Social Security To Begin Using Health Information Newwork

Social Security began obtaining medical records electronically from a hospital in Boston a few months ago. Federal News Radio reports that Social Security will soon begin obtaining medical records electronically from a Richmond, VA regional health information exchange.

You have to wonder when Social Security will begin getting medical records electronically from what used to be called the Smart Corporation, but which is now apparently called HealthPort.

Funny Business With Social Security Ruling

Here are some excerpts from Social Security Ruling 96-8p as it appears on Social Security's website:

Ordinarily, RFC is the individual's maximum remaining ability to do sustained work activities in an ordinary work setting on a regular and continuing basis, and the RFC assessment must include a discussion of the individual's abilities on that basis. ...

It is incorrect to find that an individual has limitations or restrictions beyond those caused by his or her medical impairment(s) including any related symptoms, such as pain, due to factors such as age or height, or whether the individual had ever engaged in certain activities in his or her past relevant work (e.g., lifting heavy weights.)

So what? The italics are in the original and official copy as published in the Federal Register, but not the bold face type. Adding bolding after the fact is inappropriate. Social Security can modify this ruling if it wants, but it is not supposed to do so surreptitiously. Lawyers take a dim view of this sort of thing.

More Openness Required Under Recovery Act

The Office of Management and Budget (OMB) has issued instructions for all federal agencies receiving funding under the American Recovery and Reinvestment Act (ARRA). These instructions require an extremely high degree of public accountability and transparency. Here are some items that I found interesting:

• Starting March 3rd, agencies must submit weekly reports providing a breakdown of funding, major actions taken to date, and major planned actions.
• No later than May 1st, agencies must provide their “Agency Recovery Plan” that describes both broad recovery goals and the agency’s coordinating efforts.
• Starting immediately, agencies must ensure all funds provided by the Recovery Act are clearly distinguishable from non-Recovery Act funds in all agency financial systems, business systems (i.e., grant and contract writing systems), and reporting systems.
• To facilitate transparency and reporting, agencies should establish a page on their existing website dedicated to the Recovery Act (i.e., www.agency.gov/recovery), which will link to Recovery.gov and will provide a single portal for all agency-specific information related to the Act.
• Within one week of issuing this guidance, agencies must establish a dedicated page on their website for recovery efforts.

I do not think that Social Security is all that secretive an agency, but it seldom makes the effort to tell the public what it is up to. At least for the ARRA funds, Social Security will have to make that effort. It will be more paperwork for some at Social Security, but there will be people paying attention to that paperwork.

Social Security does not have its "Recovery" page up yet, but these instructions were just issued.

Baltimore Sun Notices Social Security

The Baltimore Sun has finally noticed that there are some stories at the Baltimore area's largest employer. The newspaper has a article today dealing with Michael Astrue's desire to remain as Commissioner of Social Security for his entire term, which ends in January 2013, and the Social Security portions of the American Recovery and Reinvestment Act (ARRA). The article quotes Astrue as saying "I'm here. I'm enjoying it ... I'm looking forward to serving President Obama."

A big issue locally is where Social Security's new National Computer Center, partially funded by ARRA, will be located. Astrue says it is impractical to build it in or adjacent to Social Security's central office campus in Woodlawn, a suburb of Baltimore. The 1,000 employees who will be working at the new National Computer Center are concerned that the National Computer Center may be up to 40 miles away from Social Security's central offices where they now work-- and the Baltimore-Washington area has some of the nation's most congested traffic.

New Rules On Special Needs Trusts

David Lillesand, a Florida attorney, has prepared a detailed analysis of the recent changes to Social Security's Program Operations Manual Series (POMS) concerning Special Needs Trusts.

I am not a fan of Special Needs Trusts. I think that in almost every case there is a better way of handling a situation in which a person who is entitled to Supplemental Security Income (SSI) receives a relatively large sum of money from an estate or personal injury settlement. These other methods include paying off debts, making home repairs, buying a home, buying a car, buying clothing, buying appliances and furniture, taking a trip to visit family or friends you have not seen in years because you were too poor to travel, etc. David is well aware of these other means of dealing with this situation and I am aware that if the amount you receive is a million dollars the methods I am suggesting will not be enough. If you are involved in drafting Special Needs Trusts, you need to read David's materials.

Atlanta Getting Help

From an Atlanta Journal-Constitution editorial:

Social Security Commissioner Michael J. Astrue was in Atlanta this month with promising news for Georgians waiting to resolve disability claims with his agency.

The average time to settle a disability claim in the downtown Atlanta office has been reduced drastically, he said. On average, such claims are now handled in just 500 days. ...

Astrue lobbied for funds to hire more hearing officers and authorized a third field office for metro Atlanta.

