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“The only thing necessary for these diseases to the triumph is for good people and governments to do nothing.”

 

Social Security Insurance-U.S.A.

 
     

Main topics can be found within the left column; sub-topics and/or research reports can be found near the bottom of this page.  Thank you

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SSA rules:

We explain when vocational factors must be considered along with the medical evidence, discuss the role of residual functional capacity in evaluating your ability to work, discuss the vocational factors of age, education, and work experience, describe what we mean by work which exists in the national economy, discuss the amount of exertion and the type of skill required for work, describe and tell how to use the Medical-Vocational Guidelines in appendix 2 of this subpart, and explain when, for purposes of applying the guidelines in appendix 2, we consider the limitations or restrictions imposed by your impairment(s) and related symptoms to be exertional, nonexertional, or a combination of both. A decision by any nongovernmental agency or any other governmental agency about whether you are disabled or blind is based on its rules and is not our decision about whether you are disabled or blind. We must make a disability or blindness determination based on social security law. Therefore, a determination made by another agency that you are disabled or blind is not binding on us. The law defines disability as the inability to do any substantial gainful activity by reason of any medically determinable physical or mental impairment that can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less than 12 months. To meet this definition, you must have a severe impairment, which makes you unable to do your previous work or any other substantial gainful activity that exists in the national economy. To determine whether you are able to do any other work, we consider your residual functional capacity and your age, education, and work experience.

There are specific rules and requirements that must be met before even the consideration of coverage under SSA will even regard as viable before a determination will be made: income, the ability to work (or is there some other type of work the claimant can perform), education or lack or (can the claimant work at a lower scale if able to), gifts to the claimant, etc. This must be met or the claim may to rejected as unsound.

Document Name & Link to Document

Description

File Size /Type**

2007-Coverage through the “Doughnut Hole” Unlike most forms of insurance, the Medicare Part D prescription drug program has a hole in its middle. This coverage gap, colloquially known as the “doughnut hole,” is perhaps the most bizarre and troublesome aspect of the Part D drug program. After beneficiaries reach their initial limit of total drug expenses ($2,250 in 2006), they have no prescription drug coverage until their total drug expenses reach a catastrophic threshold for the year ($5,100 in 2006). While beneficiaries are in the doughnut hole, they must continue to pay their monthly premiums, although they do not receive any drug benefits. Only after they have spent thousands of dollars of their own money to get out of the hole ($2,850 in 2006), in addition to their monthly premiums, does their coverage resume. Pdf 534 kb

 

A CONSUMER’S GUIDE TO HEALTH INSURANCE This booklet, developed by the Vermont Department of Banking, Insurance, Securities and Health Care Administration, helps you understand health insurance and how it works.  It explains the different types of insurance policies available to you and what to expect once you have health insurance.  With a little knowledge, you can choose the right kind of coverage for you and your family.   
A History of the Disability Listings In order to facilitate the process, the Social Security Administration created a list of diseases and conditions which were felt to be incompatible with substantial gainful activity (gainful employment). Persons who were not engaged in substantial gainful activity, and whose conditions met the requirements of one or more of the listed conditions, were considered disabled. Called the listings, the criteria proved so useful that they were retained and revised periodically, and have been kept in continuous use ever since. Pdf 248 kb
Childhood-Disability Evaluation Under Social Security-2003 Rules and regulations for childhood disability 502 kb pdf
Compassionate Allowances Under titles II and XVI of the Social Security Act (the Act), we pay benefits to individuals who meet our rules for entitlement and have medically determinable physical or mental impairments that are severe enough to meet the definition of disability in the Act. The rules for determining disability can be very complicated, but some individuals have such serious medical conditions that their conditions obviously meet our disability standards. Pdf 53 kb

Disability

Hepatitis and Social Security Disability Benefits-What you need to know

PDF / 445 KB

Disability Evaluation Under Social Security
This edition of Disability Evaluation Under Social Security has 
been specially prepared to provide physicians and other health
 professionals with an understanding of the disability programs 
administered by the Social Security Administration.  It explains 
how each program works, and the kinds of information a health 
professional can furnish to help ensure sound and 
prompt decisions on disability claims
903 kb pdf
Disability Evaluation Under Social Security-Listing of Impairments—Part A Complete listing of impairments-2003 644 kb pdf
Disparities in State Health Coverage: A Matter of Policy or Fortune?

