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Wisconsin Disability Benefits Network Newsletter For Your Benefits

Vol. 5, Issue 20, August 2007

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Introduction

The Wisconsin Disability Benefits Network (WDBN) is a statewide system that provides direct assistance to benefits counseling practitioners and seeks ways to reach out to and better serve people with disabilities, their supporters, and professional service providers in Wisconsin. This newsletter provides current program news, important notices and updates, and upcoming training and educational opportunities.

WDBN Calendar:

September Quarterly Meeting:

Join us for our WDBN quarterly meeting to discuss a variety of topics and to hear from professionals in the business of providing benefit services to people with disabilities.
Sign up to attend or find out more event information.

When:
Wednesday, September 19, 2007 9:30 AM - 4:00 PM

Where:
State Bar of Wisconsin Center
5302 Eastpark Blvd.
Madison, Wisconsin 53718-2101

Questions?
Contact Stephanie Drum at drum@eri-wi.org or 608-246-3444 x229

WDBN Benefit Specialist Initial Training:

If you work with or are planning to work with people with disabilities regarding their social security, health care or other benefit-related questions, the WDBN Benefits Specialist training program is for you.

This comprehensive introductory training will cover a variety of benefit related topics including an overview of the Social Security Administration, Title II Benefits, SSI State Supplements, Work Incentives, Medicare, Medicaid, MA Purchase Plan (MAPP), HIPAA/COBRA, Subsidized Housing, Plan for Achieving Self Support (PASS), and many other essentials to benefit planning and analysis.

This training is for you if you are:

Training Dates:

* Sign up for this training * For more information, please contact Stephanie Drum at drum@eri-wi.org or 608-246-3444 x229.

Disability Rights Wisconsin Updates:

Disabled and Still Waiting. Thousands Here Face Backlog for Decision on Social Security Benefits

From the Milwaukee Journal Sentinel: The July 2007 backlog of people waiting for a hearing at the Milwaukee Office of Adjudication and Review (ODAR) is at 10,956, up 19% since September 2005. The average wait for a case at the Milwaukee ODAR is 651 days, 23 percent longer than the national average.

The Milwaukee Office of Disability Adjudication and Review, where the hearings are held, is also well above the national average in the number of days it takes to process a case. In July, the national average was 528 days, and in Milwaukee, the average was 651 days.

"It's horrible," said U.S. Rep. Paul Ryan (R-Wis.), a member of the House Ways and Means subcommittee that oversees the Social Security Administration. "No doubt about it, this is a crisis."

The agency's administrative budget has not kept up with its needs for many years, resulting in fewer staff members and administrative judges to deal with the rising number of disabled baby boomers, Ryan and others said.

In the past seven years, budget requests by the Social Security Administration have been reduced by $5 billion, Sylvester J. Schieber, chairman of the Social Security Advisory Board, told Ryan's committee.

"Social Security has been downsizing its work force, and it is not because it wants to," Schieber said in an interview. "What they need is more people. It is an extremely serious problem."

The Milwaukee hearings office has 12 full-time administrative law judges, records show. To clear the current backlog, each would have to hear about 913 cases in a year. Nationwide, the judges average 500 cases a year, according to experts.

Lost files still a problem
In addition to the backlogs, the Milwaukee Social Security disability hearings office and Chicago regional office have come under scrutiny in recent years for management problems.

In 2003, the Journal Sentinel reported that contractors hired by the Chicago office dumped documents from hundreds of active disability claims - including 86 from Wisconsin - into the garbage. This year, this newspaper reported that the confidential files of six Wisconsin residents who had sought disability benefits were lost for months, as were documents from seven other files, after a Social Security employee took them home to work on them. All of the applicants had been waiting at least two years for a decision on whether they qualify.

David Traver, a Milwaukee-area attorney who specializes in disability claims, said most applicants have worked their whole lives and paid into the system before becoming disabled. It is not uncommon, he said, for people to die or lose their home before getting a decision.

