIT in the
Department of Health and Human Service (HHS) as previously established by
suimenkova@dlcexecutive order (EO) on April 27, 2004, and establishes new position of a Chief
ma.org
2
Privacy Officer in the Office of the National Coordinator.
• HIT Policy Committee will make policy recommendations to the National
Coordinator. An HIT Standards Committee will make recommendations to
the National Coordinator on the standards, implementation specifications,
and certification criteria for the electronic exchange of information. The HIT
Standards Committee would be put together by the National Coordinator.
• The Act establishes that each federal agency (as defined by the Director of
OMB, in consultation with the Secretary of HHS) must use adopted standards
and implementation specifications when it implements, acquires, or upgrades
health information technology systems. The Act directs HHS to invest
immediately in the national HIT infrastructure. HHS can use resources to
assist healthcare providers with adopting, implementing, and effectively using
electronic health record technology. HHS would establish an HIT Research
Center and regional extension centers to assist in doing this.
• HHS will award grants to States to promote HIT and for the development of
loan programs to facilitate the wide-spread adoption of certified electronic
health record technology.
• The Act establishes guidelines for HIPAA covered entities to provide an
accounting of disclosures of an electronic health record to the subject of that
record.
• The Act establishes guidelines regarding the sale of Electronic Health Records
Reimbursement to the provider of the Electronic Health Record would be
allowed when the subject of the record signed an authorization. HHS will
regulate fees for the exchange of records.
• The Act mandates notification to affected parties in the event of a data
breach.
• The Act provides for bonus payments to Medicare providers who adopt
certified HIT systems. Those who do not adopt certified HIT systems would
eventually have their payment reduced. High-volume Medicaid providers
would be eligible for a temporary payment to subsidize the adoption,
maintenance or upgrade of a certified HIT system.
Extension of the Qualifying Individual (QI) Program
• The Act extends the Medicare Qualifying Individual (QI) program (Medicare
Savings Program) and its allocations through December 2010.
Back to the Table of Contents
3
Social Security Issues Eight SSRs on the
Functional Equivalence Analysis of
Childhood Disability for SSI
The Social Security Administration (SSA) published eight new Social Security
Rulings (SSRs) on the evaluation of functional equivalency in childhood
disability claims on February 18 and 19, 2009. These SSRs are the first issued
by SSA on the functional equivalence analysis. They do not state new policy.
Instead, as stated in the preamble for each ruling, the SSRs provide policy
interpretations and consolidate information from the regulations, training
materials and the Childhood Disability Question and Answer document from
2001.
SSRs 09-1p, 09-3p, 09-5p, 09-6p, 09-7p and 09-8p were published in the
Federal Register on February 17, 2009 (74 Fed Reg. 7527 et seq., 02/17/09),
and will become effective on March 19, 2009. SSRs 09-2p and 09-4p were
published in the Federal Register on February 18, 2009 (74 Fed. Reg. 7625 et
seq, 02/18/09) and will become effective on March 20, 2009.
The Functional Equivalence analysis is the final step in the evaluation of SSI
disability claims for individuals under the age of 18. The first two steps are the
same as those for adult disability claims:
Step 1, Is the claimant performing SGA?;
Step 2, Does the claimant have a severe impairment (i.e., more than de
minimis)?
At Step 3 in the analysis of childhood disability SSA considers whether the
child’s impairments meet or equal the severity of a listed impairment. There
are three components to this analysis, which are considered in sequence:
1) medically meeting a listed impairment;
2) medical equivalence to listed impairment; and
3) functional equivalence.
The evaluation of the first two components of Step 3 is the same as that for
adult disability claims. Functional equivalence, however, involves identifying a
child’s disability related functional capacity and assessing the severity of those
limitations, compared to same age children without disabilities. SSA considers
a child’s limitations in six domains of function:
1) acquiring and using information;
2) attending and completing tasks;
3) interacting and relating with others;
4) moving about and manipulating objects;
5) caring for yourself; and
6) health and physical well-being.
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Each SSR in this series includes a similar introduction to childhood disability
determinations that explains SSA’s process of first considering the child’s
disability-related functioning, then deciding which of the domains are involved
in the child’s functional limitations, and finally assessing the severity of the
limitations. The SSRs make clear that the limitations caused by the child’s
impairments are considered and rated in each and every domain that is affected
by the limitation. The SSRs also repeat the six questions from 20 CFR
416.926a(b)(2) that must be considered when evaluating a child’s function.
Frequent cross-referencing helps make the eight SSRs work together for better
analysis of functional equivalence.
These SSRs should be very helpful to advocates in analyzing, preparing and
presenting childhood disability claims for SSI. The full text of the SSRS can be
found on SSA’s website at
www.socialsecurity.gov/OP_Home/rulings/rulings.html
SSR 09-1p, or “The Whole Child Approach.”
This SSR explains SSA's overall "whole child" approach to SSI childhood
disability evaluations. This includes the considerations for every case,
evaluating functional limitations in all relevant domains (and across all relevant
domains) of function (with examples), and rating severity in the domains of
function. Examples are provided of activities that require multiple abilities, of
a single impairment that is rated in more than one domain, of a combination of
impairments rated in more than one domain, and of a combination of
impairments that is rated in only one domain. There is also an example of a
functional equivalence analysis. Finally, the SSR discusses the rating of
severity in the domains, including the factors to be considered (e.g., ability to
independently initiate and sustain the activity, supported settings, extra help),
the comparison to same age children without disabilities, and the fact that
limitations in “several seemingly minor activities” may point to a larger
problem requiring further evaluation.
SSR 09-2p, Documenting a Child's Impairment-Related Limitations.
This SSR explains the evidence SSA needs to document a child's impairmentrelated functional limitations, how SSA considers the evidence from schools
and early intervention (EI) programs, how SSA addresses inconsistencies in the
evidence, and other evidence development issues. The SSR includes a
discussion of evidence needed to establish a medically determinable
impairment and what evidence can be used to establish nature and severity of
the functional limitations, with examples that include medical and non-medical
sources. The discussion of EI and school evidence, which includes a piece on
considering the teacher's comparison standard, and what it means is especially
helpful.
SSR 09-3p, Acquiring and Using Information Domain.
This SSR explains the factors involved in evaluating functional limitations in
the domain of Acquiring and Using Information, including special education
services. This domain evaluates the child's ability to learn information and use
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it effectively in the community, as well as to progress in school. Helpfully, the
SSR notes that significant unexplained problems may indicate an as-yetundiagnosed-impairment and also that the lack of special education services
does not necessarily mean that a child has no limitations in this domain. In
addition, the SSR states that SSA considers other medical and non-medical
evidence about the child’s ability to learn and think, as well as formal school
evidence like grades and test scores. The SSR also notes that lack of
educational services does not necessarily mean the child does not have
limitations, pointing out that a child’s needs may go unnoticed or unmet for
various reasons.
SSR 09-4p, Attending and Completing Tasks Domain.
This domain considers a child's ability to focus and maintain attention, despite
distractions, to initiate, carry out and complete activities, to change focus and
avoid impulsive thinking and acting, and to organize, plan ahead, manage time
and prioritize tasks (in an age appropriate manner). The SSR explains that this
domain covers the mental aspects of task completion, such as the child's mental
pace, but also notes that physical impairments (e.g., pain caused by a
musculoskeletal impairment), as well mental impairments, can affect a child’s
mental ability to attend and complete tasks. The SSR includes some helpful
examples for children with AD/HD.
SSR 09-5p, Interacting and Relating with Others Domain.
This SSR explains that this domain involves a child's ability to initiate and
respond to exchanges with other people, deal with authority figures, comply
with rules, respect the possessions of others, and form and sustain
relationships with family, friends and others.
The SSR explains that both physical and mental impairments can affect a
child’s ability to related to others, and that children who are withdrawn and
isolated may have limitations in this domain, as well as child who are
disruptive. The domain includes all aspects of social interaction, including the
speech and language and non-verbal learning skills needed to speak intelligibly
and to understand and use language and communicate effectively in the
community. The SSR clarifies that SSA considers the child’s primary language
when evaluating communication ability. The SSR also explains that this
domain concerns the child’s feelings and behavior in relating to others while
the domain of Caring for Yourself involves a child’s feelings and behavior to
self. Helpful examples o children with AD/HD and ODD are included.
SSR 09-6p, Moving About and Manipulating Objects Domain.
This SSR concerns the child's ability to move his/her body from place to place
and to move and manipulative things, using gross or fine motor skills or both.
This domain also includes evaluation of the child's ability to integrate sensory
input with motor output and to have an understanding of where their bodies
are in the environment and how their bodies move in space. The SSR points out
that both physical and mental impairments and the effects of treatment can
affect a child’s function in this domain. The SSR also notes that the specific
physical effects of pain, fatigue, loss of balance, headache, etc, on physical
6
function can be evaluated in this domain while the cumulative effects would be
evaluated in Health and Physical Well-Being domain.
SSR 09-7p, Caring for Yourself Domain.
This SSR explains that this domain evaluates the child's age-appropriate ability
to maintain healthy physical and emotional states and includes helpful
examples. This domain focuses on how well a child relates to self by
maintaining a healthy emotional and physical state, (e.g., self-regulation,
healthy habits, staying safe, following treatment, coping with stress); it does not
concern the child’s physical abilities to perform self-care activities (e.g.,
dressing, bathing, which would be evaluated in Moving About and
Manipulating objects, or in Acquiring and Using Information, if limitation lies
in the cognitive ability to perform the task. The SSR also includes a reminder
that SSA does not consider a child fully responsible for failing to follow
prescribed treatment.
