1. ODMH Expedited SSI and Medicaid Application Procedures Training Program Conducted by the Social Security Administration and the Ohio Bureau of Disability Determination

2. Social Security Administration Disability Programs Disability Programs

3. Types of Disability Programs  Social Security benefits for workers  Social Security benefits for adults disabled since childhood  Social Security benefits for disabled widows  Supplemental Security Income (SSI) for children and adults

4.  To qualify, the disabled person must have a recent work history  Special rules apply to younger persons who need less work to qualify Social Security Disability Insurance

5. The amount of work you need depends on your age at the time disability starts  Before age 24 — 1-1/2 years of work in a three-year period before becoming disabled  Age 24-31 — work during half the time between age 21 and the time the disability began  Age 31 or older — work during five out of the 10 years before the disability began Social Security Disability Insurance Work Requirements

6. Work Credits  In 2009 it takes $ 1,090 to earn 1 work credit — $ 2,180 earns 2 work credits — $ 3,270 earns 3 work credits — $ 4,360 earns 4 work credits (maximum number of credits in 1 year)  Amount of earnings needed to earn a work credit changes every year Social Security Disability Insurance

7. Amount of Benefits  Benefits are calculated based on your entire work history  If your Social Security benefit amount is lower than the full SSI payment, you may be eligible to receive both Social Security and SSI Social Security Disability Insurance

8. Benefits can be paid on the record of a disabled, retired or deceased parent to an unmarried child of any age if the child became disabled before the age of 22 Social Security Benefits for Adults Disabled Since Childhood

9. Who Is a Child?  Natural Legitimate Child  Stepchild  Legally Adopted Child  Illegitimate Child  Other

10. Social Security Benefits for Disabled Widows Requirements for Entitlement Legal Spouse of Deceased Worker Surviving Divorced Spouse Married 10 Years Age 50 But Not Yet 60 Disabled Within 7 Years of Workers Death Unmarried or remarriage occurred after age 50 and onset of disability

11. Medicare Coverage  Automatic enrollment in Medicare after being entitled to disability benefits for 24 months  Information about Medicare is sent several months before coverage starts NOTE: People who have permanent kidney failure requiring dialysis or a transplant or have amyotrophic lateral sclerosis (Lou Gehrig’s disease) may qualify for Medicare almost immediately

12.  Spouse, if he or she is 62 or older  Spouse, at any age if he or she is caring for a child of worker who is younger than age 16 or disabled  Unmarried child, including an adopted child, or, in some cases, a stepchild or grandchild. The child must be under age 18 or under age 19 if in elementary or secondary school full time  Unmarried child, age 18 or older, if he or she has a disability that started before age 22. (The child’s disability also must meet the definition of disability for adults)  A divorced spouse if he or she was married to worker for at least 10 years, is not currently married and is at least age 62 NOTE: The money paid to a divorced spouse does not reduce your benefit or any benefits due to your current spouse or children Benefits for Family Members Family members may be eligible for Social Security benefits

13. Who Can Get SSI? People with limited income and resources who are: Supplemental Security Income (SSI) disabled, at any age; or blind, at any age; or age 65 or older

14.  Resource limits — $ 2,000 for individual — $ 3,000 for couple  We count — bank accounts (CDs, IRAs) — second car — stocks and bonds, 401Ks — liquid assets — property other than where you live SSI Benefits for Adults

15.  We don’t count as resources — home in which you live — first car — burial plots — some resources set aside for burial

16. Disability for All Adults (Over Age 18) Both Social Security and SSI  Must have a physical or mental impairment (or combination of conditions)  Inability to perform substantial work activity  Disability must be expected to last 12 consecutive months or result in death  We consider age, education and past work activity

17. The Application Process - Current  A paperless process  Application and disability report completed online at www.socialsecurity.gov, or during office/phone interviewwww.socialsecurity.gov  SSA creates Electronic Folder (EF) to house all forms and medical evidence  EF transferred from SSA office to Ohio Bureau of Disability Determination (OBDD) for medical decision

