Author: Stephen Goldberg

Changes to Rules Regarding the Evaluation of Medical Evidence in Social Security cases

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Social Security has finalized new regulations that dramatically change the way it evaluates evidence.  The new rules are effective for claims filed on or after March 27, 2017.  Most importantly, the new regulations eliminate the “treating physician rule” which required deference to doctors who have a treatment relationship with the claimant.   The new rule calls for evaluating opinions from acceptable medical sources by considering the supportability of the opinion and the consistency of the opinion with underlying medical records.  This evaluation is supposed to consider that the claimant has a longstanding treatment relationship with the treating source.

The new regulations add physician’s assistants, advance practice registered nurses, and, when consistent with scope of practice and state licensing rules, optometrists and audiologists.

The new regulations require express consideration of evidence from all medical sources, including evidence from sources that are not considered acceptable medical sources.  This is the only portion of the new regulations that is effective immediately for all claims.

The regulations expressly do not require a statement of how nonmedical evidence is evaluated.

The regulations state that disability evaluations from other agencies such as the Veterans Administration will no longer be given weight in Social Security’s evaluation.

The regulations repeal Social Security Rulings 96-2p, 96-5p and 96-6p.  The regulations also repeal Social Security Ruling 06-03p but state the substance of that ruling regarding evaluation of medical evidence from sources who are not considered acceptable medical sources is incorporated into the new regulations.

Revisions to Rules Regarding the Evaluation of Medical Evidence, 82 Fed. Reg. 5844 (January 18, 2017).

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Study Time for SIPS, teen participants and summer vacations

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In instructions about county data reporting, CDSS has changed its policy about counting homework time for welfare-to-work participants in Self Initiated Programs (SIPs).  A SIP is an education program started by the participant prior to welfare-to-work appraisal.  Previously, CDSS said that SIPs could not count homework time for their welfare-to-work hours.  In these data reporting instructions, CDSS states that SIPs can count homework time in the same way that any homework time is counted for any other education activity, which is actual hours spent doing homework up to one hour of unsupervised homework for each hour of class time.  Unsupervised homework time can be verified by a statement from the education program indicating the amount of homework required for the student’s course of study.  Counties can retain such statements from the education institution and use them for any student enrolled in that course of study.

CDSS also says that in a two parent household when one of the parents is a teen attending secondary school, the other parent must participate enough hours to total 35 average weekly hours.

In addition, CDSS says, for summer vacation, satisfactory progress and participation may count, regardless of the number of hours of participation, if the participant has not completed basic education requirements and is enrolled or intends to enroll as a full-time student after the school vacation.

(ACL 17-08, January 27, 2017.)

Position Statements in CDSS hearings

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CDSS has issued instructions implementing AB 2346 about position statements.  Previously, public and private agencies other than the Department of Health Care Services were required to make paper copies of their position statements available to claimants at least two business days prior to the hearing.  AB 2346 extends this requirement to the Department of Health Care Services.  This means that position statements in Medi-Cal cases must now be made available two business days before the hearing.

In addition, position statements can now be provided to the claimant in one of three ways: 1) secure electronic transmission at least two business days before the hearing, with the claimant’s permission, and if the agency can comply with state and federal electronic privacy laws, 2) first class mail with mailing early enough for the claimant to receive the position statement two business days before the hearing, or 3) paper copy available at the appropriate office of the county welfare department two business days before the hearing, with public or private agencies that are not part of the county welfare department mailing a paper copy of the position statement to the county early enough for the county welfare department to make it available at least two business days before the hearing.

If electronic transmission does not apply, the county can choose whether to mail the position statement or make it available at the county welfare department office, but the county should discuss with the claimant how the claimant would prefer to receive the position statement.

If the position statement is not made available to the claimant two business days before the hearing or the agency modifies the position statement after providing it to the claimant, the claimant will have good cause to postpone the hearing.  The claimant must waive the 90 day deadline for a decision to get this postponement.  Because the postponement was caused by the county’s failure to provide the position statement as required, this postponement will be considered the claimant first postponement for purposes of evaluating subsequent postponement requests.

(ACL 17-21, February 16, 2017.)

Federal taxation of IHSS wages

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The California Department of Social Services (CDSS) has announced that it will allow IHSS providers to self-certify that they live in the same home as the IHSS recipient for purposes of federal income taxes.

Internal Revenue Service Notice 2014-7 states that wages for an IHSS provider who lives in the same home as the recipient are not considered gross income for purposes of federal income taxes.  CDSS will allow self-certification that the IHSS provider lives with the recipient by submitting the SOC 2298 form.  Providers will only need to submit the form once.  If the living situation changes, the provider will need to submit the SOC 2299 form.

Wages will continue to be included as federally taxable income until the SOC 2298 form is submitted and processed.  CDSS Provider Bulletin, Live-In Provider Self Certification Information.

CAPI payment standard increase

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Effective January 1, 2017, the Cash Assistance Program for Immigrants (CAPI) payment standard increased by 2.76%.  This increase also caused increases in the presumed maximum value of in-kind support and maintenance, the allowance for ineligible children in deeming situations, the sponsor’s allocation in alien deeming situations and the allowance for parents in parent-to-child deeming situations.

For couples where one spouse receives SSI and the other receives CAPI, budgeting will be done prospectively to prevent the couple from receiving more than the appropriate couples payment standard because of the increase in CAPI benefits.

CDSS included a chart of the new CAPI payment standards.  (ACIN I-81-16, December 19, 2016.)

Questions and Answers about Expanded Subsidized Employment

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CDSS has issued questions and answers about Expanded Subsidized Employment (ESE) for CalWORKs recipients.  Highlights of these questions and answers include

  • ESE funds cannot be used for dental services, glasses or tattoo removal, but non-prescription glasses and tattoo removal can be ancillary supportive services.
  • ESE funds cannot be used for the 25% match for federal work study placements, but can be used for CalWORKs work study placements.
  • ESE can be used for workers’ compensation costs and backgrounds checks but not for physicals or uniforms.
  • Counties can place a recipient in a second ESE placement if the first ESE placement does not use all six months of ESE eligibility, but counties must determine on a case-by-case basis if that placement is appropriate.
  • Youth can participate in ESE either as their welfare-to-work participation or as exempt volunteers, but Non-Minor Dependents are not eligible for ESE.

(ACL 17-03, January 25, 2017.)