SSR 09-8p, Health and Physical Well-Being Domain.
This SSR explains that this domain evaluates the cumulative, physical effects of
physical and mental impairments and treatment on the child's health and
functioning not addresses in Moving About and Manipulating Objects, e.g., the
effects of recurrent illness, ongoing treatment, side effects of medications,
fatigue, poor growth, nausea, susceptibility to infection, etc. This domain
would consider a medically fragile child who appears to be functioning well but
who is doing so because of intensive medical or other care. SSA would also
evaluate the cumulative physical effects of a child’s episodic disorders in this
domain (e.g., asthma, cystic fibrosis, etc.), measuring the frequency and
duration of exacerbations. There is also a useful discussion of the relationship
of this domain to the other domains.
Back to the Table of Contents
Occupational Information Development
Advisory Panel Meeting
In a December 23, 2008, Notice SSA announced that it established the
Occupational Information Development Advisory Panel (“Panel”) under the
provisions of the Federal Advisory Committee Act (FACA). The Panel will
report to the Commissioner of Social Security and provide independent advice
and recommendations on the use of occupational information in SSA disability
evaluation process. SSA intends to use the occupational information system
(OIS) “to improve …disability policies and processes and to ensure up-to-date
vocational evidence in …disability programs.” SSA intends to replace the
outdated Dictionary of Occupational Titles (DOT) and its companion volume,
The Selected Characteristics of Occupations.
The Panel is composed of 12 members, including experts in occupational
analysis, vocational assessment, and physical and vocational rehabilitation;
medical professionals; advocates; and agency employees with expertise in SSA
disability policies and programs.
7
The Panel will hold its first meetings from February 23, 2009 to February 25,
2009 in Arlington, VA. The Panel will not hear public comments during the
inaugural meeting. However, public may submit written comments not to
exceed five pages to the Panel address at
Occupational Information Development Advisory Panel, SSA,
6401 Security Boulevard, 3-R-26 Operations,
Baltimore, MD 21235-0001.
For additional information and agenda for the Panel’s meetings please visit the
Panel Web site at http://www.socialsecurity.gov/oidap.
Back to the Table of Contents
Social Security Expands Fast-Track
Disability Processes
Michael J. Astrue, Commissioner of Social Security, announced on January 28,
2009, that improvements to the SSA computer modeling system have increased
the number of claimants receiving expedited approvals for disability benefits.
According to the SSA press release, Social Security’s two-track system -- the
Quick Disability Determination (QDD) process and Compassionate Allowances
-- is now fast-tracking about 4 percent of all disability cases.
Through Compassionate Allowances, Social Security expedites the processing
of disability claims for applicants with medical conditions so severe that their
conditions by definition meet Social Security's standards. Under QDD, a
predictive computer model analyzes specific data within the electronic file to
identify cases where there is a high potential that the claimant is disabled and
where Social Security can quickly obtain evidence of the person's allegations.
See additional information about HALLEX instructions on Compassionate
Allowances (CAL) cases in this Newsletter.
IRS Issues Guidance to Kick Off 2009 Filing
Season; Announces Taxpayer Assistance
Programs.
The IRS has issued a series of Fact Sheets to highlight tax changes for the 2008
tax filing season. Below is a brief summary of these updates. Please note that
Fact Sheets are designed to give only a general overview of the law and are not
a substitute for expert professional advice from tax practitioners.
IRS Fact Sheets FS-2009-1 and FS-2009-2 explain the changes for the 2008
tax filing season. The fact sheets include a reminder that economic stimulus
payments are not taxable, and they are not reported on 2008 tax returns. The
stimulus payments affect whether a taxpayer can claim the Recovery Rebate
Credit. For example, a taxpayer may qualify for the Recovery Rebate Credit if
8
she did not get an economic stimulus payment or had a child in 2008. Fact
Sheet 2009-3 provides more information about the RRC.
First-Time Homebuyer Credit
Taxpayers who bought a main home during the period from April 9, 2008, to
June 20, 2009, may be able to claim a first-time homebuyer credit of up to
$7,500. This credit works more like a 15-year interest-free loan in that it is
repaid each year as an additional tax. The credit is claimed on new Form 5405.
Various restrictions on income and prior home ownership apply.
Earned Income Tax Credit (EITC)
The EITC may be available to working families with incomes below $41,646
and childless workers with incomes under $15,880. Taxpayers may use a tool
available on the IRS website, the “EITC Assistant,” to determine if they qualify
for this credit. The EITC is refundable which means that individuals can get it
even if they owe no tax and even if no tax is withheld from their paychecks.
Child Tax Credit
Taxpayers may claim a $1,000 credit for each eligible dependent child under
age 17, in addition to the regular $3,500 exemption that can be claimed for each
dependent.
Credit for Child and Dependent Care Expenses
Tax payers can claim the credit for child and dependent care expenses if they
pay someone to care for a dependent child under the age of 13 or a spouse or
dependent who cannot care for himself or herself, in order for the taxpayer to
work or look for work.
Education Credits
The Hope credit and the lifetime learning credit help parents and students pay
tuition and enrollment fees for post-secondary education. Many limitations
apply, including a restriction that the education credit and the tuition and fees
deduction cannot both be claimed for the same student in the same year.
Recovery Rebate Credit
The IRS Fact Sheet FS-2009-3 provides information about the recovery rebate
credit for individuals who did not receive an Economic Stimulus Payment in
2008.
The recovery rebate credit is a special one-time benefit that most people
received in 2008 as an economic stimulus payment, based on 2007 tax return
information. Individuals who were not eligible for the economic stimulus
payment or did not receive the maximum amount may be eligible for the credit
based on 2008 tax return information due to a change in circumstances,
including a change in income, addition of a child, or, for Social Security and
veterans' benefits recipients, an increase in qualifying benefits.
9
To calculate the recovery rebate credit, individuals need to know the amount of
the economic stimulus payment received in 2008. Two online interactive tools,
The Recovery Rebate Credit Calculator and How Much Was My 2008 Stimulus
Payment? are available through the Recovery Rebate Credit Information Center
on the IRS website.
How to Get Help with Filing Tax Returns?
The IRS Fact Sheet FS-2009-6 and IRS Publication 910, Guide to Free Tax
Services lists free tax assistance services. Taxpayers with personal computers
can access information on almost every tax topic and check the status of their
refunds on the IRS's website at www.irs.org.
IRS Taxpayers Assistance Centers also offer personal help with tax issues that
cannot be handled on-line or by phone, including inquiries, adjustments,
letters, notices and payment plans. The IRS's Taxpayer Advocate Service can
help those taxpayers who are experiencing economic harm, seeking help in
resolving tax problems that have not been resolved through normal channels,
or who believe that “an IRS system or procedure is not working properly.”
Low-income taxpayers can get free assistance through a Low Income Taxpayer
Clinic. Contact a Low Income Taxpayer Clinics (LITC) in Massachusetts listed
on IRS website for more information. IRS forms and publications are available
at many libraries and post offices. Most of the IRS materials are available, free
of charge, in Braille.
Electronic Filing
IRS Fact Sheet FS-2009-5 helps taxpayers understand the process and
advantages of e-filing returns. The IRS predicts that nearly 90 million of the
140 expected returns for 2009 will be filed electronically.
Benefits of e-filing include faster refunds, elimination of paperwork, file now pay later options, reduction of errors, quick confirmation and easier state
return filing. Taxpayers can e-file by using the Free File program for eligible
taxpayers, low-cost filing programs with IRS private sector partners, IRSapproved tax preparation software, paid tax preparers, volunteer tax preparers
and Tax Counseling for the Elderly.
Taxpayers may choose to use direct deposit for their tax refunds, which can be
split up among and deposited directly to up to three different bank accounts.
Taxpayers using direct deposit will receive refunds more quickly (often within
10 days) and avoid lost or stolen paper refund checks. The Electronic Federal
Tax Payment System (EFTPS) allows taxpayers to pay both their business and
individual taxes through the internet or by telephone. EFTPS is a free and
secure service offered through the U.S. Department of Treasury. For more
information go to www.eftps.gov or call EFTPS customer service at 1-800-5554477.
Back to the Table of Contents
10
Social Security to be First Government
Agency to Use Nationwide Health
Information Network
The Social Security Administration announced in its December 17, 2008 press
release that it will be the first government agency to utilize the Nationwide
Health Information Network (NHIN).
Through the NHIN, Social Security will have instantaneous access to medical
records. This should significantly shorten the time it takes to make a disability
decision and make the process more efficient. SSA hopes that the NHIN will
help ensure records are received timely by making it easier and less laborintensive for medical professionals to submit records. Social Security is
working with Med Virginia, the North Carolina Healthcare Information and
Communications Alliance, and Kaiser Permanente to implement the NHIN. In
early 2009, the first real-world use of the system will begin between Social
Security and Med Virginia.