18. The Application Process - Current  OBDD requests medical evidence from providers  Provider has paper records  Scans records to make them electronic  Using barcode fax records to BDD to convert to electronic  Mail per instructions on BDD request letter  Provider has electronic records  Send records by uploading to Electronic Records Express secure website (ERE)

19. The Application Process – Project Overview  SSA applications, forms and questionnaires submitted with medical evidence to local SSA office as a complete package (Refer to “Checklist”)  Local office creates EF and adds all forms and evidence, begins development of non-medical eligibility factors, transfers EF to OBDD for medical decision  OBDD requests any additional medical evidence from mental health provider

20. The Application Process – Project Overview  Mental health provider submits evidence via fax gateway using barcode (866 755-6629) or ERE website  OBDD makes medical eligibility determination  SSA effectuates decision  If approved SSA may contact mental health provider for any needed non-medical evidence

21. The Application Process – Project First Steps  Initial contact between local SSA office and mental health provider to establish working relationship; then case by case…  Applicant often unaware of status with SSA  Obtain SSA-1696 at screening – allows for release of information  Contact local SSA liaison to discuss current entitlement and potential eligibility  SSA establishes protective filing for benefits based on contact

22. What You Can Complete Online Social Security Disability Benefits  Complete the Internet Disability Application (SSA-16) online at: http://www.socialsecurity.gov/applyfordisability/ http://www.socialsecurity.gov/applyfordisability/  Complete the Adult Disability and Work History Report-PRO (Form SSA-3368) online at: https://secure.ssa.gov/apps6z/i3368PRO/main.html

23. What You Can Complete Online Supplemental Security Income (SSI)  Complete the Adult Disability and Work History Report-PRO (Form SSA-3368) online at: https://secure.ssa.gov/apps6z/i3368PRO/main.html  Application for SSI (Form SSA-8000-BK) must be completed as a paper form

24. Visit Our Website www.socialsecurity.gov Visit Our Website www.socialsecurity.gov

25. ODMH Expedited Pilot Project Forms Needed

26. Application for SSI (SSA-8000-BK) Pays benefits to disabled adults and children who have limited income and resources. Also pays benefits to people 65 and older without disabilities who meet financial limits

27. Authorization to Disclose Information (SSA-827) Used to obtain medical and other information needed to determine whether or not a claimant is disabled.

28. Disability Report (SSA- 3368BK) Provide information about claimant and their medical condition, healthcare providers, medications, education, and job skills. If completed online, indicate date of completion and confirmation #

29. Work History (SSA-3369) Needed for the disability determination. Work experience is a vocational factor that helps determine what jobs an individual can do. If completed online, indicate date of completion and confirmation #

30. Online Disability Report (i3368 PRO) The iPRO gathers all of the same information you’re used to putting on a paper 3368 and 3369

31. Appointment of Authorized Representative (SSA-1696-U4) A representative can help with: completing forms; going with you to your local Social Security office; interpreting for you; gathering and giving information; taking you to medical examinations, tests, or to your local Social Security office; receiving mail for you at his or her address.

32. Physician/Medical Statement (SSA-787) This form is used to determine if we should pay this person directly or if he or she needs a representative payee to handle the funds

33. Mental Status Questionnaire Appearance and Behavior Flow of Conversation and Thought Affect and Mood Anxiety Issues Substance Abuse History Mental Content Bodily Concerns Sensory and Cognitive Functioning Intellectual and Memory Functioning Insight and Judgment

34. Daily Activities Questionnaires Living Arrangements Sleeping Habits Personal Care Meals/Eating Habits Shopping Social Contacts Concentration and Memory Treatment (Medications)

35. Medical Records and Other Pertinent Information Psychiatric Assessments Psychiatric/Nursing Notes Progress Notes Hospitalization/Crisis Shelter information IEP Claimant’s Statement Other Pertinent Information

36. Additional Forms Request for Representative Payee provides financial management for the Social Security and SSI payments of our beneficiaries who are incapable of managing their Social Security or SSI payments. Generally, we look for family or friends to serve in this capacity. When friends and family are not able to serve as payee, Social Security looks for qualified organizations to be a representative payee.

