FAQ

The Medical Summary Report (MSR) Interview Guide and Template is a great tool for writing the MSR. The Interview Guide portion contains key questions to ask applicants when gathering evidence for the application. The Template contains main headings that may be used when formatting the MSR. Be sure to remove the Interview Guide and guidance under the Template headings before turning the MSR in to DDS. It is also important to put the MSR on your agency's letterhead whenever possible.

This guide and template can be found on the SOAR Tools and Worksheets page.

When providers of substance use services (drug and alcohol) release records, they are required to include the following notice from the CFR Title 42:2.32:

“This information has been disclosed to you from records protected by Federal confidentiality rules (42 CFR part 2). The Federal rules prohibit you from making any further disclosure of this information unless further disclosure is expressly permitted by the written consent of the person to whom it pertains or as otherwise permitted by 42 CFR part 2. A general authorization for the release of medical or other information is NOT sufficient for this purpose. The Federal rules restrict any use of the information to criminally investigate or prosecute any alcohol or drug abuse patient.” Source: http://edocket.access.gpo.gov/cfr_2002/octqtr/42cfr2.32.htm

However, the law allows the records to be disclosed to any entity the person names in the consent. When you complete the SSA-827: Authorization to Disclose Information to SSA be sure that it specifically mentions the release of drug and alcohol treatment records.

We recommend using headings throughout the MSR to divide information so that DDS can quickly find the evidence they are looking for. These headings typically include: personal history, employment, physical health, psychiatric health, and functional information. You can include sub-headings in these categories to further organize the information if you’d like.

Naturally, information may overlap in some of the sections. For instance, in legal history you may talk about how an applicant’s incarceration was related to their symptoms and then add extra information about symptoms in medical history. In these areas of overlap, there’s no need to repeat information you have already provided. By avoiding excessive repetition in the MSR and grouping the information using broad headings, we can help walk DDS through the documentation of how the applicant meets the disability criteria.

The SOAR TA Center is available to review Medical Summary Reports from SOAR practitioners. To submit your MSR for review, email soar@prainc.com and attach your MSR with the applicant’s name, birthdate, and Social Security number removed for HIPAA compliance.

1619(b) is continued Medicaid coverage for those individuals that were receiving SSI benefits prior to returning to work. You can find more information on SSA's website here: http://www.socialsecurity.gov/disabilityresearch/wi/1619b.htm

Trying to write the Medical Summary Report (MSR), a key component of the SOAR approach, can seem challenging at first. Everyone is going to have a different approach to writing that works for them.

We recommend starting with the Medical Summary Report Worksheet as a template.  Work on only one section in each sitting.  Breaking it up into smaller chunks can take some of the pressure off of writing a long report. It may also help if you don't set a target length. Think about just writing a letter that tells all you know about someone's Personal History, Psychiatric History, or Functional Information. If you can get a couple sections complete and then put them together, you will likely see that the MSR comes together easier than you anticipated.

For more information about Medical Summary Reports, see the SOAR Library.

Most SOAR programs that have a hospital collaboration will work with the hospital’s billing department to collect information on reimbursed expenses for each SOAR applicant approved. Some are able to separate out Medicaid and Medicare reimbursements; others have just a total for all reimbursements. The information isn't any more complicated than: "We helped 100 individuals get approved for SSI/SSDI and the hospital has been reimbursed $500,000 in the past year in Medicaid/Medicare expenses for these individuals."  It can be helpful to also collect the totals for unreimbursed expenses for those same individuals for the year prior to approval to use as a comparison.  One SOAR provider looked at emergency room usage for the year prior and the year after approval to see if there was a reduction. They found a 24 percent reduction in ER usage and 52 percent reduction in psychiatric ER usage.

Some SOAR providers will meet monthly with the billing department and collect reimbursement data, others will do it quarterly.  We would recommend doing whatever works best for the staff at the hospital and the SOAR staff.  

It is unfortunate when we run across physicians who are unwilling to help people access the benefits that they are entitled to, although it is a common problem.  Many doctors will say that they have not seen a person enough to support a report such as the MSR.  Sometimes doctors on ACT (Assertive Community Treatment) teams or in PSR (Psychosocial Rehab) programs may be willing to co-sign reports. When you can’t find a doctor to cosign the report, we recommend you submit the MSR as collateral information along with the medical records that you have collected that document the diagnostic information from a physician.  

You may want to find out why they are refusing to sign the report. Is it because they feel they don't know enough to sign it?  Or that it wasn't written by them so they don't want to sign it?  Are there other reasons?  One of the things we find is that the doctors often misunderstand what we are asking them to do. They believe that, by signing the report, they are "approving" the person for disability benefits. DDS makes that decision. What they're doing is simply attesting that the information contained in this report is true. It's fine if they even write a statement that they believe the information in this report is true. 

You might remind the doctor and the clinic/hospital that when someone is approved for SSI/SSDI they are also going to be eligible for Medicaid/Medicare which means retroactive reimbursement for services provided and ongoing payment for treatment and services in the future.  

One SOAR program contacted the state medical association for the names of retired physicians and asked if anyone was willing to do one assessment pro-bono.  It was fairly successful.