The NHIN is an initiative of the Department of Health and Human Services and
is supported by multiple government agencies and private sector entities. You
can find more information at
www.hhs.gov/healthit/healthnetwork/background/
Back to the Table of Contents
OIG Report on Disability Claims Overall
Processing Times
The Office of Inspector General issued a report after conducting a study on the
SSA average overall processing time for disability claims decided by Disability
Determination Services (DDS), Administrative Law Judges (ALJ), the Appeals
Council (AC) and Federal Courts. See, A-01-08-18011
The OIG conducted this review to determine processing time from a claimant’s
perspective (how long it took, on average, for a claimant to go through the
entire disability process from the date he or she filed an application until the
date SSA denied the claim or awarded the claim and issued the benefits due at
that time).
The OIG obtained files of all disability decisions made in Calendar Year 2006.
The OIG randomly selected 275 sample cases from each DDS population and
100 sample cases from each of the other populations—for a total of 850 cases—
and conducted a detailed analysis to determine the average overall processing
time and the average processing times based on SSA’s performance measures.
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DDS
The OIG determined that in 2006 it took SSA 131 days, on average, to
completely process an initial claim—ranging from 16 days to about a year. SSA
measures the average processing time from the application date to the date of
denial or date the award. This measure does not capture all the processing time
because the Agency determines the back payments after it processes an award.
Using SSA’s measure, the OIG determined the average processing time for
initial disability claims was 121 days.
The OIG also reviewed a sample of 275 cases with a DDS determination in
2007. Based on this review, it determined that it took SSA 121 days, on
average, to completely process an initial claim—ranging from 22 days to about
a year.
Of the 275 sample cases, 61 had a reconsideration determination in 2007.
Based on the review of these cases, the OIG determined that it took SSA 283
days, on average, to completely process a reconsideration claim—ranging
from about 3 months to over a year.
ALJ
Based on the review of 100 sample cases, the OIG determined that it took SSA
811 days, on average, to completely process a disability claim through the
hearing level—ranging from about 6 months to just over 4 years.
Appeals Council
Based on the review of 100 sample cases, the OIG determined it took SSA
1,053 days, on average, to completely process a disability claim through the AC
level—ranging from about a year to just under 10 years.
Federal Court
The OIG determined that it took 1,720 days, on average, to completely process
a disability claim through the Federal Courts level—ranging from about 2½
years to about 14 years. The OIG noted that SSA has no control over how long
it takes the Federal Courts to review a case and render a decision, nor does SSA
have any performance measures associated with these cases.
Recommendations
Not surprisingly, the OIG concluded that “the overall processing time [when
measured from the claimant's perspective] may amount to years, during which
time, a claimant’s condition may worsen or additional evidence may become
available. As a result, he or she may be denied benefits at one adjudicative level
and later allowed at another adjudicative level. “
Back to the Table of Contents
12
HEALTH CARE UPDATES
American Recovery and Reinvestment Act
(PL 111-5) Sec. 5001 Grant Award
On Wednesday, February 25, 2009, the Department of Health and Human
Services started releasing over fifteen billion dollars, as authorized by the
American Recovery and Reinvestment Act to qualifying states, insuring
that necessary health care needs are met.
According to the announcement on the DHHS web site, Massachusetts is
entitled to receive $594, 257, 179.
MassHealth Budget Summary for FY 10
MassHealth Overall Spending
MassHealth program spending for FY10 is projected at $8,970.2M, which
is $554.4M (or 6.6%) above the FY09 projected spending. This growth
includes moving $290M in spending not previously in MassHealth budget
(including the Children’s Behavioral Health Initiative, the Essential
Community Provider Trust Fund, and certain hospital and physician rate
payments and pay-for-performance payouts) into the MassHealth budget.
After adjustment for anticipated enrollment growth, MassHealth program
spending for FY10 is -0.3%. The FY10 budget projection assumes coverage
of 1,231,000 MassHealth members in FY10, a 3.5% increase from FY09
projected caseload.
MassHealth Caseload
MassHealth enrollment is projected to grow at 4.5% in FY09 and 3.5% in
FY10. The FY10 MassHealth budget projections anticipate a more than
40,800 net caseload increase from FY09 to FY10, from an average of
1,190,900 members in FY09 to 1,231,000 members in FY10.
MassHealth Funding Increases
The Children’s Behavioral Health Initiative (Rosie D v. Romney) is funded
at $43.5M in FY10. The FY10 funding level is an increase of over $18.5M
from the FY09 spending.
The Community First 1115 Waiver is funded at $21M in FY10. This will
enable the Commonwealth to phase in the waiver, initially serving people
with disabilities under the age of 60.
Detailed report is available on line at MassHealth website.
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MassHealth Copayments Increased
Effective February 1, 2009
Copayments for most generic and over-the-counter drugs increased
from $1 to $2 for MassHealth members. Copayments for generic and overthe-counter drugs used for diabetes, high blood pressure, and high
cholesterol will stay at $1. Copayments for brand-name drugs remain the
same at $3. Copayments for CMSP and the Health Start did not increase.
The MassHealth cap for pharmacy copayments will remain at $200 per
calendar year. MassHealth will send the member a notice when the cap is
met. It is good practice for members to keep the “copayment cap met” letter
and receipts for copayments paid during the calendar year.
MassHealth Copayment Exemptions
The following groups of MassHealth enrollees will not have to pay a
MassHealth copayment for any service covered by MassHealth:
members under 19 years old;
members who are pregnant or whose pregnancy ended within 60 days of
the service;
members who are getting benefits under MassHealth Limited (emergency
MassHealth);
MassHealth members who are getting a Medicare-covered drug at a
pharmacy that is a certified provider for Medicare and who are getting
benefits under MassHealth Senior Buy-In (MassHealth and Medicare) or
under MassHealth Standard;
MassHealth members who are in inpatient in a nursing facilities, chronicdisease or rehabilitation hospitals, or intermediate-care facilities, or are
admitted to a hospital from such facilities;
EAEDC (Emergency Aid to the Elderly, Disabled and Children) Program
members not covered under MassHealth Basic, Essential, or Standard; or
members getting hospice care.
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14
MASSHEALTH Publication Changes
Eligibility Letter 184 (02/01/09)-Annual
Change to the Federal Standard Maintenance
Allowance and Standard Shelter Expense
This letter transmits revised regulations about the annual increases to the
federal standard maintenance allowance from $1,712 to $1,750 and
the standard shelter expense from $514 to $525. The regulations are
being issued as emergency regulations, effective July 1, 2008.
Eligibility Operations Memo 09-02 (02/15/09)Marriage Equality Law
On July 31, 2008, Governor Deval Patrick signed into law a measure that
requires MassHealth to apply existing spousal rules to determine eligibility
for medical benefits for people in same-gender marriages. MassHealth now
recognizes state marriage laws in assessing eligibility for all programs
determined by MassHealth.
The definition of “spouse” in MassHealth regulations at 130 CMR 501.001
and 515.001 has been revised as follows:
Spouse — a person married to the applicant or member according to the
laws of the Commonwealth of Massachusetts.
Effective for applications and eligibility review forms received on or after
October 31, 2008, notwithstanding the unavailability of federal financial
participation, no person who is recognized as a spouse under the laws of the
Commonwealth will be denied benefits that are otherwise available under
M.G.L. c. 118E due to the provisions of 1 U.S.C. § 7 or any other federal
non-recognition of spouses of the same gender.
If a member’s eligibility changes as a result of updated or corrected
information about marital status, the change in eligibility will be effective as
of the date the MassHealth agency receives the information, but no sooner
than October 31, 2008.
For applications and eligibility review forms received on or after October 31,
2008, any applicant or member who identifies his or her relationship with
another household member as “spouse” will be treated as such for purpose
of determining eligibility, regardless of gender. The designation of spouse
requires that persons be legally married and has the same effect for all
married couples with regard to the application of MassHealth rules about
defining family groups, counting income and assets, establishing federal
15
poverty level, the transfer of assets, and spousal impoverishment
consideration. Applicants or members must submit all information
necessary for both spouses in order to determine eligibility.
The Memo reminds that federal rules do not recognize same-gender
marriages. Therefore, persons in same-gender marriages whose eligibility is
based in any part on marital status will receive state-funded benefits and
claims for those individuals will not be submitted for federal
reimbursement. Claims adjustments will be made by the federal reporting
unit and should have no impact on the eligibility process.
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Health Care Reform Individual Mandate
The Massachusetts Health Care Reform Law requires most Massachusetts
residents age 18 and over who can afford health insurance to have health
coverage or pay a penalty through their tax returns. Beginning January 1,
2008, adult residents are required to have health insurance for the entire
year. The penalties in 2008 will accrue for each month of non-compliance.
However, there is a grace period permitting lapses in coverage of three or
fewer consecutive months.
To comply with the law, residents and certain part-year residents must file
Schedule HC, Health Care Information, with their paper or electronic Form
1 or Form 1-NR/PY. There is a new video on DOR website at
http://www.mass.gov/dor designed to give taxpayers guidance in
completing Schedule HC.
Exemptions to Individual Mandate
Taxpayers who do not have health insurance are exempt from the penalty if:
1. Insurance is deemed not affordable
2. Individual has a religious exemption
3. Individual obtained a “Certificate of Exemption” in advance stating that
no health insurance product was affordable (even individuals for whom
health insurance is deemed affordable may claim a hardship for an
exception to the penalty)
Tax Filing Process for 2008
Taxpayers with Health Insurance
Individuals with private health insurance (through an employer or
purchased privately) in 2008 will receive a Form MA 1099-HC,
Massachusetts Health Care Coverage, from their health insurance carrier.
