SSA--Office of Disability Pub. No. 64-040 Issue II– 2002(No.32) The Office of Disability at the Social

Security Administration publishes DISABILITY NOTES. It is distributed free of charge to readers interested in the

disability programs administered by Social Security. It is intended to be informational and not an official expression of

policy. Readers may reproduce all or part of this publication for further dissemination.

FROM THE ASSOCIATE COMMISSIONER:

This will be my last message to you.

After more than 30 years of service to

SSA, I have decided to retire.

Over the course of my career, I have had

the opportunity to work in many

different positions throughout SSA and

to meet many dedicated civil servants. I

can sincerely say that my tenure in the

Office of Disability has been the most

professionally satisfying and the most

personally interesting and stimulating. I

am very proud to have had a leadership

role in Social Security's disability

programs and am proud to have had the

opportunity to work with the many

dedicated individuals in the federal and

state governments who bring SSA's

disability programs to the American

public.

It has also been an honor to work with so

many of you in the disability

community. I know many of you

personally and have had the opportunity

to obtain your perspectives on issues of

mutual interest and to learn about your

experiences (good and bad!) with the

disability programs.

It has been a challenging and fulfilling

experience. We can take great pride in

what we have accomplished together.

We all know that more still needs to be

done—I am confident that with your

help my successor will build on those

accomplishments.

 

 Ken Nibali

 

In This Issue

SECOND NATIONAL DIALOGUE ON

CHILDHOOD DISABILITY- A SUCCESS

THE DEFINITION AND EVALUATION OF

DISABILITY FOR CHILDREN FILING FOR SSI

BENEFITS

REQUESTING INFORMATION FROM SCHOOLS

AND TEACHERS

PROTOTYPE UPDATE

EVALUATING HEMATOLOGICAL DISORDERS

AND MALIGNANT NEOPLASTIC DISEASES

MEDICARE SAVINGS

PROGRAMS – YOU MAY QUALIFY

THE TICKET TO WORK PROGRAM
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SECOND NATIONAL DIALOGUE

ON CHILDHOOD DISABILITY -A

SUCCESS 

Researchers, policy analysts and

program administrators met with

community groups and families to

discuss trends in childhood disability

programs March 14-15 in Washington,

DC. The co-chairs, Stephanie Smith

Lee, Office of Special Education

Programs, Department of Education, and

Eileen Sweeney, Center on Budget and

Policy Priorities, brought together an

ambitious agenda with sessions covering

such issues as:

 Accessing medical care and quality

health care services

 Income and resources reporting 

 Educating the teacher community on

SSA’s definition of disability

 Gathering and securing the best

possible information about the

child’s impairments. 

One of the major highlights of the

conference was a speech by SSA

Commissioner Joanne Barnhart. She

noted the conference was one of many

ways “to talk and to strengthen our

relationships with the disability

community and the families and children

that we serve.”

A central goal of this conference was to

ensure that children with disabilities

receive all of the benefits they're eligible

for under the law and that benefits are

paid only to children who meet the SSI

program's strict definition of disability.

THE DEFINITION AND

EVALUATION OF DISABILITY

FOR CHILDREN FILING FOR SSI

BENEFITS

Like the definition for adults under the

Title II program, the definition of

disability for children under the Title

XVI program-- SSI--is found both in

statute and regulations. A child under the

age of 18 is disabled if he or she has a

medically determinable physical or

mental impairment or combination of

impairments that causes marked and

severe functional limitations and that can

be expected to cause death or has lasted

or can be expected to last for a

continuous period of not less than 12

months. 

The evaluation process to determine

disability under the above definition

assesses whether the child’s impairment

or combination of impairments results in

marked and severe functional

limitations. There are three steps in the

evaluation process.

Step One. Is the child performing

substantial gainful activity (SGA)?

Just like in the adult rules, if a child is

working and the work is SGA, the child

is not disabled. If the child is not

engaged in SGA, we proceed to Step 2.

Step Two. Does the child have a

severe impairment or combination of

impairments that is severe?

a. “Severe” means that an

impairment or combination of

impairments has more than a

minimal impact on a child’s

functioning.
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b. At this step, we consider the

combined effects of all a child’s

physical or mental impairments.

If the child does not have a "severe"

impairment(s), disability is not

established. If the child does have a

severe impairment(s), we proceed to

Step 3.

Step Three. Does the child’s

impairment meet, or medically or

functionally equal, the severity of a

listing?