Download a copy of the article (WORD).

FoodShare

FoodShare (FS) Handbook Release 07-02, effective July 10, 2007, includes about two dozen changes to FS policy. The most relevant changes are summarized below. Download a copy of the handbook with changes outlined (pdf).

Health Insurance Risk-Sharing Plan (HIRSP)

The HIRSP Board of Directors recently made several changes to HIRSP policy, most of which were effective July 1, 2007. Major changes are outlined below and will be reflected in the HIRSP outline on the DBS website.

  1. HIRSP: New Requirement: Prior Approval of Health Care Services. Prior approval is now required for certain health care services covered by HIRSP; services requiring prior approval will not be covered under HIRSP if such approval is not obtained. Prior approval can be requested by calling the HIRSP Plan Administrator (WPS) at 1-800-333-5003. In response to a request for prior approval, the Plan Administrator will issue a written determination, review of which can be requested following the Review and Grievance Procedure in the Plan. Examples of some of the services requiring prior approval are surgical services for morbid obesity, transplant services and inpatient hospital admissions; emergency hospital admissions must seek approval within two business days after the hospitalization. Prior approval for some health care services (e.g., spinal surgery) is waived when the services is provided on an emergency basis. See the HIRSP policy for the complete list of health care services requiring prior approval.
  2. HIRSP: Change to Medicare Deductible and Coinsurance. HIRSP Plan 2 is available to people who qualify for Medicare under various scenarios. Under a new policy, HIRSP participants who are also eligible for Medicare (Plan 2 participants) may have increased expenses. If a charge for a covered health care services is denied by Medicare solely because the services was not provided by a Medicare-certified provider, HIRSP's reimbursement for the services will not exceed 20% of the HIRSP allowed amount. Services not covered by Medicare solely because the service is not a Medicare-covered benefit will continue to be subject to deductible and coinsurance policies, per the previous policies.
  3. HIRSP: Limited Waiver of Six-Month Waiting Period for Pre-Existing Conditions. Previously, all applicants for HIRSP who qualified under category "B" were subject to a six-month waiting period for coverage of pre-existing conditions. Under the new policy effective April 1, 2007, HIRSP will waive the six-month waiting period for pre-existing conditions for applicants who qualify under the "B" criteria, have lost Medicaid or BadgerCare coverage, and apply for HIRSP within 63 days of losing their Medicaid or BadgerCare coverage.
  4. HIRSP: Prescription Drugs. HIRSP now offers a mail-order pharmacy program through which a policyholder can get a 90-day supply of prescription drugs (other than specialty drugs), subject to the applicable coinsurance. The physician must indicate a 90-day supply on the prescription. Also, under the new policy, "specialty drugs" are only available through a "specialty pharmacy". Examples of specialty drugs include drugs related to treating HIV/AIDS, rheumatoid arthritis, multiple sclerosis and some cancer medications.


Download the complete list of DRW Updates (WORD).

What's New

17th Anniversary of the ADA

July 26, 2007 marked the 17th anniversary of the signing of the ADA. To mark this occasion federal agencies released information highlighting various accomplishments and/or further challenges under the ADA.

The National Council on Disability (NCD) held a press conference in Chicago, Illinois during their quarterly meeting meeting to highlight two reports:

These reports are posted on the NCD website in both PDF and Text Format at http://www.ncd.gov/newsroom/publications/2007/publications.htm Hard copies can be obtained through contacting Stacey Brown by email at sbrown@ncd.gov.

The following information is forwarded to you by the DBTAC-Great Lakes ADA Center (www.adagreatlakes.org) for your information:

The US Department of Justice, Civil Rights Division released the Seventh installment of the Tool Kit of Best Practices for State and Local Government to commemorate the 17th anniversary of the ADA. The seventh installment includes:

The entire Toolkit including the latest Chapter can be found on-line at: http://www.ada.gov/pcatoolkit/toolkitmain.htm

Now Open for Your Membership:


National Association of Benefits and Work Incentives Specialists

The National Association of Benefits and Work Incentives Specialists is now accepting applications for membership. The goal of the organization is to serve as a medium for deliberation, exchange of ideas, knowledge, skills and experiences, and for compilation and dissemination of information.