16
MassHealth and Commonwealth Care Members
Members enrolled in MassHealth or Commonwealth Care in 2008 with
incomes above 150% of the federal poverty level will also receive a Form
MA 1099-HC.
Members with incomes at or below 150% FPL are not subject to any
penalty and thus will not receive MA 1099-HC.
Members of Government Health Insurance plans, Medicare, VA
Plans
Individuals enrolled in Medicare, Veterans Administration Program, TriCare or “Other” government health insurance in 2008 will not receive a
Form MA 1099-HC. Instead, the individual must check the appropriate box
on Schedule HC to indicate the plan they were enrolled in.
Toll free numbers are available for members who did not receive a MA 1099HC but wants/needs one.
Taxpayers without Health Insurance or Gaps in Coverage
In 2008, the penalty for not having health insurance has increased and can
reach up to $76 a month or $912 a year. See the Guidelines regarding the
tax penalties for not having health insurance in 2008.
MA adult residents who do have medical insurance coverage should contact
the Commonwealth Health Connector for assistance with finding the right
health plan at 1-877-MA-ENROLL, TTY number (888-213-8163) or visit
www.MAhealthconnector.org.
Health Care Appeals
Individuals for whom health insurance is deemed affordable may claim a
hardship for an exception to the penalty. Taxpayers who claim a hardship
must request an appeal on the Schedule HC and respond to DOR notice with
hardship documentation within 30 days of receipt. The Connector may
decide that there is insufficient evidence after a paper review and schedule a
hearing. There will be no penalty assessed pending the outcome of an
appeal. If the appeal is dismissed or denied a taxpayer will be responsible
for any penalty, including interest.
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17
DID YOU KNOW?
Resolving MassHealth Eligibility Issues
MassHealth applicant or members who have questions or concerns should
contact MsasHealth Enrollment Centers at 888-665-9993 for a consultation
with a customer service representative at Maximum. If Maximum
representatives have been uncooperative, unhelpful, or provided wrong
information consumers and advocates can e-mail MassHealth Operations
supervisor Russ Kulp at russ.kulp@state.ma.us to bring individual or systemic
issues to the attention of MassHealth. Consumers may contact policy hotline at
(617) 210-5331 with legal issues.
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FEDERAL COURT DECISIONS
COURTS OF APPEALS
Misleading Use of Social Security Language. Constitutionality of the
Social Security Act. National Taxpayers Union v SSA, OIG, No. 073381 (3rd Cir, 12/1108)
The National Taxpayers Union (“NTU”) petitioned for review of a decision of
the Department of Health and Human Services Departmental Appeals Board
that upheld an ALJ determination that NTU mailed correspondence that used
“social security” in a manner that violated Section 1140 of the Social Security
Act, 42 U.S.C. Sec. 1320b-10 and a civil penalty of $274, 582 against NTU.
NTU argued that Section 1140(a)(1) is unconstitutional as-applied, overbroad,
and that the ALJ’s decision was not supported by substantial evidence. The
Third Circuit found none of the NTU arguments persuasive and denied the
petition to review.
NTU mailed thousands of direct mail pieces to consumers to solicit donations.
The brochures included the language in large, red, bold type that stated
“Official National Survey on Social Security.” The brochures also included the
statement that the Survey was “commissioned by the NTU for the Social
Security Administration, White House, and Congress of the United States.” The
OIG determined that mailings violated Section 1140 of the Social Security Act
which prohibits the use of nineteen phrases, including “social security”, in a
manner that either 1) the writer knows or should know, or 2) the reader could
reasonably perceive as conveying the false impression of official endorsement
of the material by the SSA or the government. After several cease-and-desist
letters failed to stop NTU from using “social security” in the manner that was
not ambiguous the administrative litigation ensued.
18
The Third Circuit court joined the Fourth Circuit in holding that Section 1140
was not unconstitutional as-applied because its limitation on protected activity
(speech) serves a sufficiently strong, subordinating interest in protecting Social
Security recipients from deceptive mailings. In a somewhat optimistic way the
court noted that “mail that appears from the SSA piques beneficiaries’ interests
and induces them to read and respond accordingly.” As such, any mail that
appears to be associated with SSA sets itself apart from other “junk mail” and is
more likely to induce the recipient to act upon it. The court agreed that the
objective prong of Section 1140 (“the writer should know”) could reach some
protected speech, however, any such speech constituted, “at most a miniscule
portion of the speech reached by the statute.” The court also found that the fine
of $ .50 per unit was not excessive especially when compared to the cost of the
government to enforce Section 1140.
In considering NTU’s claim that the testimony of the government witness in the
administrative hearing failed to meet Daubert (Dabuert v Merell Dow Pharms,
Inc., 509 U.S. 579 (1993)) standard and was “sloppy and unscientific” the court
stated that “neither the Federal Rules of Evidence nor Daubert apply to
administrative hearings. SSA regulations state that “the ALJ will not be bound
by the Federal Rules of Evidence, but may be guided by them in ruling on the
admissibility of evidence.” 20 C.F.R. Sec. 498.217(b)
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ALJ Duty to Develop the Record. Unrepresented Claimant. Nelms v
Astrue, No. 2::06 –cv-00273-CNC (7th Cir, 1/28/09)
Remand was appropriate when the ALJ failed to adequately develop the record
of an unrepresented claimant. The Seventh Circuit court noted that although
the claimant bears the burden of proving disability, the ALJ in a Social Security
hearing has a duty to develop a full and fair record. This duty is “enhanced
when a claimant appears without counsel; then the ALJ must scrupulously and
conscientiously probe into, inquire of, and explore for all the relevant facts.”
The court proceeded to state that it will uphold generally the “reasoned
judgment of the Commissioner on how much evidence to gather, even if the
claimant lacks representation.” The court will find that the record was not
developed in cases where there is a significant and prejudicial omission.
In the case at hand, the record lacked any evidence for the period of two years
prior to the date of the hearing. Additional medical evidence submitted to the
federal court contained specific objective findings that demonstrated the
existence of a back impairment that was never considered by the ALJ.
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19
Credibility Determination: Credit-as-True Rule, Res Judicata, Pain
Evaluation, Vasquez v. Astrue, 547.3d 1101 (9th Cir., 11/5/08),
No.06-16817 D.C. No. CV-05-03857 JW
A younger claimant filed two applications for concurrent SSI and SSDI benefits
both of which were denied by SSA and subsequently by the United States
District Court for the Northern District of California. The Ninth Circuit Court
vacated the District Court’s judgment and remanded the case for a new hearing
to give the ALJ the opportunity to consider substantial medical evidence of the
claimant’s mental impairment that was submitted to the Appeal Council but not
reviewed by the ALJ.
The Court held that the ALJ failed to properly evaluate the claimant’s
credibility when considering the effect of pain on the claimant’s residual
functional capacity. The ALJ failed to give “specific, clear and convincing
reasons” when she determined that the claimant’s allegations of pain were only
partially credible.
The Court applied the Ninth Circuit “Credit-as-True Rule” and accepted the
claimant’s allegations of pain as fully credible as a matter of law. Under the
Credit-as-True rule, the claimant’s testimony should be considered as true and
an immediate award of benefits is appropriate when the ALJ has failed to
provide legally sufficient reasons for rejecting such pain evidence, there are no
outstanding issues that must be resolved before a determination of disability
can be made, and it is clear from the record that the ALJ would be required to
find the claimant disabled were such evidence credited. See, Varney v. Sec’y of
Health and Human Services (Varney II), 895 F.2d 1396 (9th Cir., 1988),
Harman v. Apfel, 211 F.3d 1172 at 1178 (9th Cir. 2000) The purpose of the
Credit-as-True rule is to discourage ALJs from “reaching a conclusion about a
claimant’s status first, and then attempting to justify it by ignoring any evidence
in the record that suggests an opposite result. “ See, Varney II, 895 F.2d at
1398.
The court further instructed the ALJ that the principles of res judicata were not
applicable in this case because the claimant raised a new issue, namely, the
existence of an impairment not considered in the original application during
the first ALJ hearing.
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Treating Physician Rule. Evaluating Migraines. Brownawell v.
Astrue, No. 07-4405 (3rd Cir, 2008), 2008 WL 5147953 (C.A. (Pa),
12/09/08)
An SSI applicant with a history of severe migraines, anxiety, and depression
had two ALJ hearings followed by two petitions to the Appeals Council, two
appeals to the district court and a final appeal to the Appeals Court for the
Third Circuit.
The Appeals Court for the Third Circuit concluded that a remand was
appropriate where the ALJ’s decision was based on factual errors and incorrect
evaluation of the opinions of the claimant’s treating physicians. The court
further held that after eight years of litigation the substantial evidence on a fully
20
developed record indicated that the claimant was disabled and entered an order
to pay SSI benefits.
The court rejected the ALJ’s conclusion that the opinion of the claimant’s
treating physician was unsupported by the treatment notes where the physician
stated that the claimant’s headaches “were stable and under control as they
respond well to medication.” The court emphasized that the physician’s
observation that the claimant’s condition is controlled by medication does not
necessarily support the medical conclusion that the claimant can return to
work. The court went on to state that a doctor’s notation that the claimant’s
condition is “stable” during treatment does not necessarily support the
conclusion that the patient is able to work.
