From Improving Access: Expanding Acceptable Medical Sources for the Social Security Administration Disability Determination Process, a report by the National Law Center on Homelessness and Poverty:
Currently, the process for obtaining SSI [Supplemental Security Income] and SSDI [Social Security Disability Insurance] can be cumbersome and, too often, there are unnecessary delays. Allowing nurse practitioners, physician assistants, and licensed clinical social workers to provide diagnostic evidence of certain medical conditions would streamline the process for obtaining benefits, ensuring that eligible individuals gain access to these critical benefits in a timely manner.
For individuals who are homeless, such expansion would have an especially meaningful impact. Currently, many people who are homeless and who are generally uninsured have great difficulty accessing assessment, treatment, and care from physicians and, for mental health problems, psychologists and psychiatrists. Programs and services dedicated to serving homeless people are increasingly overwhelmed by the tremendous need for treatment and services, and many programs cannot meet this rising demand.This will only get poor people so far. There's no way you can get around it. Decision-makers aren't going to give as much weight to CNAs, PAs and LCSWs as to MDs.
I represent a fair number of homeless people. Lack of access to medical care is a huge problem for this population. So many of these people would get on disability benefits quickly if they just had medical insurance. I expect that a lot of people who work at Social Security would agree. Obamacare should do that before long if the Supreme Court doesn't get in the way.
9 comments:
obamacare? really? how are these homeless people supposed to pay the mandatory premium to buy into it? Why aren't they on Medicaid already? Better yet, how does obamacare work at all? It has never been explained--just generalities like yours that somehow everyone will now be covered and everything will be hunkydory.
The point of the report is that a Medically Determinable Impairment (MDI) must be established by an "acceptable source." In current practice in many states, as noted by the report, nurse practitoners and physician assistants have prescribing authority, and in fact are the only treatment source many claimants actually see - especially at mental health centers. The issue isn't the weight that is given to any particular Treating Source Opinion, but delaying an initial claim to buy a Consultative Examination merely to establish a MDI. "Some of the delays in the application process may be
unavoidable but, as discussed in detail above, many delays arise when SSA requires a consultative
examination to confirm the diagnosis made by a nurse practitioner, physician assistant, or licensed
clinical social worker."
When a claimant has an Advanced Practice RN (APRN) for a treatment source, and then is also sent to a CE with a PhD or MD to establish a MDI, time and money are wasted at the initial level.
As for weight given to the opinion of either “ Noncontrolling Treating Source Medical Opinions” ( i.e. APRN or LISW) or a “Nontreating Source Medical Opinions”(i.e. CE consultant) - neither would be controlling, but either could be given considerable weight. The POMS/CFRs already provide detailed guidance on how the opinions are weighed, noting for Noncontrolling Medical Opinions “ All things being equal, treating source medical opinions will generally be given more weight than medical opinions from nontreating sources, unless there are good reasons why the treating source medical opinions are outweighed.”
Sorry Charles. I work at SSA and I do not agree that more access would speed things along. The homeless population around my area is very well served by state and other nonprofit clinics, all of which go well out of their way to help get people on SSI. What ends up happening is we get very questionable evidence without much explanation that sometimes ends up delaying the process due to all the conflicts. Factor in drug use and the failure of these claimants to take advantage of these health providers until they want disability benefits, and you have another problem unto itself.
It tends to amaze me the number of homeless with back problems and bi-polar with marked difficulties in social activities that request Viagra or Cialis. Not to mention the mentally retarded 18 year old cessation that had 2 three year old daughters and 2 four year old sons, all by different mothers. If he had been paid, that would have put 5 families on the dole.. Political correctness forbids we speak of sterilization, but considering the load on the medical system and on Social Security, when will we address reality??
10:35 PM....Wow.....Orwell would be rolling in his grave. When the totalitarian regime picks the Sterilization Staff, we should make sure your name is first on the list to round up all the bums in Anytown, USA, and you can be personally responsible for snipping all the vas deferens and saving the world from the injustice of homeless reproduction!
Or in another light, saving the world from bankruptcy secondary to Dr. Spock's failed experiment of non-punishing children so they don't comprehend the consequences of their actions.. Maybe you would prefer to wait for sterilization until China takes us over (Oh in case you didn't know, China does sterilize.)
I would love to see the Constitutional justification for forced sterilization of people. Or maybe the Constitution only applies for people you agree with?
Demographically China is doomed to fail long term. Think of it this way if we all had double incomes and no kids we would have more time to be more productive workers. However eventually there will be no next generation to carry on. This is a fact. There are millions of marriage aged chinese males with no women to marry. Who is going to work their economy when they all age?
Three generations of imbeciles are enough -- Justice Holmes, Buck v Bell
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