NABWIS members will include individuals, governmental agencies and non-governmental organizations, including voluntary and private organizations, public and private not-for-profit rehabilitation providers, disability advocacy organizations, consumer organizations, self-help groups and individuals. Categories of membership are:

Membership Levels:

Find out more at http://www.nabwis.org.

National Association of Disability Specialists (NADBS)

The National Association of Disability Specialists (NADBS) is a Division of the National Rehabilitation Association (NRA).

Our MISSION: To increase public understanding of the social and economic gain to individuals and communities through empowerment of persons with disabilities to become self-sufficient, self-supporting, and contributing members of the community. NADBS will also:

Approved by the NRA Board in November 2006, the NADBS is now accepting members!

Professional Membership is $30 (requires NRA membership)
Student Membership is $15 (requires NRA membership)

For more information about this exciting new Division, contact the NRA office at 888-258-4295 or download a copy of the National Association of Disability Specialists Membership Flyer (pdf).

Benefits News Roundup


SSI RMA and Budgeting

With the Retrospective Monthly Accounting (RMA) system that the Social Security Administration uses to calculate Supplemental Security Income (SSI) monthly payments, the income an SSI recipient receives one month normally affects his/her payment two months later -- issue #13 dated March 2006 of For Your Benefits has an detailed article about the RMA process (WORD).

This delay in the effect of income can be a problem in a month when a recipient's earned income goes down or stops because the SSI payment for that month and the following month will be based on the higher income from the prior months.

For example, if an SSI recipient has been consistently earning wages that make his/her SSI payment $50 a month and then stops working at the end of March, the payment of $50 per month will continue for April and May based on the earnings from February and March. A higher SSI payment will not start until June which is based on April, so for February and March the recipient's total income will be significantly less.

Recipients need to keep in mind how this works and budget to have some money ready in reserve to take up the slack for such a two month period.

In contrast, when an SSI recipient's earned income goes up without making him/her ineligible, he/she will still receive SSI payments for two months based on the lower earned income from the prior months. (POMS SI 02005.001)

RIB/SSDI Claims

It is not unusual for a person to become disabled and unable to work after early retirement age (62), but before reaching full retirement age (FRA) for Social Security Retirement Insurance Benefits (RIB). With the FRA rising to 66, this type of situation is becoming even more frequent.

Anyone who becomes disabled before their FRA can apply for Social Security Disability Insurance (SSDI) benefits even though they may be eligible for a reduced RIB (age 62 up to FRA.) The RIB amount taken before FRA can be up to 25% less than the SSDI benefit, so it is to such a person's advantage to be found disabled and entitled to SSDI before FRA.

When a person is filing for RIB, SSA will ask if he/she is disabled; if the response is positive, SSA will have the person also file an SSDI application. SSA will process and pay the RIB claim while the medical part of the SSDI is being developed. If SSA finds the person disabled, SSA will pay the higher SSDI benefit based on the original application and the disability onset dates. If the entitlement date for SSDI is after the date the reduced RIB started, the SSDI benefit would be reduced for every month the reduced RIB was paid. (POMS RS 00615.110)

VA Disability Benefits

The U.S. Department of Veterans Affairs (formerly known as the Veterans Administration and still called the VA) provides benefits and services to disabled military veterans and their survivors. Included are several distinct programs: income support programs (compensation and pension), health and medical care, education and rehabilitation programs, home loans, and burial-related benefits.

Eligibility involves the general qualification of being a veteran and then for certain benefits more specific factors must be met, such as a certain type of military service (active duty or reserves), a certain length of service, other than a dishonorable discharge, and being disabled.