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DISTRICT COURTS
“Common Issue” Requirement for Holding Consolidated Hearings,
Issue Preclusion, Authority of the Federal Court to Review a
Complaint without Jurisdiction to Review the Merits of the
Complaint. Whitzell v Astrue, Civil Action No. 06-11951-WGY, 2008
WL 5159255 (D. Mass, 12/10/08)
The case presents a complicated procedural issue that although rare may
present a substantial problem by depriving the claimants of due process.
A younger claimant filed concurrent applications for SSI and SSDI in 2001 that
were denied initially and at all levels of the administrative review. While the
2001 applications were pending at the Appeals Council level the claimant filed a
subsequent SSDI application in 2004. In June of 2004, the Appeals Council
denied the claimant’s request to review concurrent 2001 applications and the
claimant filed an appeal in the U.S. District Court. In July of 2005, the Court
remanded the 2001 concurrent applications back to the Commissioner with
instructions to review the issue of work in the national economy and noting that
there was a conflict between the VE’s expert testimony and the DOT. See,
Hynes v. Barnhart, 379 F. Supp.2d at 220.
In March of 2006, the hearing officer held a consolidated hearing to review
upon remand the 2001 concurrent applications and to review de novo the
claimant’s 2004 application. The officer issued an unfavorable decision
concluding that the claimant’s 2001 and 2004 applications were denied. The
decision stated that the claimant could file any exceptions with the Appeals
Council within thirty days from the date she received the decision.
In October 2006, the claimant requested that the AC review the denial of her
“claim for SSDI/SSI benefits.” The claimant argued further that the
consolidation of her initial concurrent applications field in 2001 with her
subsequent application filed in 2004 deprived her of her right to have AC
review the decision made with respect to her subsequent application. In
November of 2006, the AC dismissed the claimant’s request for review as
untimely and the claimant filed her second appeal in the U.S. District Court.
21
The court reviewed the requirements of 20 C.F.R. Sec. 404.952 for holding a
consolidated hearing:
i)
a claimant has requested hearings to decide her benefit rights under
Title II of the Social Security Act and under another law that falls
within the ambit of the administrative jurisdiction of the Social
Security Administration; and
ii)
ii) at least one issue to be considered at the requested hearings is the
same that is involved in the other pending claim.
The court held that there was no “common issue” involved in the claimant’s
2001 applications and subsequent 2004 application. In the first proceedings
related to the claimant’s appeal, the court remanded concurrent applications
only to review the Commissioner’s decision at step V of the sequential
evaluation process and affirmed the rest of the decision. All the matters
affirmed by the court were not subject to review by the hearing officer during
the consolidated hearing. The issue preclusion principle was applicable in this
instance because neither the Commissioner nor the claimant appealed the
issues affirmed by the court. The court instructed that decision after the
consolidated hearing should have been divided into two separate decisions:
the decision reviewing the “initial” application on remand, that would discuss
the claimant’s disability at step V; and
the decision of the hearing officer in the first instance whether the claimant
was disabled based on her “subsequent” application.
The court noted that at the time of the consolidated hearing the issue of
disability was common to both applications. However, the hearing officer
should have proceeded through five steps of the sequential evaluation process
when determining disability based on the subsequent 2004 application. The
officer could have concluded that the claimant was disabled at any of the steps
prior to step V. This would mean that there would be no common issue
between the two consolidated applications. The court noted that it was “a very
technical point..” yet it had “a significant impact on [the claimant’s] exercise of
her rights to appeal.”
The court held that the claimant had the right to appeal the hearing officer’s
determination as to her 2004 subsequent application to the Appeals Council
within sixty days after she received the decision. 20 C.F.R. Sec. 404.967,
416.1467. She could appeal the hearing officer’s decision to the Appeals
Council as to her 2001 concurrent applications within thirty days after she
received the decision. The appeals procedures for decision on matters
remanded by a district court are different and give a shorter time for appeal.
The AC may, but is not required to, assume jurisdiction upon the timely
submission of the claimant’s written exceptions. In the case at hand, the
claimant filed her appeal on the 58th day after the day she received the decision
of the hearing officer. The court concluded that although her request was
untimely as to her 2001 applications, she filed her request to review the 2004
application in a timely manner.
22
The District Court held that the Commissioner erroneously dismissed the
claimant’s appeal of her subsequent application and therefore, until the AC
makes a decision on the claimant’s request to review the hearing officer
decision covering the disability period alleged in that application, the court
does not have jurisdiction to review the claim on the merits. However, the
court stated that the claimant had the right to file the current petition because
her right to appeal from the hearing officer’s decision “was invaded” when AC
refused to review her appeal of 2004 application and she suffered a legal wrong.
The court “must hold unlawful and set aside agency actions, findings, and
conclusions found to be…not in accordance with law.” 5 U.S.C. Sec. 706 (2)(A)
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Continuing Disability Review. Martin v Astrue, Civil Action No. C.A.
07-388 A (D. Rhode Island, 12/2/08)
The District Court held that the ALJ failed to explicitly evaluate the claimant’s
treating physician’s report and notes when she determined that the claimant’s
medical condition (polycythemia vera) no longer met the Social Security Listing
7.09 and was sufficiently improved as to allow the claimant to return back to
work. The court noted that the ALJ erroneously inferred from the medical
notes stating that the claimant had “no increasing symptoms” or “no new
complaints” that the claimant’s overall condition has improved- “while the
absence of increasing or new symptoms may suggest a stabilizing of Plaintiff’s
condition, it does not necessarily suggest an improvement, in, or absence of,
symptoms.”
The court remanded the case for a new hearing with specific instructions to
evaluate the reports from the claimant’s treating physician and if appropriate
supplement the record with additional medical, consultative or expert evidence.
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Remand. Use of the Grid and VE Testimony at Step V of the
Sequential Evaluation Process. Conley v. Astrue, Civil Action No.
08-202-P-S (D. Me., 01/28/09), 2009 WL 214557
A younger individual with high school education and unskilled past relevant
work filed SSI and SSDI application under the Disability Service Improvement
procedures alleging disability due to anxiety, depression, opiate abuse in
remission and paraspinal mass. Both applications were denied initially and
after an administrative hearing. The ALJ held that the claimant retained the
residual functional capacity to perform a full range of sedentary work, limited
to simple, routine, repetitive tasks involving sustained attention in two-hour
blocks, normal, routine interaction with co-workers and supervisors, no
interaction with the public, and the ability to adapt to changes in a work setting.
The ALJ’s conclusion that the nonexertional limitations included in the residual
functional capacity he assigned to the claimant “virtually leave the sedentary
occupational base intact” was erroneous. The court reminded that when the
adjudicator uses the Grid as a framework, the adjudicator must either consult a
23
vocational expert or demonstrate “ample support in the record for the
proposition that the nonexertional impairment at issue only marginally reduces
the relevant occupational base.” See, Ortiz v Secretary of Health and Human
Servs., 890 F.2d 520, 524-26 (1st Cir. 1989).
The court found no evidence in the record including VE testimony that would
substantiate the ALJ’s conclusion that limitations to simple, routine, repetitive
tasks involving sustained attention only in two-hour blocks and no interaction
with the public, do not significantly affect a claimant’s ability to perform the full
range of sedentary work. The court disagreed with the ALJ who has taken
“administrative notice” that “unidentified unskilled sedentary occupations
existed in significant numbers that would not be affected by the claimant’s
identified mental limitations…” The court held that it was not enough to define
“administrative notice” as “recognition that various authoritative publications
identify occupations which exist in the national economy…” There was
insufficient information to support the ALJ’s conclusion and therefore, the
court could not review it “intelligently.” The court opined that if the ALJ has
taken “administrative notice” of the contents of an “authoritative publication”,
he had to “at a minimum, identify the publication and the page or pages on
which the relevant information appears.”
The court agreed with the claimant’s assertions that a limitation to simple,
repetitive tasks, even without the two-hour limit on sustained attention,
“eliminates sedentary jobs with a General Educational Development reasoning
of 3 or more” See, Carter v Barnhart, 2005 WL 3263936 (D. Me. 11/30/05) and
a limitation to “no public contacts eliminates unskilled sedentary jobs such as
cashier and clerk.”
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Use of the Grid as a Framework. Fletcher v. Astrue, Civil Action No.
08-150-B-W (D. Me. 01/28/09), 2009 WL 214579
The ALJ found that a younger claimant with high school education who
alleged disability to due to Fibromyalgia, Anxiety Disorder, and Depression
retained residual functional capacity to perform work at the sedentary level,
limited to simple and repetitive unskilled tasks.
The ALJ erroneously relied on the Grid because the limitation to “simple and
repetitive unskilled tasks” reduced the sedentary occupational base more than
marginally. The adjudicator may use the Grid to determine the availability of
work in the national economy for a claimant who has only physical
impairments. See, Heggarty v Sullivan, 947 F.2d 990, 995-96 (1st Cir. 1991).
