Can't Get Heart Transplant Because Of Social Security -- Medicare Spokesperson Calls Two Year Medicare Waiting Period "Insane"

From the Spartanburg (SC) Herald Journal:

Brandon Palmer, a 24-year-old from Gaffney, needs a heart transplant. He was diagnosed about two years ago with a condition known as severe cardiomyopathy, which means - in his case - the muscles on the left side of his heart aren't strong enough to pump blood the way they should. His doctor said that side of his heart is likely operating at less than 30 percent of capacity.

But Brandon hasn't been able to get on a transplant list.

He was denied at the Medical University of South Carolina, the family says, because he didn't have insurance. He's been denied access to Medicaid because he has not been classified as "disabled" by the Social Security Administration. And he's been denied disability coverage - and status - by Social Security because twice he's been deemed able to "perform some ... type of work." ...

Brandon's family recounted the story recently as they stood around his hospital bed. He lay there, writhing at times, hooked up to various machines, breathing labored, often able to talk for only a few minutes. ...

If the Social Security Administration classifies someone as disabled, then that person is eligible for two different types of benefits. One is a cash payment that's often just enough to price someone out of being eligible for Medicaid. That benefit, however, does allow a person to qualify for Medicare - after a two-year waiting period."

Congress designed it as a way to save money," said Mary Kahn, a spokeswoman for the Centers for Medicare and Medicaid Services, part of the U.S. Department of Health and Human Services. "It's insane."

A spokeswoman for Medicare says the two year waiting period for Medicare after going on Social Security disability benefits is insane! Now that is change!

Update: The newspaper has a hard-hitting editorial about this case.

Fee Cap To $6,000 -- Effective June 22

This notice will be published in the Federal Register tomorrow (update: here's the link to the notice as actually published in the Federal Register):

SUMMARY: We are increasing the maximum dollar amount limit for fee agreements approved under sections 206(a)(2)(A) and 1631(d)(2)(A) of the Social Security Act to $6,000. Effective June 22, 2009, decision-makers may approve fee agreements up to the new limit provided that the fee agreement otherwise meets the statutory conditions of the agreement process.

FOR FURTHER INFORMATION CONTACT: Marg Handel, Office of Income Security Programs, phone (410) 965-4639, e-mail: marg.handel@ssa.gov.

SUPPLEMENTARY INFORMATION: The Social Security Act (Act) provides a streamlined process for a representative to obtain approval of the fee he or she wishes to charge for representing a claimant before the agency. See, §§ 206(a)(2)(A) and 1631(d)(2)(A) of the Act, as amended by the Omnibus Budget Reconciliation Act (OBRA) of 1990, Public Law No. 101–508, § 5106. To use that process, the representative and the claimant must agree, in writing, to a fee that does not exceed the lesser of 25% of past due benefits or a prescribed dollar amount. OBRA of 1990 set the initial fee amount at $4,000 and gave the Commissioner the authority to increase it periodically, provided that the cumulative rate of increase did not at any time exceed the rate of increase in primary insurance amounts since January 1, 1991. The law further provided that notice of any increased amount shall be published in the Federal Register. On January 17, 2002, we published a notice raising the maximum fee to $5,300. With this notice, we announce that the maximum dollar amount for fee agreements will increase to $6,000. This increase does not exceed the rate of increase provided in OBRA of 1990. We believe this increase will adequately compensate representatives for their services while ensuring that claimants are protected from excessive fees. A decisionmaker may approve fees up to the new amount effective June 22, 2009. This effective date will ensure adequate time to provide training and guidance to our employees and to make necessary changes in our information technology infrastructure.

Status Of Appropriations -- Are You Wonk Enough To Try To Understand It?

Congress is tied up now with the President's vast and vastly important economic stimulus package, but this is slowing action on two other vital budget matters.

