Release 88: Effective January 1, 2018

State Family Pre-SSI Program Worker Guide #1 -
State Family Pre SSI (SFPSS)


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  1. Referral process
  2. TANF program staff will use the SFPSS referral checklist to assist in making appropriate referrals. TANF program staff may also use the presumptive SSI criteria checklist to make an automatic referral.

    The SFPSS referral checklist sets up three possibilities based on the information regarding the participant. Those possibilities include:

    The referral, using the State Family Pre-SSI Program Referral to Disability Analyst form (DHS 7813), is made by the TANF case managers. The need for the referral may come from information provided by the participant, consultation with a JOBS contractor or service provider, consultation with the disability analyst, etc.

    If a referral is being made on a TANF applicant, TANF eligibility must be determined, and the TANF grant opened prior to referral.

  3. Intake process
  4. The SFPSS program's administrative specialists will schedule all eligibility interviews with potential participants.

    The disability analyst meets with the potential program participant to conduct a SFPSS program eligibility interview. The disability analyst has 30 days to make a decision. They may need additional information and may also consult with the program's Program Review Team (PRT).

    Information that is needed for the eligibility interview may include:

  5. Disability determination
  6. The disability analyst will determine if the program is offered to the participant based on SSA criteria. The disability analyst has access to the SFPSS Program Review Team for consultation if needed. SFPSS program eligibility is to be determined within 30 days from the date of eligibility interview unless additional time is needed.

    Once a decision is made, a decision notice is provided to the participant. If the program is not offered, the client may request their case be reviewed by the SFPSS Program Review Team or SFPSS-PRT.

    If the SFPSS program is offered to the participant, the following steps must be taken:

  7. Program Review Team (PRT)
  8. The SFPSS Program Review Team (SFPSS-PRT) is available throughout the SSI process. The team reviews documentation to determine eligibility for the program. They are also involved in reviewing case information when the participant is in the program and has their SSI application denied at the hearing level.

    Once the PRT makes a decision, the information is documented in TRACS using the SFPSS page. A notice regarding the decision is sent to the participant. In the event they will not be offered the program, the case will be staffed with the TANF case manager and partners to help provide guidance regarding activities and potential accommodations or modifications.

  9. Transition from TANF to SFPSS
  10. The following will need to be done before transition into the SFPSS program:

    NOTE
      There will be times when the program is offered but the participant declines the offer. In situations such as this, follow the guidelines for transitioning participants back to the TANF program.

  11. Program process
    1. Disability documentation and summary

      Program staff will be responsible for ensuring that the application process for SSI, if eligible, progresses. This will include the following:

      • Ordering medical evaluations;

      • Ordering medical documentation;

      • Organizing medical documentation;

      • Developing a disability summary report;

      • Updating TRACS SFPSS page to indicate initial application for SSI;

      • Completing the SSA:

        • - Disability Report form;
        • - Work History form;
        • - Pain form;
        • - Third Party report form; and
        • - Fatigue form.

      • Completing the Appointment of Representative (SSA 1696) form;

      • Gathering and organizing any pertinent legal documents.

    2. Initial SSI application

      The initial application stage takes approximately 90 days for a determination from Disability Determination Services. There are two potential outcomes:

      1. SSI is approved;

      2. SSI is denied.

      When the initial application is denied, there are two possibilities relating to the SFPSS program.

      1. The participant will continue to pursue SSI and therefore remain in the SFPSS program; or

      2. The participant will decide not to pursue SSI and be transitioned back to TANF.

        1. Approval

          When the SSI application is approved at the initial application stage follow these steps:

          • Transition the family back to TANF;

          • Change the coding on UCMS;

          • Process the payment from SSA for the adult portion of the grant while the family was in the SFPSS program;

          • Update TRACS SFPSS page to indicate results of initial application;

          • Make and prepare for the final SSA interview appointment.

        2. Denial

          When the SSI application is denied at the initial application stage follow these steps:

          • Determine if the SSI process will continue to Reconsideration. If process will continue, file Reconsideration appeal;

          • Create a new, individualized case plan in partnership with the participant;

          • Change the coding on UCMS if transitioning back to the TANF program;

          • Update TRACS SFPSS page to indicate next step - Reconsideration or Transition back to the TANF program;

          • When possible, staff with Disability Determination Services staff regarding decision;

          • Obtain new records or new/different evaluations, if necessary.

    3. Reconsideration appeal

      After the initial application for SSI has been denied, the participant enters a Reconsideration appeal. These appeals take approximately 90 days for a decision.

      Like the initial application stage there are two possible outcomes at reconsideration:

      1. SSI is approved, and

      2. SSI is denied.

      When denied, the participant has two choices: they can continue in the SFPSS program or transition back to TANF.

      1. Approval

        Follow process for transitioning the family back to TANF, to include notification of when SSI will be received:

        • Change coding on UCMS;

        • Process the payment from SSA for the adult portion of the grant while the family was in the SFPSS program;

        • Update TRACS SFPSS page to indicate results of Reconsideration appeal;

        • Make and prepare for final SSA interview appointment.