In cases where the claimant has both physical and mental limitations, the Grid
may be used as a framework in cases where the nonexertional impairment
reduces the relevant occupational base only marginally. See, Ortiz v. Secertary
of Health & Human Servs. 890 F.2d 520, 524 (1st Cir. 1989) A limitation to
simple repetitive tasks limits available jobs to those to which the DOT assigns a
General Educational Development (“GED”) level of 1. See, Flagg v Barnhart,
2004 WL 2677208 (D. Me., 11/24/04)
24
Continuing Disability Review. Conflict Between VE Testimony and
the DOT. Laskey v. Astrue, Case No. 08-153-P-S (D. Me., 01/29/09),
2009 WL 232549
The case presented a lengthy procedural history including three administrative
hearings of a continuing disability review. A remand was appropriate where
the ALJ declined to adopt an RFC from the claimant’s treating source without
identifying specific clinical findings that could have supported the ALJ
determination that an opinion from a non examining DDS physician was
preferable. The ALJ failed to provide adequate reasons for rejecting a treating
source’s opinion and ignored material evidence.
Additionally, the ALJ’s finding that the claimant was able to perform other
work existing in significant numbers in the national economy was not
supported by substantial evidence because the ALJ relied on an erroneous VE
testimony and failed to resolve an apparent conflict between VE evidence and
the DOT (a VE provided an incorrect DOT number for the job of a “ticket taker”
and incorrectly characterized this position as being “sedentary with sit-stand
option”. In fact, the job under the number VE quoted and the job of a “ticket
taker” described light work according to the DOT.)
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Administrative Decisions
Please note: You will need to log on to www.masslegalservices.org to
read these decisions. If you do not have an account or forgot your
user name or password, go to
http://www.masslegalservices.org/reset If you are not able to get
the documents online and would like hard copies, please contact
Svetlana Uimenkova at suimenkova@dlc-ma.org or Linda Landry at
llandry@dlc-ma.org
Decision Review Board
Remand. Treating Physician Rule. DAA.
The Decision Review Board vacated the ALJ hearing decision and remanded
the case for a new hearing to evaluate an SSDI application of a younger
individual alleging disability due to Bipolar Disorder, General Anxiety Disorder,
and Psychotic Disorder with a GAF in the range of 40-60. The DRB instructed
the ALJ to consider the professional medical opinions of the claimant’s treating
sources to determine the nature and severity of his mental impairments.
Additionally, the DRB disagreed with the ALJ’s conclusion that the claimant’s
alcohol abuse was not material to the determination of his disability and
directed the ALJ to re-evaluate the effect of the claimant’s alcohol abuse should
the ALJ decide that the claimant’s impairments meet the SSA disability
standard.
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25
Administrative Law Judge
Childhood Disability Standard. Extreme Limitations in the
Domain of Acquiring and Using Information.
A parent of a sixth-grade student with Bipolar Disorder, Learning Disorder, and
Borderline Intellectual Functioning filed an application for SSI childhood
benefits that was denied initially and at the Federal Reviewing Official level.
Administrative Law Judge held after a hearing that the child’s impairments
caused extreme limitations in the domain of acquiring and using information.
The child was reading at the preprimary to primary level, was not meeting any
of the educational benchmarks and was functioning at a borderline intellectual
level with WISC IQ scores in the range of 85-94. The ALJ disagreed with the
Federal Reviewing Official’s decision after reviewing new and material evidence
submitted at the hearing level.
Anne Marie Taylor represented the child.
Childhood Disability Standard. SS Listing 112.11
A parent of a thirteen year old student with Attention Deficit Hyperactivity
Disorder and Anxiety filed an application for SSI childhood benefits that was
denied initially and at the Federal Reviewing Official level. The Administrative
Law Judge held after a hearing that the severity of the child’s ADHD met the
criteria of section 112.11 of 20 CFR Part 404, Subpart P, Appendix 1. The record
contained objective medical evidence that the child’s ADHD resulted marked
degree of inattention, impulsiveness, and hyperactivity. A Medical Expert
present at the hearing testified that the claimant had marked impairments in
age-appropriate function and marked difficulties in maintaining concentration,
persistence or pace. The ALJ disagreed with the FedRO conclusion on
disability because new evidence submitted at the hearing demonstrated that the
claimant’s impairment was of Listing level severity.
Anne Marie Taylor represented the child.
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We need your help. Please send or email us your decisions and
briefs
Email to Linda Landry at llandry@dlc-ma.org or Svetlana
Uimenkova at DLC at suimenkova@dlc-ma.org
26
Regulatory Activity
Final Rule: Expiration Date Extension for Musculoskeletal Body
System Listings, 74 Fed. Reg. 5807 (02/02/09)
This final rule effective February 2, 2009 extends for 2 years (until February
18, 2011) the current version of the Musculoskeletal System Listing of
Impairments. Other than extending the effective date of the Listings, SSA made
no substantive revisions. The electronic file of this document is available on the
date of publication in the Federal Register at http://www.gpoaccess.gov/fr/
index.html.
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Amendment to Final Rule; Delay of Applicability date: Federal
Acquisition Regulation; FAR Case 2007-013, Employment Eligibility
Verification, 74 Fed. Reg. 5621 (01/30/09)
The Department of Defense, the Department of Homeland Security, General
Services Administration, and National Aeronautics and Space Administration
have agreed to delay the applicability date of FAR Case 2007-013,
Employment Eligibility Verification, to May 21, 2009.
Final Rule: Clarification of Evidentiary Standard for
Determinations and Decisions, 73 Fed. Reg. 76940 (12/18/08)
SSA clarified that effective January 20, 2009, it will apply the
preponderance of the evidence standard when it makes determinations and
decisions at all levels of the administrative review. Note that these rules do not
change SSA's policy that the Appeals Council applies the substantial
evidence/error of law standard when it reviews a decision by an ALJ to
determine whether to grant a request for review. 20 CFR 404.970, 416.1470.
SSA adds definitions of the terms "substantial evidence" and "preponderance
of the evidence" for use in applying these rules.
"Preponderance of the evidence” means “such relevant evidence that as a
whole shows that the existence of the fact to be proven is more likely than not."
20 CFR 404.901, 408.1001, 416.1401.
"Substantial evidence” means “such relevant evidence as a reasonable mind
might accept as adequate to support a conclusion." 20 CFR sec.s 404.901,
408.1001, 416.1401.
These definitions already appear in the DSI regulations at 20 CFR 405.5.
Back to the Table of Contents
27
Notice of Proposed Rulemaking: Use of Date of Written Statement
as Filing Date, 73 Fed. Reg. 76573 ( 12/17/08) Comments due by
February 17, 2009.
The proposed rule would shorten the period within which to complete a Title II
benefits application after making a written statement of intent to file.
Specifically, SSA proposes to revise from 6 months to 60 days the time period
during which one must file an application for benefits after a prior written
statement informing SSA of the intent to file. The time will start running from
the date of a notice SSA sends explaining the need to file an application.
SSA states that this change is intended to make the time period used in the title
II program consistent with the time period used in other programs
administered under the Act. SSA states that this will make it easier for the
public to understand and follow SSA's rules, e.g., for those who are filing
concurrently for Title II and Title XVI benefits. SSA adds that the change will
also help streamline procedures for SSA field office employees who currently
use separate protective filing procedures for claims under Title II and Title XVI.
Note that the proposed rule will not become law unless it is published as a final
regulation in the federal register sometime after the comment period ends.
Back to the Table of Contents
Notice of Proposed Rulemaking: Technical Revisions to the
Supplementary Security Income (SSI) Regulations on Income and
Resources, 73 Fed. Reg. 74663 (12/9/08) Comments due by
February 9, 2009
SSA proposes to amend the SSI home counting rules to exclude from resources
a home that an individual has left due to domestic violence. Currently, a home
that one owns but which is no longer the principal place of residence counts as
an asset for SSI purposes. The proposed rule would not count the home, with
evidence of domestic violence, until the individual establishes a new principal
place of residence or otherwise takes action rendering the home no longer
excludable.
SSA proposes to eliminate the liquid resources limitation on the ability to elect
conditional SSI payments while attempting to dispose of an excess non-liquid
resource. A prerequisite for receiving conditional SSI payments is that the
individual may not have countable liquid resources in excess of 3 times the
monthly SSI FBR. It is this prerequisite that SSA proposes to eliminate since in
2009 the limit on liquid resources exceeded the statutory limit on total
resources ($2,000 for an individual and $3,000 for a couple) and became
meaningless.
SSA also proposes several "technical corrections" regulatory amendments, most
of which are required by the Consolidated Appropriations Act of 2001, the
Economic Growth and Tax Relief Reconciliation Act of 2001 (EGTRRA), an
amendment to the National Flood Insurance Act of 1968, the Energy
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Employees Occupational Illness Compensation Program Act of 2000, and the
Social Security Protection Act of 2004 (SSPA). Most of these revisions were
effective in 2001 and have been implemented via POMS, e.g.:
Effective 1/1/01, treatment of statutory employees (e.g., agent-drivers,
commission-drivers, home workers) as self-employed individuals, which means
that their earnings are countable as net self-employment income. POMS SI
00820.100;
Effective 1/1/01, treatment of refundable child tax credit from both income in
the month of receipt and from resources for the following month for SSI
purposes. POMS SI 00820.570, SI 01130.675;
Effective 1/7/05, treatment of certain flood mitigating payments from income
and resource counting for SSI (or any federal means-tested benefits)
purposes. SI 00830.099E.
Back to Table of Contents
Emergency Messages
EM-09011, Medicare Part D Extra Help (Subsidy) – Effect of the
American Recovery and Reinvestment Act of 2009 (P.L. 111-5) on
Income and Resources
On February 17th, 2009, President Osama signed into law the “American
Recovery and Reinvestment Act of 2009” which provides for economic
recovery payments of $250 to certain Social Security, Railroad Retirement,
Veterans Administration, and Supplemental Security Income beneficiaries.