Almost all federal agencies are operating under a continuing funding resolution which allows them to spend money only at the same rate they were spending it in the last fiscal year, which ended September 30, 2008, more than four months ago. This CR (Continuing Resolution), as it is called, expires on March 6. Neither the White House, nor either of the Appropriations Committee chairmen, has released any plan for the omnibus (one big bill for everything, rather than several separate bills for various parts of the government) appropriations bill for Fiscal Year (FY) 2009 -- although much work is going on behind the scenes. Congress Daily reports that there may be action next week on the FY 2009 omnibus, but that the March 6 deadline may not be met and a new CR may be needed. This is not good news for Social Security which will certainly be getting a good deal more money once the FY 2009 appropriation is passed.

The FY 2010 appropriations are also being held up. The new administration needs to get a budget ready to submit to Congress. This is always a challenge but it is especially a challenge with the Office of Management and Budget (OMB) already working overtime on the economic stimulus and the FY 2009 budget. OMB is not promising a full budget proposal for FY 2010 until March, which makes it hard for Congress to finish its appropriations work in time to accomplish what everyone desires -- passage of appropriations bills before the beginning of FY 2010, October 1, 2009.

Complicating everything for Social Security is the fact that Social Security Commissioner Michael Astrue is a Republican trying to work with a Democratic OMB and a Democratic Congress. Astrue's willingness to even ask for the sort of budget his agency needs is open to question. To what extent OMB and Congress will listen to what he has to say about his agency's appropriation is also open to question. Outside groups are lobbying on Social Security's appropriation and they are being heard, but there is no sign of any coordination between these groups and Commissioner Astrue.

What happens on these bills will have a dramatic effect upon the quality of service that the Social Security Administration offers the public and the working environment for Social Security employees. As wonkish and confusing as this may be, if you are reading this blog this is very important to you.

Watch Out For Faux Phishing Scam

Fedblog reports that the Department of Justice tried a scam to test the vulnerability of its employees to internet phishing scams. The faux scam has now spread to the Department of Commerce. There is no telling whether other federal agencies, such as Social Security, will pull the same one on its employees. The scam involved an e-mail concerning the Thrift Savings Plan (TSP) of federal employees:

It states that if participants have lost more than 30% of their TSP account value, they are eligible for a one-time U.S. Government bailout to recover their losses. The message directs participants to a "look-alike" TSP web site that asks for account credentials (User Name and Password). The email is signed "TSP Account Coordinator."

If an employee responds to this message by posting their user name and password, nothing bad happens. Apparently, they just receive a message telling them that they just did something really, really stupid and that they had better be more careful.

I suppose this is for a good cause, but it strikes me as wrong.

The Crisis That Ain't

From the blog of Nobel prize-winning economist and New York Times columnist, Paul Krugman:

A while back Jon Chait wrote a great piece about the peculiar insistence of many people in DC that Social Security is a looming crisis, despite the fact that the numbers say it ain’t so. I can’t find a link to the original, but there’s a good summary here. ...

And to prove their seriousness, people are ready to repeat any number they’ve heard about Social Security’s problems — or, worse yet, a number they think they’ve heard, which isn’t remotely correct.

Getting What They Had Coming

From the decision of the Third Circuit Court of Appeals in National Taxpayers Union v. Social Security Office of Inspector General:

In 2001, NTU [National Taxpayers Union] sent thousands of direct mail pieces to consumers to solicit donations. The brochures included language in large, red, bold type that stated, “Official National Survey on Social Security.” The brochures also included the statement that it was “commissioned by the NTU for the Social Security Administration, White House, and Congress of the United States.” The Social Security Administration (“SSA”) received a complaint, and the Inspector General of the SSA determined that the mailing violated Section 1140 of the Social Security Act. Section 1140 prohibits the use of nineteen phrases, including “social security,” in a manner that either (1) the writer knows or should know, or (2) the reader could reasonably perceive as conveying the false impression of official endorsement of the material by the SSA or the government. The Inspector General sent a cease-and-desist letter to NTU, and NTU responded with an apology. SSA subsequently received an additional complaint, and determined that the basis of the new complaint was a slightly altered version of the same brochure which NTU mailed after the cease-anddesist letter. The SSA Inspector General sent another letter to NTU, demanding that NTU provide written confirmation of its intent to comply with Section 1140 within ten days. Instead of complying, NTU filed a lawsuit in United States District Court, claiming that Section 1140 was unconstitutional. While the action was pending, NTU mailed a third version of the brochure, which SSA also considered misleading and in violation of Section 1140.