Similar to, but different from, VA disability benefits are "military" disability benefits for military service retirees with at least 20 years of service or with a disability. Even if a military benefit is based on a disability, it is normally called a retirement benefit. Military benefits are federal public disability benefits based on a veteran's period of military service. Military benefits for the disabled compensate for the loss of a military career while the intent of VA benefits is to compensate for lost civilian earning capacity.

The VA expresses a veteran's disability in terms of a certain degree (percentage) of being disabled, which can be any where from 10% to 100% in increments of 10. The percentage is important because it determines the nature and extent of the veteran's and his/her dependents' benefits.

The different VA programs are handled by different administrative units within the VA. The State of Wisconsin also has benefits available to veterans that are administered separately. So in assisting or completing a benefits analysis for a veteran, benefit specialists may have to contact multiple sources in connection with a client's benefits.

Sources of verification and information for veterans' programs are:

Future issues of "For Your Benefit" will have articles with more specific information about the various programs available to disabled veterans in Wisconsin.

Medicare Part C and/or D Premium Refunds

The Centers for Medicare and Medicaid Services (CMS) is in the process of reconciling Medicare Part C and Part D premiums owed and paid for prescription drug coverage in 2006. As part of these efforts, CMS recently forwarded to SSA a large number of transactions to release Medicare Part C and/or Part D premiums withheld from beneficiaries' Title II payments in 2006. A total of about 92,000 beneficiaries should receive a notice within the next week informing them of the upcoming refunds of the premiums withheld from their Title II payments. We have attached a copy of a sample notice for your information (WORD) .

If beneficiaries have questions about the premium refunds, they should contact 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048.

The premium refund notice also contains information about the extra help available to help pay Medicare prescription drug costs.

Medicare Advantage

Medicare Part C (originally called Medicare+Choice and now Medicare Advantage) has been an alternative to the traditional Parts A and B of Medicare since 1999. Under Medicare Advantage beneficiaries obtain Medicare health plans through privately managed care plans, such as Health Maintenance Organizations (HMO's), Preferred Provider Organizations (PPO's), and Private Fee for Service (PFFS) plans. The initial intent for creating Medicare Advantage was to achieve greater efficiency while holding down costs in delivering Medicare services.

Under Medicare Advantage the Center for Medicare and Medicaid Services (CMS) contracts directly with private health insurance providers who receive a set amount of money for the cost of all covered services to their Medicare beneficiaries. In 2004 the federal government started subsidizing Medicare Advantage plans to lower premiums and increase its appeal.

While enrollment in Medicare Advantage has greatly increased recently (almost a fifth of Medicare beneficiaries now belong to a private Medicare Advantage plan), a growing concern has arisen about some of the sales practices used to market these plans and about the level of service provided beneficiaries.

In a recent US House of Representatives Energy and Commerce Oversight and Investigations Subcommittee hearing, CMS revealed reports of alleged improper and illegal sales practices used by private Medicare Advantage plans. Two-thirds of private Medicare Advantage plans have been cited for violating federal rules when enrolling or dealing with beneficiaries. Such aggressive and improper sales practices include signing up beneficiaries without their consent or knowledge and sales agents misrepresenting themselves as employees of Medicare or other federal government agencies. In addition, U.S. Senate investigators have found in at least 39 states improper sales practices which include aggressive sales tactics. The Wisconsin Insurance Commission has reported abuses, the worst being agents enrolling beneficiaries with reduced capacity into inappropriate plans. Complaints about lack of responsiveness, difficulty in accessing services, and even neglect from certain Medicare Advantage plans have also come from beneficiaries.

Another major issue is the cost of and the federal subsidies for the Medicare Advantage program: the actual cost has become around 12% more than traditional Medicare with subsidies scheduled to increase and overpayments to insurers estimated to exceed $50 billion for a five year period. The concern is that this level of government subsidy is problematic in the long run and could cause a funding crisis that would result in benefits being cut, more costs shifted to beneficiaries (by escalating the rise of the Part B premium for traditional Medicare beneficiaries), or even the demise of the of the program.