These one-time $250 payments will be issued starting in May 2009.
The emergency message explains how these payments will be treated for
purposes of determining eligibility for Medicare Part D Extra Help (Subsidy).
$250 payment not counted as income
The one-time payment will not be counted as income for purposes of
determining eligibility for the Part D subsidy.
$250 economic recovery payment’s effect on resources
The one-time payment will not be counted as a resource for the month of
receipt and the following 9 months. For example, if the individual receives a
payment in May 2009, it is not a resource for May 2009 and is excluded from
resource counting from June 2009 through February 2010.
EM-09010, Effect of American Recovery and Reinvestment Act of
2009 P.L. 111-5 on SSI Income and Resources
The emergency message explains how the Economic Recovery Act payment will
be treated for purposes of determining eligibility and payment amount for
TXVI Supplemental Security Income (SSI).
29
$250 payment not counted as income
The Economic Recovery Act payment will not be counted as income for
purposes of determining eligibility and payment amount for SSI.
$250 payment effect on underpayments and overpayments
The payment is not a SSI payment; therefore, it cannot be used to recover an
existing SSI overpayment or be included as part of an SSI underpayment.
$250 payment effect on resources
If the payment is retained by the SSI recipient, it will not be counted as a
resource for the month of receipt or for 9 months following the month of
receipt. For example, if the payment is received in May 2009, it will be excluded
from resources in May 2009 through February 2010. The funds, if retained,
would be countable as a resource starting in March 2010.
Back to the Table of Contents
EM-09003, Conditional Benefits Liquid Resource Limits
(1/13/2009)
EM directs SSA staff to deny SSI applications in all cases where an individual or
a couple filing for SSI conditional benefits has liquid resources in excess of
$2,000 for an individual or $3,000 for a couple.
An individual or couple who meets all financial eligibility requirements for
Supplementary Security Income (SSI), but fails to meet the resource
requirement due solely to excess nonliquid resources, can receive SSI
benefits conditionally (conditional benefits) for a limited period of time while
they attempt to sell the nonliquid resources.
Currently, to be eligible for conditional benefits an individual’s or couple’s
countable liquid resources cannot exceed three times the applicable Federal
Benefit Rate (FBR). In January 2009, for the first time, three times the FBR
exceeds the statutory SSI resource limits of $2,000 for an individual and
$3,000 for a couple. Beginning January 2009, individuals or couples who have
liquid resources exceeding the statutory $2,000/$3,000 resource limits are
NOT eligible for conditional benefits. All other criteria for conditional benefits
remain the same.
Please refer to SI 01150.200 Conditional Benefits in General for more
information on conditional SSI benefits.
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30
HALLEX
Transmittal No. I-2-73, Prehearing Analysis and Case Workup
The Transmittal incorporates updated ODAR instructions on critical cases.
Hallex I-2-1-40 has been modified to include references and necessary
procedures for Compassionate Allowance cases (CAL). In January 2008, SSA
made changes to the requirements for terminal illness (TERI) cases.
Additionally, in October 2008, the agency indicated that any previous
designations to Military Service Disability Claims (MSDC) should now be
referred to as Military Service Casualty Cases (MSCC). All MSCC cases must be
processed as critical cases.
Under curtain circumstances ODAR may designate a case requiring special
expedited processing as a “critical case.” SSA must use the Critical Request
Evaluation Sheet to evaluate cases for purposes of expedited review in the
following five situations:
The claimant’s illness is terminal (TERI cases);
The case involves a disability claim for any military service personnel injured
October 1, 2001 or later regardless of how and where the disability occurred;
The case is designated as a Compassionate Allowances case (CAL);
The claimant is without, and is unable to obtain food, medicine or shelter
(Dire Need case);
There is an indication that the claimant is suicidal or homicidal.
Critical Cases must be prepared for a hearing or considered for a possible on
the record decision (OTR) on an expedited basis. ODAR must schedule critical
cases in the first available open hearing slots after consultation with the
claimant and his/her representative and coordination of any expert
witnesses. If there are less than 20 days before the hearing date, the claimant’s
case should be scheduled only if the claimant and his/her representative waive
the right to the 20-day advance notice of hearing in writing.
If a claimant calls or walks in with an allegation of a critical situation, the
ODAR employee must complete a record of contact (SSA-5002) and obtain as
much information as possible using the Critical Request Evaluation Sheet. The
claimant may use SSA-795 to describe his/her critical situation. If a critical
allegation is received by fax/mail, the ODAR employee who handles the mail
must fill out the Critical Request Evaluation Sheet and bring the case to the
attention of the “critical case designator” who can be the Hearing Office Chief
Administrative Law Judge (HOCALJ) or his/her designee.
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TERI
POMS DI 11005.601 provides general guidance in the identification of TERI
cases. The list shown in the POMS is not all-inclusive.
Military Service Casualty Case (MSCC)
SSA will expedite disability claims of any military service personnel injured
October 1, 2001 or alter regardless of how or where the disability occurred
provided that the individual was on active duty when the injury occurred. The
term “active duty” applies to:
Individuals on full time duty in the U.S. Army, Navy, Air Force, Marine Corps,
or Coast Guard and includes active duty training;
Students at U.S. Military, Naval, Air Force, or Coast Guard academies;
National Guard components of the U.S. Army and the U.S. Air Force ordered to
active federal full time duty by the President in times of war or national
emergency;
Reserve components of the U.S. Army, Navy, Air Force, Marines, and Coast
Guard and includes active duty during full time training, annual training duty,
and attendance while in the active service at a school designated as a Military
Service School by law or by the Secretary concerned.
Compassionate Allowance Cases (CAL)
CAL cases include any case already identified as such when received by the
ODAR, or any previously undesignated case in which a newly identified medical
condition would qualify under the Listing of Impairments based on minimal
objective medical information. The list of qualifying impairments is at
http://www.socialsecurity.gov/compassionateallowances/conditions.htm
Please note that paper cases are not initially considered for CAL because CAL
cases are identified via the “productive model” electronically. ODAR may
designate a paper case as CAL upon review of the claim or receipt of any
additional medical evidence.
Dire Need Cases
A dire need situation exists when a person has insufficient income or resource
to meet an immediate threat to health or safety (lack of food, clothing, shelter
or medical care). The claimant must allege specific circumstances when
requesting expedited processing. Absent evidence to the contrary, ODAR must
accept a claimant’s allegation that he/she does not have enough income and
faces an immediate threat to health or safety. If the allegations are
questionable ODAR must contact SSA field office and request verification.
SSA instructions direct ODAR to “err on the side of expediting versus not
expediting” the claim whenever individual consideration is necessary.
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POMS
GN 00502.113 Interviewing the Payee Applicant (01-09)
This POMS section sets out procedures for interviewing payee applicants in the
filed office (FO). SSA staff must use the interview to:
determine the applicant's qualifications and motive for filing to be a payee;
judge the applicant's ability to carry out the payee's responsibilities; and
explain the payee’s duties, reporting responsibilities, and liability of noncompliance of reporting.
The staff must explain to the payee applicant that, in completing the
application, the applicant states that he or she:
agrees to receive benefits on behalf of the beneficiary and use or conserve
them in the beneficiary's best interest;
understands the reporting responsibilities which have been explained to him
or her; and
is willing to carry out the responsibilities of a payee, and understands the
liability for any overpayment for which they are at fault.
Face-to-Face Interviews
FO staff must interview each payee applicant (including parents with custody
who are completing an application for Social Security benefits and
Supplemental Security Income for a child) in a face-to-face setting unless doing
so would cause undue hardship or the payee applicant previously had a face-toface interview, is currently serving as a payee and is qualified to do so. SSA
always has the discretion to require a subsequent face-to-face
interview if SSA determines that one is needed to protect the
beneficiary’s interests (i.e., any question about the payee’s past
performance or compliance of reporting requirements).
Undue hardship might exist if:
an applicant lives too far from the FO and a field visit is not possible, or work
prevents the applicant from visiting the FO during regular business hours.
A face-to-face interview is always required if the applicant, residing in the US,
does not have a SSN.
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Telephone Interviews
In the event a face-to-face interview is not required, a telephone interview will
be sufficient. POMS instructions direct SSA staff to explain the prospective
payee his/her responsibilities:
• meeting with the beneficiary on a regular basis to ascertain his/her current
and foreseeable needs;
• using funds in the beneficiary's best interest;
• conserving and investing benefits not needed for the beneficiary's current
needs;
• keeping detailed and accurate records of how benefits are used in order to
provide an accurate report to SSA when requested;
• reporting events that may affect the beneficiary's entitlement or amount of
payment (including the beneficiary's death or incarceration);
• cooperating with Title XVI periodic redeterminations of eligibility;
• ensuring that medical treatment is obtained for minor children receiving
SSI disability payments;
• reporting changes of address and custody;
• reporting any change in circumstances which would affect performance as
payee;
• returning any benefits to which the beneficiary is not entitled;
• acting for the beneficiary on matters relating to the beneficiary's claim;
• notifying SSA if the beneficiary no longer needs a payee; and
• turning over any conserved funds or unused benefits to SSA when services
as a payee terminate.
A payee has no authority to enter into any binding contracts on behalf of the
beneficiary and must refrain from doing so.