I note with interest that Commissioner Astrue now wants it known that he has lobbied for more funds for his agency. He also mentioned this in the broadcast e-mail he sent out yesterday.

5,000 to 6,000 New Jobs

A broadcast e-mail to all Social Security employees:

From: ^Commissioner Broadcast
Sent: Tuesday, February 17, 2009 5:51 PM
Subject: COMMISSIONER'S BROADCAST -- 02/17/09

A Message To All SSA And DDS Employees

Subject: Economic Stimulus Bill

President Obama has just signed the American Recovery and Reinvestment Act of 2009, commonly referred to as the stimulus bill. I’d like to take a few minutes of your time to explain what I think this legislation means for SSA in both the short run and long run.

In the short run, our most immediate task is to issue the $250 stimulus payments to our beneficiaries and recipients as soon as possible. The legislation is complex and requires extensive coordination with other agencies to avoid duplicate payments, but I am optimistic that we will issue payments to the public by late May—about three weeks earlier than the statute requires. We are working on a communication plan and guidance for field offices so that we can handle the inevitable questions that will arise.

The legislation provides $90 million for the administrative cost of the stimulus payments and an additional $500 million to process the additional work that we are receiving as a result of the economic downturn. However, we are still under a continuing resolution, so we must continue to operate cautiously. We believe that when Congress passes the FY 2009 appropriation in March or April, we will have an opportunity to hire between 5,000 and 6,000 new employees before the end of the year. If you have hiring responsibilities, please do not let the legislative situation translate into inaction. Post the jobs, interview the candidates, plan for training, and hope Congress provides the money to pull the hiring trigger in the next 30 – 45 days.

As part of the legislation, Congress is investing about $20 billion in health information technology across the Federal government which has important strategic implications for us. Our pilot testing at Beth Israel-Deaconess Hospital in Boston demonstrates that we can become significantly more timely, efficient, and accurate if our field and DDS staff can access complete electronic medical records early in the process. We are running additional pilots in Virginia and expect to expand into many other locations in the next three years.

Congress has also provided a critical $500 million for replacement of the National Computer Center (NCC). When I first started as Commissioner, I was disturbed to learn that the NCC was physically fraying and was increasingly at risk of failure from electrical interruption or other facility issues and that we had no plan in place to address the problem. Replacement of the NCC will allow us to provide 24/7 service and avoid outages and slowdowns that disrupt service delivery. Building the new NCC with today’s technology will, in three to five years, make your lives easier and greatly improve our service to the public.

The kind of progress we have made in the past few months doesn’t happen by accident. We started planning early and extensively for the possibility of additional funding, and we have had excellent support from President Obama’s transition team and the new officials at the Office of Management and Budget. This teamwork allowed us to make an effective case to Congress in a difficult time.

We should all be grateful to the people who worked with us and for us on this bill.

Michael J. Astrue

Commissioner

The Other Two Childhood SSI Rulings

For unknown reasons, Social Security published only six of eight new rulings on childhood disability in the Federal Register today. The other two will be published in the Federal Register on Wednesday, but you can read them today:

• SSR 09-2p Determining Childhood Disability - Documenting a Child's Impairment-Related Limitations
• SSR 09-4p Determining Childhood Disability - The Functional Equivalence Domain of "Attending and Completing Tasks"

Changes In Critical Case Rules

The Social Security Administration has just adopted changes to its HALLEX Manual concerning "critical" cases. Critical cases are those where:

• The claimant's illness is terminal
• The case involves a disability claim for any military service personnel injured October 1, 2001 or later regardless of how or where the disability occurred, whether in the United States or on foreign soil, provided that the individual was on active duty when the injury occurred.
• The claimant's file is flagged as a Compassionate Allowance case, which means that the claimant has or is alleged to have a condition on a list maintained by Social Security.
• The claimant is without, and is unable to obtain, food, medicine or shelter.

Here is a link to the prior version of this HALLEX section, available on the Wayback Machine, if you want to compare it. Anybody else remember the original Wayback Machine?

The main changes are to add the language italicized above which makes it clear that Social Security intends to be quite inclusive about the military service personnel category and to add military service cases to the TERI (Terminal Illness) category, the subcategory of critical cases that get the very most expedited review.

Treating military service cases as TERI cases seems over the top to me Let me say something out loud that I have only heard whispered because it is so politically incorrect. Why are the military service cases so urgent? These folks already have an income from their military service pension or VA or both. Most military service personnel who become disabled are not disabled as a result of hostile action. Have a heart attack while on military service stateside and you get TERI treatment? Get injured in a car wreck because you were drunk and you qualify for TERI because you happened to be in the Army at the time? Why? Shouldn't we be worrying more about the disability claims of people who are in homeless shelters? I think someone got carried away.