The SSA Inspector General wrote NTU, stating that it planned to impose a penalty in the amount of $274,582, or $.50 per offending direct mail piece. NTU requested a hearing in front of an ALJ, who found that NTU violated both prongs of Section 1140. ... NTU appealed the ALJ’s decision to the Appeals Board of the Department of Health and Human Services, which refused to review the decision, thereby adopting the ALJ’s decision as final. NTU petitions this Court for review of the agency’s final decision. ...

For the foregoing reasons, we will deny NTU’s petition.

Musculoskeletal Listings Extended

Social Security's Listings of Impairments for Musculoskeletal impairments has been extended by two years to February 18, 2011.

Delays -- With A Twist

From the San Mateo County Times:

Dierde Miner nearly died giving birth to her son, Elijah, in 2005, with medical complications leaving her in a coma for a day. When she awoke, she was left with a seizure disorder, and nearly a third of her life memories had been erased. ...

Miner's glaring disabilities forced her to make a decision she thought she would never face, and in January 2007 she chose to rely on the government safety net of the Social Security Administration for disability benefits.

That choice was the beginning of a two-year battle with the government agency's county offices that culminated in Miner's homelessness and [her sister] Ditlevsen's financial ruin. The sisters won their case for the payment of retroactive benefits with help from the Legal Aid Society of San Mateo County ...

Ditlevsen said Social Security immediately acknowledged in January 2007 that Miner was legitimately physically disabled by her seizure disorder and the liver failure she is experiencing as a result of her seizure medication.

But after months of waiting, the agency denied Miner her benefits in June 2007 because they counted the money Ditlevsen was loaning Miner to pay for her rent and care for her children as income instead of the legally bound financial loan the sisters had arranged.

For three months the sisters attempted to work with the agency. When Miner was facing eviction due to disagreements with her landlord, Ditlevsen was told to "come back when she's under a bridge." They were told to call the office after 4 p.m., which is when the phone is no longer answered.

When Ditlevsen presented officials with the notarized promissory note they requested of her to prove the loan was not income, she was told it "wasn't good enough." The sisters are still in disbelief about an incident in which an employee tried to rip a ticket proving Ditlevsen had shown up in the Social Security office as required out of her hand. Employees earned the monikers of "insensitive," "incompetent," and "smug." ...

In September 2007, Ditlevsen contacted the late Rep. Tom Lantos for help, and he directed her to Legal Aid. Douglas fought on the sisters' behalf for more than a year before the case was seen by a judge, who immediately ordered Social Security last November to grant Miner the $16,000 she was owed in retroactive benefits, which would cover less than half of the money for which she is indebted to her sister.

What You Missed Over The Weekend

Here is what you missed on Social Security News over the weekend:

• Astrue Gives Interview (Read this one even if you don't read any of the other items posted over the weekend and do pay attention to the 4th comment to the post)
• DDS Employees Being Furloughed In California And Maryland
• Action Line Gets Results (and posters thus far seem to agree with my guess on what went wrong to begin with)
• Verizon Bugs Social Security Office
• Congressmen Want Action On Government Pension Offset

Congressmen Want Action On Offsets

From Government Executive:

An old fight resumed on Thursday when two House lawmakers unveiled legislation that would ease the burden of two Social Security laws that significantly reduce benefits for some public sector retirees.

The bill (H.R. 235), introduced by Reps. Howard Berman, D-Calif., and Howard (Buck) McKeon, R-Calif., would repeal two provisions in Social Security law -- the Government Pension Offset and the Windfall Elimination Provision -- that reduce or eliminate Social Security benefits for federal employees who entered the government before 1984 and are covered by the Civil Service Retirement System. Employees in CSRS [Civil Service Retirement System] do not pay into Social Security and receive a government pension instead.

There is almost no change that the Government Pension Offset and Windfall Offset will be eliminated, but it is not inconceivable that there could be some modification. I am merely saying it is conceivable, not saying it is likely.