Evidence to determine medical equivalence in Social Security cases

Social Security has issued a ruling regarding evidence needed for a finding of medical equivalence to a listing.  This ruling rescinds and replaces Social Security Ruling 96-6p.

An impairment is considered medically equivalent to a listed impairment if it is at least equal in severity and duration to the criteria of a listed impairment.  Social Security can find medical equivalence in three ways:  1) the individual does not exhibit one or more of the findings required by a listing or one or more of the findings is not as severe as required by a listing, but there are other findings related to the impairment that are at least of equal medical significance to the required criteria; 2) the individual has an impairment not described in a listing but has findings related to the impairment that are at least of equal medical equivalence to an analogous listing or 3) the individual has a combination of impairments no one of which meets a listing but has findings related to the impairment that are at least of equal medical equivalence to an analogous listing

To demonstrate an individual is disabled based on medical equivalence, the record must contain either 1) a prior administrative finding from a medical consultant or psychological consultant; 2) medical expert evidence at the hearing level or 3) a report from the Appeals Counsel medical support staff.  It seems that evidence from the claimant’s provider cannot support a finding of medical equivalence.

An administrative law judge (ALJ) is not required to obtain medical expert evidence if the ALJ believes that the evidence does not reasonably support a finding of medical equivalence.  ALJs are not required to articulate specific evidence to support a finding that an impairment does not equal a listing.  A statement that the impairment does not equal a listing is sufficient.  SSR 17-2p (March 27, 2017).

 

 

 

Posted in SSI

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

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).

Posted in SSI

Updates to SSI Allocations and MSP property limits

DHCS has informed counties about the increase in the standard and parent allocations for SSI in 2015.  This DHCS letter also includes information about the decrease in Medicare Part A premiums, and the lack of change for Part B premiums and deductibles.  Similarly, the property levels for the various Medicare Savings Programs remain at $7,160 for an individual and $10,750 for a couple.  DHCS ACWDL 15-13 (3/3/15).

ACL 14-55: Termination Of State Funding For Supplemental Security Income Advocacy Programs (SSIAP) For Cash Assistance For Immigrants (CAPI) (9/10/14)

Announcing the demise of state funding reimbursement for SSI advocacy for CAPI folks to transition to SSI.  The funding was set to expire years ago, and was repeatedly extended, and intended to cover immigrants of age 65 or older, who entered the U.S. before August 22, 1996, and allege a disability.  [Download]

ACWDL 11-31: Lomeli Litigation Settlement Updates Supplemental Security Income/State Supplementary Income (SSI/SSP) Applicant and Recpient Medi-Cal Information Notices and Retroactive Eligibility Processing (08/17/11)

The Lomeli settlement agreement requires Department of Health Care Services (DHCS) to send written notice to SSI/SSP applicants and recipients about the opportunity to receive retroactive Medi-Cal coverage for the three month period prior to the SSI/SSP application month.  This change will help ensure that SSI/SSP beneficiaries do not miss the window to request retroactive coverage. The letter instructs Counties how to process retroactive eligibility requests.  Beneficiaries should also be informed about the opportunity to seek reimbursement for medical costs incurred during the retro period and disability evaluation period. [Download]