      2. Denial

        • Determine if SSI process will continue to Hearing stage;

        • If the participant is continuing, file appeal;

        • Create a new, individualized case plan in partnership with the participant;

        • Change coding on UCMS, if transitioning back to the TANF program;

        • Connect participant with legal services;

        • Update TRACS SFPSS page to indicate next step - Hearing or Transition back to TANF/JOBS;

        • Update records with new and/or different information and provide to attorney or ODAR;

        • Continue as authorized representative. Change status if necessary.

    1. Hearing (ALJ)

      When the Reconsideration ends in a denial, the participant has an option to continue on with the SSI process or return to the TANF program. If they continue, the next stage in the process is the Hearing stage. This stage may take up to 30 months to complete.

      The participant will be provided a list of attorneys or will be required to find one of their choosing. Attorney fees are paid only when the SSI application is approved and will be paid from the initial SSI lump sum payment.

      During this time period it is important that the department maintain contact with the family. The program will need to consider continued eligibility both in regarding to the SFPSS program and TANF. It is important that the individualized case plan remain updated.

      1. Approval

        • Follow process for transitioning the family back to TANF;

        • Change coding on UCMS;

        • Process the payment from SSA for the adult portion of the grant while the family was in the SFPSS program;

        • Update TRACS SFPSS Page to indicate results of Hearing;

        • Make and prepare for the final SSA interview appointment.

      2. Denial

        • Determine if SSI process will continue by resubmitting participant's need to remain in the program to the Program Review Team;

        • Create a new, individualized case plan in partnership with the participant;

        • Change coding on CMS if transitioning back to the TANF program;

        • Update TRACS SFPSS page to indicate next step - Program Review Team for re-evaluation or Transition back to TANF;

        • May reapply for SSI while attorney appeals the judge's application of law to the Appeals Council, Appellate Court and/or Supreme Court. The decision to reapply is based on the recommendation from the SFPSS participant's attorney;

        • Obtain copy of the ALJ Hearing decision.

    2. Program Review Team (PRT) - re-evaluation

      When the participant's SSI application is denied at the Hearing stage, most families will transition back to the TANF program. However, there are times when new or worsening conditions may require a participant to remain in the SFPSS program. The Program Review Team will make the determination of whether or not the participant will remain in the program.

      1. The re-evaluation process:

        1. Re-evaluation of participation in SFPSS program will take place at the request of the disability analyst when there is a worsening of the current condition or a new condition.

        2. Disability analyst will take the participant's case before the PRT.

        3. The PRT determines if participant will continue in the SFPSS program or if they will transition back to the TANF program.

        4. Update TRACS SFPSS page to indicate next step.

        5. Evaluate for other undiagnosed conditions such as mental health, addiction, etc.

  12. Responsibilities
    1. Case manager

      • Identification of potential participants;

      • Review and update the TRACS Disability/Limitation and Accommodation pages;

      • Staffing with appropriate partners to determine if referral to disability analyst is appropriate;

      • Complete the State Family Pre-SSI Program JOBS Activity Exit Summary (DHS 7815) or ensure that the JOBS partner has completed form;

      • Complete the State Family Pre-SSI Program Referral to Disability Analyst form (DHS 7813) and submit to the Program for determination by disability analyst;

      • Provide copies of paperwork such as the My Self Assessment (DHS 7823), screenings and evaluations, etc., to the SFPSS program;

      • Develop individualized case plan in partnership with the participant, which needs to include an SS activity;

      • Complete Authorization for Use & Disclosure of Information (MSC 2099) forms for providers and include the disability analyst;

      • Update the coding on UCMS when program is offered and accepted;

      • Conduct the re-engagement process in partnership with the disability analyst. Use the TRACS Re-Engagement page to document the process;

      • Manage activities on the individual case plan;

      • Issue SFPSS support services;

      • Continued case management functions.

    2. Disability analyst

      • Contacting the case manager to ensure any available documentation is provided;

      • Providing consultation to case managers to help staff with making appropriate referrals or determining disability issues and accommodation needs;

      • Availability for quick staffing of potential participants;

      • Assisting in the transition to and from the SFPSS program. Include such things as discussions of appropriate JOBS activities, need for accommodations, etc.;

      • Training for local TANF program staff on appropriate referrals, screening for disabilities, accommodations, etc.;

      • Analysis and interpretation of federal and state rules and regulations;

      • Developing SSI claim, if eligible; writing disability summaries as part of the SSI application;

      • Completing SSA forms for claimants who are not able;

      • Acting as claimant's Representative for SSI;

      • Close monitoring of case status while in the SFPSS program;

      • Updating the case manager regarding the participant's progress towards SSI;

      • Participate in the re-engagement process of SFPSS program participants;

      • Participate on local Medical Review Teams, Community Review Teams, Branch Review Teams, etc.;

      • Reviewing other disability analyst's program determination process using standardized reporting form;

      • Participation on the SFPSS Program Review Team;

      • Arranging/coordinating appointments using strength-based philosophy;

      • Ordering medical exams when necessary;

      • Regular contact with SFPSS program participants.

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