37. Additional Forms (cont.) Advance Notice of Representative Payee

38. Bureau of Disability Determination Fatimata Kamara 614-438-1839 fatimata.kamara@ssa.govfatimata.kamara@ssa.gov Darlynn Nero 614-438-1709 darlynn.nero@ssa.govdarlynn.nero@ssa.gov

39. Definition of Disability  Inability to engage in Substantial Gainful Activity (work)  Due to a Medically Determinable Impairment (mental/physical)  Expected to or having lasted for no less than 12 months or  Expected to result in death

40. Application filed at SSA-FO Forwarded to DDS for Medical Development & Decision Assigned to DCA – Primary Point of Contact Obtains & analyzes supporting medical & non-medical evidence

41. Sequential Evaluation 5 Step Evaluation Process SGA Severe Impairment Meets/Medically Equals Listing Severity Return to Past Work Ability to Perform Other Work

42. Listing of Impairments Medical evaluation criteria ensures program consistency May be accessed at: www.socialsecurity.gov/ www.socialsecurity.gov/ disability/pdisability/professionals/bluebook

43. MENTAL LISTINGS 12.02 Organic Mental Disorders 12.03 Schizophrenia, other Psychotic Disorders 12.04 Affective Disorders 12.05 Mental Retardation

44. MENTAL LISTINGS 12.06 Anxiety Related Disorders 12.07 Somatoform Disorders 12.08 Personality Disorders 12.09 Substance Addiction Disorders 12.10 Autism and other PDD

45. Drug and Alcohol Use Details of Drug and Alcohol use are needed, including:  Frequency of use  When last use occurred  Periods of sobriety  Functional limitations when using  Functional limitations when sober

46. A Criteria--Substantiates the particular mental disorder. It contains a composite of the medical criteria usually used to establish the presence of that impairment. LISTING STRUCTURE

47. Examples of A Criteria Medically documented persistence, either continuous or intermittent, of one/more of the criteria in the listings, examples include: Delusions/Hallucinations Incoherence, loosening of associations, illogical thinking, or poverty of content of speech if associated with the following: Blunt, Flat, or Inappropriate affect Emotional withdrawal and/or isolation

48. LISTING STRUCTURE B Criteria--Assesses the severity of the impairment. It is expressed in terms of functional limitations

49. THE B &C CRITERIA 1. Activities of Daily Living 2. Social Functioning 3. Concentration, Persistence or Pace 4. Episodes of Decompensation Document episodes of decompensation, including duration

50. THE FIVE CONTEXTS USED TO 1. Effectiveness or Quality 2. Independence 3. Appropriateness 4. Sustainability 5. Longitudinal History EVALUATE B1 AND B2

51. Effects of Medication Effects of a Structured Setting

52. Acceptable Medical Sources Psychiatrists Licensed Clinical Psychologists School Psychologists for Mental Retardation and Other Learning Disorders

53. Other Good Sources of Information MH Counselors/Therapists Hospitals/ Clinics Rehabilitation Centers Schools

54. GENERAL DOCUMENTATION REQUIREMENTS FOR MENTAL CLAIMS 1. History 2. Mental Status Exam 7. Capability 3. ADL’s 4. Social Functioning 5. Concentration, Persistence, Pace 6. Deterioration and Decompensation

55. Completing ODMH forms Mental Status Questionnaire  Ensure all information is consistent with the medical evidence in file  If inconsistencies exist, explain them Daily Activities Questionnaire  Ensure that the claimant’s day to day functioning is fully described  Where problems exist in functioning, be sure to describe problems in detail

56. ODMH Checklist  In addition to SSA forms  BDD needs as much medical and functional evidence as possible to make a fair and accurate decision. Evidence can be given to the SSA office upon filing Evidence can be faxed to BDD using a barcode after the case is transferred from SSA to BDD.

57. Final Determination Adjudicator must consult with and have decision signed by physician/ psychologist prior to finalizing

58. Notification By Mail Appeal Rights DDS Accountability