(Large Report-Increase Download Time)

This paper explores the reasons why states differ in their 
Medicaid coverage of the at-risk population, focusing in particular 
on the large disparities in Medicaid spending associated 
with these differences.
3378 kb pdf

 

Guilty until proven innocent-Dealing with a flawed SSDI Application process The Social Security Disability Insurance system, which is supposed to protect workers from suddenly losing all sources of income with an unexpected disability, is seriously flawed and becoming more so. There's a widespread national myth that people are "faking it". I understand that Connecticut spent over a million dollars to unroot all those fakers in their system, and only found 6  

Handbook

SSA Handbook on obtaining benefits

PDF / 8,144 KB

HEALTH AND DISABILITY INSURANCE, and SOCIAL SECURITY DISABILITY: A HANDBOOK FOR IBD PATIENTS, Patients with chronic illnesses unfortunately must advocate for themselves, whether it be with a doctor or an insurance company. Knowing your rights will help. If you have internet access, you have access to the best research tool in the world.  

Hepatitis C & Disability

Social Security disability benefits are often the ultimate safety net for persons suffering from medical impairments which make it impossible for them to work

 

Hepatitis C-Information on Disability

Links to agency’s

 

Health Hippo: Evaluations of Social Security Disability Part ONE 

(Large report-increased download time)

HIPPA regulations

 

Health Hippo: Evaluations of Social Security Disability Part TWO  

(Large report-increased download time)

HIPPA regulations  
Health Hippo: Evaluations of Social Security Disability Part THREE 

(Large report-increased download time)

HIPPA regulations  

We offer a monthly newsletter dealing with the various issues surrounding infectious diseases.  To find out more click HERE.

How States Can Make More Patients Eligible for Part D’s Full Low Income Subsidy/Extra Help at Little or Even No State Cost

 

Medicare patients with incomes (using the SSI income counting rules and disregards)  under 135% of the Federal Poverty Level, or FPL ($1103 monthly for one) and with assets (other than a home of any value; any vehicles of any value; and a separate burial fund up to $1500 per person) under $6.000 ($9,000 per couple) qualify for full Low Income Subsidy (LIS) Extra Help Medicare Part D prescription coverage: No deductible or premium; no donut hole; co-pays of only $1/$2 per generic and $3/$5 per brand name drug. Co-pays and income and asset levels will rise with inflation yearly, as will the non-Extra Help Part D premiums, deductibles and donut hole and catastrophic thresholds.  
MEDICAID AND PERSONS WITH DISABILITIES Special Medicaid Eligibility Provisions for Persons with Disabilities for New York Pdf 163 kb
Medicare Stand-Alone Prescription Drug Plans By state  
MSP PROGRAMS OFFER $88.50 MORE IN SOCIAL SECURITY CHECKS, PRESCRIPTIONS WITH SMALL CO-PAYS AND EVEN---FOR MANY-- COVERAGE OF MEDICARE DEDUCTIBLES AND CO-PAYMENTS

The little-known Medical Savings Programs (MSPs) can mean an extra $88.50 monthly in Social Security checks in 2006 and extra medical and prescription drug benefits for disabled and elderly persons who are on Medicare but are not also on SSI or Medicaid already.

 
Pulling away the safety nets The Safety Net She Believed In Was Pulled Away When She Fell Debra Potter made a good living selling disability coverage. But like many working Americans, she learned the hard way that federal law now favors insurers.  

The Language of Disability

Language. . .has as much to do with the philosophical and political conditioning of a society as geography or climate. . .people do not realize the extent to which their attitudes have been conditioned since early childhood by the power of words to ennoble or condemn, augment or detract, glorify or demean.