By the way, Social Security also removed a list of possibly terminal illnesses that it had in the prior version. One condition which was on the list previously was being on a liver transplant list. I guess that turned out to be a little embarrassing since Social Security is turning down most claims of people who are on a liver transplant waiting list.

$250 Economic Stimulus Payment Questions And Answers

Here are some questions and answers that I have prepared about the $250 stimulus payments under the American Recovery and Reinvestment Act (ARRA):

• Who is eligible? Anyone who was entitled to Supplemental Security Income (SSI) or to any of the following Social Security benefits at any time during the period November 2008 to January 2009: retirement, wife's and husband's, disabled adult child (but not other child's benefits), widow's and widower's, mother's or fathers', parent's, disability insurance benefits, special age 72 benefits. Note that my answer relates only to eligibility based upon Social Security entitlement. There is also eligibility based upon receiving VA or Railroad Retirement benefits.
• Update: Are children eligible for $250 payments? I thought that I had already made this clear, but I keep getting questions about it, so let me be very specific. Children only qualify if they are on SSI or if they are receiving disabled adult child benefits. Only children who are receiving benefits because they are disabled are eligible for the $250 payments. Generally, children do not qualify for the $250 payments.
• Update: Do I have to do something to get the $250 payment? No. It is supposed to come automatically.
  
• Does the payment to Social Security beneficiaries come out of the Social Security trust funds? No. The Act says that these payments come out of appropriated funds.
  
• Will the payments be made to people living outside the U.S.? No. The Act limits it to those whose listed residence is in the U.S. or a U.S. territory.
• Will I be taxed on this income? Not by the federal government.
• Can my $250 payment be seized for payment of my debts? Generally no, but it could be seized for a federal tax debt or a child support obligation to the same extent that Social Security benefits could be seized. I think it could be seized for a debt owed the Social Security Administration or for another federal debt, such as a student loan, but I would have to study it more to be certain.
  
• Will an individual who is entitled to two benefits, such as Social Security and SSI, get two checks for $250? No, but avoiding this will be a challenge for the computer systems at Social Security and the other agencies involved. Mistakes, even a lot of them, would not surprise me. The databases were not set up with the idea of administering this program.
  
• Can more than one $250 payment be made on a Social Security number? Yes.
• Can more than one $250 payment be made to a household? Yes.
  
• When will the checks or direct deposits be issued? As soon as the Treasury can do it, but no later than 120 days after enactment. If President Obama signs the bill on Tuesday, February 17 as planned, the deadline for payment would be June 17. Update: Social Security hopes to get the payments out by late May.
  
• I am applying for benefits for the time period November 2008 to January 2009 but I have not yet gotten the benefits yet. Once I get approved for these benefits, do I get the $250 payment? Yes, but there is a time limit on this. No payment can be made after December 31, 2010.
• I am on SSI. Does the $250 count as income which would reduce my SSI benefits? No and it will not affect your Medicaid or Food Stamps or other federally funded needs based benefits either.
• I am an attorney who represents Social Security claimants. My fee is one-quarter of my clients' back benefits. Some of them will receive a $250 payment as back benefits. Will I receive a quarter of the $250 payment? Probably not. Update: I had earlier thought that the problem of claimants dying before receiving payment was an argument in favor of these payments being treated as a Social Security benefit subject to attorney fee withholding, since the Social Security Act has rules which are convenient to the agency on how payments to decedents are handled, but this Act actually forbids payment to those who die before receiving payment. That does not completely solve the problem of people dying before receiving their money but it does greatly limit the problem -- and Social Security may be able to offload the remaining problem to the Department of the Treasury anyway. Probably, they will not treat these benefits as being subject to attorney fee withholding since the Social Security Act limits withholding to benefits paid under the Social Security Act. 42 USC §406(a)(4). The ARRA does not amend the Social Security Act, so the benefit payments are not made under the Social Security Act. It may be easy for Social Security's Office of General Counsel to say this, but it may be considerably more difficult for Social Security's payment centers to implement it in this way.
  
• Will computing and authorizing these payments and dealing with questions from the public relating to them cause problems for an understaffed Social Security Administration? My guess, or perhaps hope, is that this will not be too hard for Social Security. The Act is fairly simple and Social Security is getting a $90 million appropriation for administering it. The holdup might be Social Security's computer system. They did do something like this last year without much of a problem, but this is still going to be a challenge. Avoiding double payments may be the hardest part and that problem goes beyond Social Security, since the Department of Veterans Affairs and the Railroad Retirement Board are also involved.