The 131st Annual Meeting (November 15-19, 2003) of APHA

Abstract #54478

Beverley Brown Losey, RN BSN JD, Solo law practice, retired public health nurse, 1001 Fourth Avenue, Suite 3200, Seattle, WA 98154, 206-625-2200, BbLoseyJD@ABAnet.org

Critical to health care access for the vulnerable disabled population is the availability of health insurance. Those with terminal or long-term disabilities may be eligible for Medicare or Medicaid under the Social Security Disability Insurance Benefits or Supplemental Security Insurance programs. While disability for these programs is not based solely upon a medical diagnosis, treatment notes are a primary source of documentary evidence of disability. Thus, descriptive treatment notes are important for an accurate determination of disability. A basic understanding of how adjudicators and judges determine disability can clarify what descriptive information may evidence disability. Social Security uses a five-step sequential evaluation process to determine disability. In non-legal terms, Step 1 is whether the individual works at substantial gainful activity. Step 2 is whether the impairment is severe enough to impact physical or mental work. Step 3 is whether the impairment is the same or equivalent to an impairment in the Social Security “Listing of Impairments”. Step 4 is whether the individual can perform past work. Step 5 is whether or the individual can perform any work. At Step 5, the individual’s age, education, vocational experience, and functional, exertional and non-exertional limitations are considered. Thus, descriptive chart notes concerning the individual’s ability to perform physical aspects of work such as standing, lifting, and manipulating objects, and ability to perform mental aspects of work, such as understanding instructions, relating to others, and maintaining focus, are invaluable to an accurate determination of program eligibility and access health care.

Learning Objectives:

Learning objectives:
• Describe the importance of health records and descriptive chart notes in determining a disabled person’s eligibility for Medicare and Medicaid;
• List the five step process for determining a disabled person’s eligibility for Medicare and Medicaid;
• Explain how functional limitations observed by the health professionals can assist in documentation of disability.

Keywords: Access, Disability

Related Web page: References: www.ssas.com/ http://www.ssa.gov

Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: Social Security Administration
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.

Handout (.doc format, 52.5 kb)