SSA maintains a listing of impairments.

These listings cover the major body

systems and include descriptions of

physical and mental impairments (such

as cerebral palsy, mental retardation)

along with specific medical severity

criteria. The listings can be found in

Title 20 of the Code of Federal

Regulations in Appendix 1 to subpart P

of part 404. (Note: Part B of the

appendix exclusively applies to the

evaluation of impairments in children.)

You can find the listings on SSA’s web

page at:

http://www.ssa.gov/OP_Home/cfr20/404

/404-ap09.htm. If the child’s

impairment or combination of

impairments meets the criteria of a

listing and lasts long enough, the child

meets the definition of disability.

If the child’s impairment or combination

of impairments does not meet any of the

listings the child may meet the definition

of disability by medically equaling a

listing. To medically equal the listings,

an impairment or combination of

impairment must be of equal medical

severity to a listed impairment.

If the child's impairment or combination

of impairments does not meet or

medically equal any listing, the child can

still qualify if his or her impairment(s)

functionally equals the listings. To

functionally equal the listings, an

impairment or combination of

impairments must be of “listing-level

severity”; i.e., it must result in marked

limitations in two domains of

functioning or extreme limitation in one

domain.

We use the following six domains:

 Acquiring and using

information. In this domain, we

consider how well the child

acquires or learns information

and how well he/she uses the

information learned.

 Attending and completing

tasks. In this domain, we

consider how well the child is

able to focus and maintain

attention and how well he/she

begins, carries through and

finishes activities, including the

pace at which the activities are

performed and the ease with

which the child changes them.

 Interacting and relating with

others. In this domain, we

consider how well the child

initiates and sustains emotional

connections with others,

develops and uses the language

of his/her community, cooperates

with others, complies with rules,

responds to criticism and respects

and takes care of possessions of

others.
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 Moving about and

manipulation objects. In this

domain, we consider how the

child moves his/her body from

one place to another and how

he/she moves and manipulates

things. These are called gross

and fine motor skills.

 Caring for yourself. In this

domain, we consider how well

the child maintains a healthy

emotional and physical state,

including how well the child

copes with changes in his/her

environment and whether he/she

takes care of his/her own health,

possessions and living area.

 Health and physical well-being.

In this domain, we consider the

cumulative physical effects of

physical or mental impairments

and of their associated treatments

or therapies on the child’s

functioning that we did not

consider in the “moving about

and manipulating objects”

domain. When the child’s

physical impairment(s), mental

impairment(s) or combination of

physical and mental impairments

has physical effects that cause

“extreme” limitation in his/her

functioning, the child will

generally have an impairment(s)

that “meets” or “medically

equals” a listing.

If you want a detailed description of the

process and the requirements for

entitlement, we suggest you read

sections of 20 CFR 416.906 , 416.924 ff.

These sections can be found on the SSA

web site at

http://www.ssa.gov/OP_Home/cfr20/416

/416-0000.htm.

REQUESTING INFORMATION

FROM SCHOOLS AND TEACHERS 

Information from schools and teachers is

often very important in determining

whether a child meets the definition of

disability. This coming school year, the

State Disability Determination Services

(DDSs) will be using a new form,

appropriately titled “Teacher

Questionnaire” (TQ), (Form SSA-5665-

BK) to request information from these

vital sources. The TQ, together with the

related “Request for Administrative

Information” (Form SSA - 5666), will be

accompanied by a signed authorization

from the parent or legal guardian for the

disclosure of information. The signed

authorization form, “Supplement to

Form SSA-827 For Use in Cases of

School-Age Children,” was developed to

comply with the laws that govern

whether schools can supply information,

particularly the Family Educational

Rights and Privacy Act (FERPA), and

the U. S. Department of Education

regulations. 

Teachers and others in the education

profession are very busy. We worked

very hard during the development of

these forms with educators and with the

Department of Education to make the

TQ easy to understand, navigate and

complete. The form employs a

consistently clear numeric rating system-

- many questions may be answered by

circling the applicable rating number.

The form is designed to get a picture of

the child’s day-to-day functioning in

school and the child’s functioning
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compared to that of other children the

same age who do not have impairments. 

The TQ (Form SSA-5665-BK) and

“Request for Administrative

Information” (Form SSA - 5666) can be

reviewed and downloaded and /or

printed from the SSA web site at:

http://www.ssa.gov/online/forms.html.

