FAQ

The Mental Status Exam must be performed by an "Acceptable Medical Source" (AMS) in order to establish a "medically determinable physical or mental impairment."

Acceptable Medical Sources include physicians, psychologists, advanced practice nurse practitioners (APRN), or physician assistants (PA).  Further, the APRN category includes: Certified Nurse Midwife, Nurse Practitioner, Certified Registered Nurse Anesthetist, and Clinical Nurse Specialist. Audiologists are also acceptable medical sources for hearing-related disorders.

Licensed Clinical Social Workers (LCSWs) are not included.

Great question! While we do typically advise to collect all records, 500 pages is understandably a lot! Not all applicants will have this many, but if you are seeing that certain hospitals/providers tend to send significant amounts (particularly if they aren't helpful for the application), you could ask for: Inpatient hospitalization records, discharge summaries, outpatient/emergency records, and psychiatric examinations/mental status exams. Those are all pretty key for the application. When you submit the records to DDS, I'd recommend adding a note that these were all that you requested, so that it doesn't look like you just weren't sending everything you have.

Generally speaking, medical providers are not legally bound to provide records to a third party. They are not required to provide records to DDS, either. However, HIPAA regulations require healthcare providers to provide individuals copies of their own records: 

"The Privacy Rule generally requires HIPAA covered entities (health plans and most health care providers) to provide individuals, upon request, with access to the protected health information (PHI) about them in one or more “designated record sets” maintained by or for the covered entity.”

We hear from most SOAR providers that they are able to get medical records from most sources. Some states have special laws that cover access to records for disability applications. We also do our best to build relationships with commonly used providers and the medical records departments to try to improve those relationships, and clarify and expedite processes.

Yes, you should file a SOAR-assisted application because even if you don’t have access to the medical evidence, DDS will request directly from prior treating sources and/or schedule appropriate Consultative Examinations (CE) to obtain diagnoses. Remember, SSA needs a diagnosis to make a disability determination. Remember, to write in the “Remarks Section” on SSA forms, about your efforts to obtain medical information so that DDS will know what they need to do to medically develop the claim.

HIPAA requires medical providers to release the patient's records within 30 days after the request is received (https://www.hhs.gov/hipaa/for-professionals/privacy/guidance/access/ind…). Some states have laws that require the release of medical records in fewer than 30 days.

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

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.  

If a person is approved for both SSI and SSDI they will maintain Medicaid because SSI benefits include Medicaid. However, some states require a separate Medicaid application, (https://www.ssa.gov/disabilityresearch/wi/medicaid.htm).

Medicaid coverage for services varies from state to state. Here is a link that will take you to your state's Medicaid agency: https://www.medicaid.gov/about-us/contact-us/contact-state-page.html.

SSDI benefits include Medicare, but there is typically a 24 month waiting period before the SSDI beneficiary can begin to have Medicare coverage (see Page 12 at https://www.ssa.gov/pubs/EN-05-10029.pdf).

Once the beneficiary has both Medicaid and Medicare, Medicare is typically the primary insurance.