Training and Educational Opportunities:

Hispanic/Mexican Culture Workshop for Health Care, Education, Community, & Social Service Providers 2007

presented by Melina Kolbeck
Tuesday, August 14, 2007 8:30 a.m. — 3:30 p.m.
Jefferson Street Inn
201 Jefferson Street
Wausau, WI

Employer Education Seminar:

Worker's Compensation — Understand the Law and Control Costs
Learn to effectively manage Worker's Compensation claims and control costs in partnership with your insurance carrier. Jodie Connor, WC Claim Manager for Wausau Insurance Companies, will present Claims Management, A Working Partnership.

Obtain up-to-date information on Wisconsin's Worker's Compensation law and practical ideas for handling WC claims and presenting evidence at hearings. Jim O'Malley, Director of the Worker's Compensation Bureau of Legal Services, will present Understanding the Principles of the Worker's Compensation Law.

Thursday, August 23, 2007
8:00 a.m. to 11:30 a.m.
Western Technical College
Academic Resource Center — Room 200A
400 N.7th Street, La Crosse
Continental Breakfast begins at 8:00 a.m.
Seminar begins at 8:30 a.m.

National Council on Disability Quarterly Meeting 2007

The NCD's summer quarterly board meeting will be held July 24-26 at the Crowne Plaza Chicago. During the meeting the NCD is expected to release its ADA Implementation and Impact Study.
July 24-26
Chicago, IL
Crowne Plaza
www.ncd.gov

2007 National Council on Independent Living (NCIL) Annual Conference

The annual conference features a variety of workshops and events focused on ensuring that people with disabilities live independently. This year's Conference will also serve as the 25th Anniversary Celebration for the organization.
July 30-August 2
GRAND HYATT, D.C.
www.ncil.org

Job Accommodation Network (JAN) 2007 Conference

The 2007 JAN conference will be held at the Hyatt Regency Crystal City in Alexandria, VA. The annual JAN Conference will cover employment law, innovative employment practices, and disability issues. Visit the JAN web site for information about conference registration and program descriptions.
August 6-7, 2007
Arlington, VA
http://conference.jan.wvu.edu

The Kennedy Center Leadership Exchange in Arts and Disability: 2007 Conference and Training

Drawing on national and local resources, the conference will provide an array of opportunities to discuss: issues ranging from physical and programmatic access to ticketing policies and marketing strategies; ideas and learn what has been successful at other arts organizations and cultural institutions; with representatives from the Disability Rights Section of the Department of Justice; best practices and how to develop sound policies.
August 16-19,2007
Minneapolis, MN
www.kennedy-center.org/accessibility/lead/conference.html

Contact Us:

Name Job Title Extension Email
Benbow, John Researcher/Curriculum Developer 247 benbow@eri-wi.org
Fowler, Megan CWIC Benefits Specialist
HEC Regional Screener		 230
Toll Free WIPA line
(877) 242-1357
Toll Free HEC line
(800) 391-2950 		fowler@eri-wi.org
Fuller, John Director of Employment & Benefits Counseling Services 223 fuller@eri-wi.org
Goodman, Phil Assistive Technology Consultant 234 goodman@eri-wi.org
Hurst, Maria Office Manager 0 hurst@eri-wi.org
Kulow, Theresa Marketing & Communications Director 224 kulow@eri.org
Larson, Meredith Benefits Specialist 227 larson@eri-wi.org
Liddicoat, Tammy Executive Director 222 liddicoat@eri-wi.org
Line, Stephanie Learning Services Program Lead 229 drum@eri-wi.org
Schramm, Randy Financial Manager 237 schramm@eri-wi.org
Wanek, Jolene Benefits Counseling Project Lead
HEC Regional Screener 		231
(toll free #) (877) 826-1752
wanek@eri-wi.org


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