Organizational Payees
Organizational payees must perform all the duties listed above. In addition,
because organizational payees often have access to a wider range of services,
SSA must encourage organizations to go beyond managing finances and to be
actively involved in the beneficiary's life. Other ways organizations can help
beneficiaries include:
• establishing a budget and involving the beneficiary as much as possible;
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• explaining Social Security and/or SSI payments and the beneficiary's
expenses to the beneficiary;
• ensuring that the beneficiary is aware of current and large retroactive
payments;
• helping the beneficiary find other services he/she needs (e.g., food stamps,
housing subsidies, etc.);
• learning all impairment-related-work expenses, blind countable expenses,
and reporting them to SSA so the beneficiary can take advantage of work
incentives in the program and perhaps higher benefit payments;
• helping the beneficiary complete applications for other needed services and
cooperating with caseworkers; and
• helping the beneficiary file income tax returns and recommending an
alternate person or agency if they can no longer serve as payee for the
beneficiary.
Back to the Table of Contents
Internet Resources
Spotlight on New Web Resources:
www.DoctorScoreCard.com- This independent site provides a forum for
consumers to “exchange experiences regarding doctors and medical
businesses.” One can look up licensing information and information about
pending or past litigation by identifying a doctor’s name and location.
Consumers assign ratings to each doctor who, in turn, is given an opportunity
to post a comment or rebut a critical review. The site may be useful in finding
background information about medical specialists who conduct consultative
examinations and/or provide testimony at SSA hearings.
website sponsored by the Department of Transitional Assistance provides a
searchable list of free tax assistance sites in MA. Trained volunteers may help
consumers verify eligibility for possible tax credits and fill out forms.
Other Web Resources:
Back to Table of Contents
Resource for Seniors Looking for Information on Reverse
Mortgages
The Executive Office of Elder Affairs (EOEA) and the Office of Consumer
Affairs and Business Regulation (OCABR) launched a new web site to educate
seniors about an increasingly popular product, reverse mortgages.
35
The web site, Reverse Mortgage Loans - Office of Consumer Affairs and
Business Regulation, is designed to provide information and guidance to
potential borrowers about this complicated product. The website contains a list
of approved Reverse Mortgage Counselors The local elder services provider at
1-800-AGE-INFO (1-800-243-4636) and the Division of Banks at (617)9561500 may also address any questions consumers have.
Benefit Calculator - Beginning July 19, 2008, the public will be able to use a
new benefit estimator at the SSA website at
<www.ssa.gov/planners/calculators.htm.>
All MA courts decisions issued since February 25, 2008, have been posted at
www.massreports.com, the website of the office of the Massachusetts Reporter
of Decisions. Future summary decisions pursuant to Rule 1:28 will also be
available online at that location. Attorneys and the general public may search
decisions by docket number, release date, party name, and work or phrase.
SSA has created a “Wounded Warriors” website at
www.ssa.gov/woundedwarriors The site explains what types of benefits are
available, how to apply, and what can be done to speed up the determination of
eligibility. It also includes links to new SSA publication “Disability Benefits for
Wounded Warriors.” Military service members can receive expedited
processing of disability claims from Social Security. The expedited process is
used for military service members who become disabled while on active
military service on or after October 1, 2001, regardless of where the disability
occurs.
Veterans agents in MA. Every city and town in MA has a veteran agent who
can connect vets with services, including representation by veteran’s service
officers in Veteran’s benefits eligibility cases.
National Consumer Law Center’s Student Loan Borrower Assistance
Project at http://www.studentloanborrowerassistance.org/ is a resource for
borrowers, their families, and advocates representing student loan borrowers.
This site is for people who already have student loans and want to know more
about their options and rights.
Plan to Achieve Self-Support (PASS) info from the University of Montana
Rural Institute: http://www.passplan.org/.
Work Incentives Planning and Assistance (free service counseling clients
about the effect of work on SSI/SSDI and other public benefits):Project
IMPACT, BenePLAN
Review regulations currently under review by the Office of Management
and Budget for a sneak preview of proposed and final regulations on the
horizon. Just select SSA from the drop-down list. Check out the Reg Map for
an overview of the informal rulemaking process.
Reports from Congressional Research Service - The Congressional
Research Service (CRS) provides nonpartisan policy and legal analysis to
36
committees and members of Congress. The CRS issued a series of studies and
fact sheets relating to disability benefits and Supplementary Security Income
(SSI) benefits. The CRS website is at
<http://www.loc.gov/crsinfo/whatscrs.html>
Disability Law Center of Massachusetts: www.dlc-ma.org. The Protection
and Advocacy agency for people with disabilities in Massachusetts. Also home
of the Disability Benefits Project support center. There are lots of user-friendly
information sheets about SSI and SSDI at http://dlc
ma.org/Resources/benefits.htm. http://www.masslegalservices.org.This
website is a collaborative effort of all the MLAC- funded legal services
programs, including the Disability Benefits Project of the Disability Law Center.
DLC manages the Disability section of the website. Our goal is to use the
website to keep advocates informed of new developments in SSI/SSDI law and
practice, share practice materials and resources that are at the heart of
disability benefits practice, and help make internet-based legal research
accessible and even fun for advocates.
In order to have access to the advocate-only material on the website, you need
to sign up and log in. To do this, go to http://www.masslegalservices.org/login.
You don’t need to be a legal services advocate to benefit from the website,
however. Most of the materials posted in the Disability and other sections are
available to public. In addition, members of the SSI coalition, including
private attorneys, can get access to the restricted parts of the website by
permission. This website is a work in progress. If you have resources you want
to share with other advocates, let us know. Please direct your comments and
questions to Svetlana Uimenkova at suimenkova@dlc-ma.org or 617-723-8455
x133.
SSA Website: http://www.socialsecurity.gov. The regulations, POMS,
HALLEX, and other useful resources are at
http://www.socialsecurity.gov./regulations/index.htm. You can also find them
by clicking on “Our Program Rules” on the right hand side of the home page of
http://www.socialsecurity.gov. SSA has been steadily expanding its online
services. To see what you can do online at SSA’s website, go to
http://www.socialsecurity.gov/onlineservices/#benefits.
National Organization of Social Security Claimants’
Representatives: http://www.nosscr.org/.
National Senior Citizens Law Center: http://www.nsclc.org/.
Martin on Social Security:
http://www.law.cornell.edu/socsec/martin/.
Social Security Advisory Service: http://www.ssas.com/.
Masshealth (formerly the Division of Medical Assistance):
http://www.state.ma.us/dma/.
MassHealth Defense Group:
http://www.hcfama.org/index.cfm?fuseaction=Page.viewPage&pageId
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=175.
Affiliated with the Massachusetts Law Reform Institute and Health Care for All.
Information about changes and proposed changes to the MassHealth programs.
Medicare Prescription Drug (Part D) Information:
 Center for Medicare and Medicaid Services:
http://www.cms.hhs.gov/PrescriptionDrugCovGenIn/.
 Government website for Medicare beneficiaries:
http://www.medicare.gov.
 Social Security info on Low-Income Subsidy (extra help):
http://www.socialsecurity.gov/prescriptionhelp/.
 MassMedLine. Information re: discounted and free prescription
medication programs; free analysis and comparison of Medicare
Prescription Drug Plans. Run by Mass. College of Pharmacy and Health
Sciences. http://www.massmedline.com.
 Medicare Rights Center info on Prescription Drug Plan:
http://www.medicarerights.org/drughelp.html.
Medical Resources
 MA Board of Registration in Medicine, http//www.massmedboard.org.

erck Manual online, http://www.merck.com/pubs/mmanual.

IH Medication Information,
www.nlm.nih.gov/medlineplus/druginformation.html.

ational Library of Medicine Journals,
http://www.ncbi.nlm.nih.gov/pubmed\.

ink to all institutes within National Institutes of Health,
http://www.nih.gov/icd/.

enters for Disease Control, http://www.cdc.gov.

Tests Online at http://www.labtestsonline.org Provides better
understanding of lab tests during routine care, as well as diagnosis and
treatment of a broad range of conditions and diseases.
Find out how to get vital records in every state at the CDC’s National Center
for Health Statistics at http://www.cdc.gov/nchs/howto/w2w/w2welcom.htm.
Government Printing Office, for access to federal regulations and statutes,
the Federal Register, and other government publications. Government Printing
Office, for access to federal regulations and statutes, the Federal Register, and
other government publications http://www.gpoaccess.gov/index.html.
Figure out appeal deadlines look at calendars for years past and future,
calculate the number of days between two dates at
http://www.timeanddate.com/.
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The Government Accountability Office produces many interesting reports
on the SSI and SSDI programs. Get GAO reports at http://www.gao.gov.
Thanks to advocates for sharing their web finds. If you know of useful Website
that you want to share with us, contact Linda Landry at llandry@dlc-ma.org or
Svetlana Uimenkova at suimenkova@dlc-ma.org
Back to Table of Contents
The SSI Coalition Newsletter is a publication of the Disability
Benefits support unit at the Disability Law Center of Massachusetts.
This newsletter is an electronic publication designed to provide
access to all persons with disabilities. The design is printer
friendly. Current and past issues of the newsletter can be viewed on
www.masslegalservices.com in the Disability section.
Please note that some administrative decisions and articles
referenced in the newsletter are restricted to legal services
advocates and members of SSI Coalition.
39