Once at this site enter Form Number in

the ”Search” block and the form number

in the “For” block. 

If you want more information or have a

question about the TQ form, the

Professional/Medical Relations Officers

in the DDS in your state can help. You

can find a complete list on the web at:

http://www.ssa.gov/disability/profession

als/procontacts.htm.

PROTOTYPE UPDATE 

As we have reported in prior issues of

Disability Notes, SSA has been

conducting prototypes – tests of changes

to the way disability applications are

processed. (For more background, check

out:

http://www.ssa.gov/disability/disabilityn

otes.) 

SSA has been conducting a prototype of

a combination of redesign features in ten

States: New Hampshire, Pennsylvania,

New York, Alabama, Louisiana,

Michigan, Missouri, Colorado,

California, Arkansas. These features

include:

 Giving disability examiners

(commonly referred to as single

decisionmaker or SDMs) the

authority to make decisions

independently in most cases. 

 Providing the claimant the

opportunity in less than fully

favorable cases to speak with the

decisionmaker about their case (a

claimant conference). 

 Eliminating the reconsideration step

of the appeal process.

The SDM feature enables the medical

and psychological consultants to act as

true consultants, and also frees up time

for them to provide training and

mentoring to the examiners as well. The

elimination of the reconsideration step

provides the resources for more

complete development and improved

explanations of how the disability

determination is made in order to

enhance the quality of decisions.

We have been doing the prototype since

October 1999. We found that while the

prototype process had some good results

in terms of better initial decision making

and more efficient use of DDS

adjudicative resources, overall it did not

accomplish what we had hoped it would.

Based on what we have learned, the

Commissioner has decided that we

cannot implement the prototype process

as it exists, but she has decided to pursue

the nationwide expansion of the single

decisionmaker feature to make the most

effective use of examiner and medical

and psychological consultant resources. 

 Implementing SDM authority

nationwide will result in more effective

use of examiner and medical and

psychological consultant resources.

SSA must publish a final regulation in

the Federal Register before national

expansion of the SDM, which we expect

to do this summer. 
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When the current prototype authority

expires in June we will no longer be

testing the claimant conference. Instead,

SSA will encourage early and ongoing

contact with the claimant when

appropriate. The end-of-line conference

added processing time, and was not as

effective as we had hoped. Most States

that have been participating in the

prototype found early and ongoing

contact with the claimant to be more

effective. 

We also intend to extend the authority

for elimination of the reconsideration

step in the ten states as we consider

broader issues related to the entire claim

process and any changes that need to be

made. 

You can check on regulations for these

proposed changes in the upcoming

months on the web at:

http://policy.ssa.gov/pnpublic.nsf/LawsR

egs

These steps affirm the Commissioner’s

words before the Subcommittee on

Social Security of the House Ways and

Means Committee on May 2, 2002: “I

feel very strongly that we must move

forward now and make decisions on

what we can do immediately to improve

disability processing while laying the

groundwork for additional mid- and

longer-term improvements.”

EVALUATING HEMATOLOGICAL

DISORDERS AND MALIGNANT

NEOPLASTIC DISEASES 

We reopened the comment period for the

notice of proposed rulemaking (NPRM)

we published in the Federal Register (66

FR 59306) on November 27, 2001. The

reopened NPRM describes how we

propose to revise the hematological

disorders and malignant neoplastic

disease listings 

Comments that we had received during

the rulemaking period raised significant

issues; therefore we decided to provide

an additional 60-day public comment

period for these rules beginning April

18th, 2002. During this time we met with

a number of key advocates. You can

review the meeting proceedings on the

web at:

http://policy.ssa.gov/erm/rules.nsf/Rules

+Open+To+Comment. 

The update of this listing is part of our

initiative to update all of the listings. 

MEDICARE SAVINGS

PROGRAMS – YOU MAY

QUALIFY

Studies have shown that millions of

Americans may be eligible for

programs called "Medicare Savings

Programs" but are not taking advantage

of them.

“Medicare Savings Programs” is an

umbrella name given to the Qualified

Medicare Beneficiary (QMB), Specified

Low-Income Medicare Beneficiary

(SLMB), Qualifying Individual (QI) and

Qualified Disabled and Working

Individual (QDWI) programs. These

state-administered Medicaid programs

subsidize certain Medicare expenses for

beneficiaries with limited means. 

Under the authority of a recently enacted

provision of the Social Security Act,

SSA is identifying potential Medicare

Savings Program eligible individuals.