 

REDDICK v CHATER This case involves a claim for Social Security disability benefits by Susan Reddick ("Claimant") who was diagnosed with Chronic Fatigue Syndrome ("CFS"). The Administrative Law Judge ("ALJ") found that Claimant suffered from CFS but that she was not disabled because the disease did not undermine her ability to perform substantial gainful work. The district court concluded that the ALJ's decision was supported by substantial evidence and granted summary judgment for the Commissioner. A principal issue in this case is whether the ALJ was justified in discounting the testimony of Claimant, her treating doctor, and an examining doctor concerning her disability from fatigue, and instead relying upon the testimony of two consultative examiners who concluded that she was not disabled.  
Sample Disability Policies The following sample policy statements are for various types of disability policies.  Generally, disability leaves are granted with pay, or with pay provided through an insurance plan, and without loss of credit for the employee’s length of service with the company for short-term disability.  The following samples are for illustration purposes only.  The policy terms and conditions available from your insurer could be quite different from the terms set out in these policies.  These policies, however, should be useful in giving you a sense of how a disability policy is structured and the types of issues you’ll need to discuss with your insurer.  
Social Security Bulletin-2005 Current information about SSI benefits as of 2005 1300 kb pdf
Social Security findings should play key role ''As long as the worker can engage in 'substantial gainful activity,' he is not disabled even if the only work that he is capable of doing is only part time. E.g., Brewer v. Chater, 103 F.3d 1384, 1391-92 (7th Cir. 1997); 20 C.F.R. §404.1572(a). Of course, the work must not be so meager as not to be substantial and gainful. See 20 C.F.R. §§404.1573(e), 404.1574(a), (b). But the same, it turns out, is true under ITT's disability plan  
SSA ISSUES RULES IMPORTANT TO BENEFICIARIES IF SSA DECIDES THAT THEIR CONDITIONS ARE NO LONG DISABLING For over two decades, federal law has required that the Social Security Administration continue payment of disability benefits to a person whom SSA has determined if SSA determines that the person is participating in a vocational rehabilitation program and there is a likelihood that completing the program will make it less likely that the person will need to resume receipt of Social Security or Supplemental Security Income disability benefits in the future...The purpose of this paper is to explain the new regulations and to alert people with disabilities, their families, schools, service providers, and advocates that these regulations will take effect on July 25, 2005 and will be of significant benefit to some individuals who otherwise would lose their benefits when SSA decides that they currently are no longer disabled  
STATE ELIGIBILITY POLICIES WHICH DISCRIMINATE AGAINST THE DISABLED IN THE MEDICAID, MEDICAID WAIVER EXPANSION, CHIP, AND STATE-FUNDED HEALTH & PHARMACY ASSISTANCE PROGRAMS Some state Medicaid, Medicaid waiver expansion, Child Health Insurance (CHIP), state-funded health assistance and state pharmacy assistance programs (SPAPs) have rules that deny eligibility, coverage, equal income levels or benefits to disabled and aged persons.  
State Medicaid Actions—2005: What the States Said, Did and Plan to Do States faced gaping budget deficits that required lawmakers to cut program spending, including that for higher education, social services and health care.  During this period the states reduced spending by $236 billion due to shortfalls in revenue 1675 kb pdf
State Medicaid Buy-In Programs: Implementation Status, Enrollment and Program Design Features By state and features of each  
State Pharmaceutical Assistance Program (SPAP) Legislation & Policy Changes To Coordinate With & Supplement Part D: Issues, Possibilities & Challenges for HIV, Disabled & Other Patients Several states passed legislation and/or regulations creating, altering or--in once case-- abolishing SPAPs in response to the coming implementation of Medicare Part D, especially to coordinating with and supplement drug coverage for those Low Income Subsidy (LIS)/”Extra Help” patients with incomes under 150% FPL.   SPAPs can cover drugs not on individual Part D plans’ formularies; pay LIS/Extra Help patients’ co-pays, coinsurance, deductibles and premiums; do likewise for slightly “richer’ limited income patients (as some newly-created or adapted SPAPs will do); and---if they meet CMS standards—have such drug payments count toward True Out Of Pocket (‘TrOOP”) credit for moving patients over 150% FPL through and out of the donut hole and into Part D’s catastrophic coverage.  

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