SSA will share the list of potential
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eligible individuals with state Medicaid

agencies.

In addition, from May 10 to November

8, nearly 16.5 million potentially eligible

individuals will be sent a letter alerting

them to their potential eligibility for

QMB/SLMB/QI benefits. The letters

encourage them to contact the state

agency administering Medicaid if they

believe they meet eligibility criteria

described in the letter or have questions.

These programs pay the Medicare Part B

premium, now usually $54 per month.

The QMB program also pays other

Medicare-related expenses.

Letters to individuals who may be

eligible as QDWIs will be mailed the

last week of November. After

contacting their state Medicaid agencies,

potentially eligible QDWIs no longer in

their initial enrollment period will need

to file a Medicare application with SSA

as a disabled and working individual

during the January-March General

Enrollment Period. The QDWI program

pays the Medicare Part A premium. The

monthly premium is either $175 or $319

per month. The premium amount

depends on the individuals work history. 

The outreach letters vary from state-tostate to reflect different State contact

information and variations in State

eligibility rules. 

If you or someone you know receives

one of these letters, we encourage you to

act on it and check out eligibility for

these programs.

THE TICKET TO WORK

PROGRAM

The Ticket to Work and Self-Sufficiency

Program (Ticket to Work Program) was

established by the Ticket to Work and

Work Incentives Improvement Act of

1999. It assists Social Security and

Supplemental Security beneficiaries with

disabilities to obtain, regain and

maintain self-supporting employment by

expanding their choice of employment

services, vocational rehabilitation

services and other support services.

Phase one of the ticket rollout is

underway and over 1.2 million tickets

have been mailed to beneficiaries with

disabilities in Arizona, Illinois,

Oklahoma, Wisconsin, Colorado, Iowa,

Oregon, Delaware, Massachusetts, South

Carolina, Florida, New York and

Vermont.

To date beneficiaries have assigned over

2,400 tickets to Employment Networks

and to state vocational rehabilitation

agencies. 

 SSA has approved over 400 applications

from organizations seeking to serve as

Employment Networks. MAXIMUS, the

Ticket to Work Program manager, is

sponsoring free Employment Network

Recruitment Conferences around the

country. Any state or local agency or

private organization that is qualified to

provide services to beneficiaries with

disabilities can apply to be an

Employment Network. For a complete

listing of future employment network

conferences, visit MAXIMUS’ web site

at www.yourtickettowork.com or call

toll free 1-866-968-7842 or the toll free

TDD Line 1-866-833-2967.
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Phase Two of the ticket mailings will

begin later in 2002. Tickets will be

mailed to over 2.7 million beneficiaries

with disabilities in Alaska, Arkansas,

Connecticut, Georgia, Indiana, Kansas,

Kentucky, Louisiana, Michigan,

Mississippi, Missouri, Montana, Nevada,

New Hampshire, New Jersey, New

Mexico, North Dakota, South Dakota,

Tennessee, Virginia and the District of

Columbia. Employment network

application requests are now being

accepted from Phase Two States.

In 2003, during the third and final phase,

SSA will mail tickets to beneficiaries

with disabilities in the following States

and territories: Alabama, California,

Hawaii, Idaho, Maine, Maryland,

Minnesota, Nebraska, North Carolina,

Ohio, Pennsylvania, Rhode Island,

Texas, Utah, Washington, West

Virginia, Wyoming, American Samoa,

Guam, Northern Mariana Islands, Puerto

Rico and the Virgin Islands.

For more information on the Ticket to

Work Program and other employment

support programs for beneficiaries with

disabilities, visit the Office of

Employment Support Programs’

“WorkSite” at http://www.ssa.gov/work.

EDITOR'S NOTE

In Search of your Ideas and Materials 

This newsletter is your newsletter. We

welcome your articles, letters to the

editor, comments, or suggestions for

improvement. Many of your past

suggestions have been implemented.

Please submit the ideas or materials to

the address or e-mail listed below.

Subscription

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If you are interested in receiving your

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DISABILITY NOTES

Social Security Administration

Office of Disability

524 Altmeyer Building

Baltimore, MD 21235-6401

Julian Manelli, Editor

Telephone (410) 965-9022

TDD (410) 966-6210

FAX (410) 965-6503

julian.a.manelli@ssa.gov

Current and past issues of DISABILITY

NOTES are available online via Internet:

http://www.ssa.gov/odhome
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