Michael J. Astrue, Commissioner of Social Security, announced on February 1, 2010 that 15 healthcare providers and networks have received $17.4 million in contract awards to provide electronic medical records to the Social Security Administration (SSA). These electronic medical records, which will be sent through the Nationwide Health Information Network (NHIN), will hopefully shorten the time it takes Social Security to make a disability decision and will improve the speed, accuracy, and efficiency of the disability program.

“Using health information technology will improve our disability programs and provide better service to the public,” Commissioner Astrue said. “We’ve seen a significant increase in disability applications. To process them, the agency sends more than 15 million requests annually for medical records to healthcare providers. This largely paper-bound workload is generally the most time-consuming part of the disability decision process. The use of health IT will dramatically improve the speed, accuracy, and efficiency of this process, reducing the cost of making a disability decision for both the medical community and the American taxpayer.”

The contract awards are funded through the American Recovery and Reinvestment Act (Stimulus). They will require awardees, with a patient’s authorization, to send Social Security electronic medical records through the NHIN. The NHIN, a safe and secure method for receiving access to electronic medical records over the Internet, is an initiative of the Department of Health and Human Services supported by multiple government agencies and private sector entities.

For the last year, Social Security has been successfully testing health IT to obtain electronic medical records. Disability applications processed with electronic medical records from the test sites have significantly reduced processing times. Some decisions are now made in days, instead of weeks or months. Social Security expects to receive more than 3.3 million applications in fiscal year (FY) 2010, a 27 percent increase over FY 2008.

©2010 Virginia Disability Law Blog. All Rights Reserved.

HealthVault is a free online service that enables people to gather, store and manage their families’ health information, and share that information with their physicians and healthcare providers.   These “personal health records” contain the same types of information that Social Security generally obtains from people applying for disability benefits.

The use of personal health records holds great promise for ensuring that the medical information we collect from someone applying for disability benefits is accurate and complete,” Commissioner Astrue said. “Combined with other advancements in health information technology, our use of HealthVault should result in faster decisions for disability applicants. I look forward to working closely with Microsoft, a world-wide leader in information technology.”

Social Security and Microsoft are developing a technical prototype connecting the two organizations that will be available later this year. The agency also will collaborate with Microsoft to study current personal health record standards, gaps in those standards, and options for filling those gaps.

©2010 Virginia Disability Law Blog. All Rights Reserved.

A “pre-existing condition” is considered to be any condition for which medical advice, diagnosis, care or treatment was recommended or received within the previous six-month period. The maximum amount of time a plan can refuse coverage for any such condition is twelve months. If an individual starts a new job and is subject to a waiting period before being eligible to join the health plan, the waiting period and twelve-month period for the pre-existing conditions must coincide.

The twelve-month period for pre-existing conditions may also be reduced if the individual provides the new insurance plan with proof of their prior health coverage. When leaving a health plan, the plan must provide you with a Certificate of Coverage which details the dates you were covered under the plan. This continuous coverage can be credited toward the pre-existing condition period, provided there was not a “significant break” in coverage between jobs – this is defined as sixty-three days.

Therefore, if you had at least twelve months of “creditable coverage” (which can be from a group health plan, HMO, individual health insurance policy, Medicare, or Medicaid) and then left your job and you started a new job within sixty-three days thereafter, the pre-existing condition period would not apply. Your condition would be covered immediately (provided that the plan regularly covers that condition). COBRA coverage can also be credited towards continuous coverage.

HIPPA can also help provide access to individual insurance when group coverage is not an option. HIPAA guarantees access to an individual plan if: the individual had group coverage for at least eighteen months; did not have their group coverage terminated because of fraud or nonpayment of premiums; is ineligible for COBRA or has exhausted COBRA benefits; and is not eligible for coverage under another group health plan.

©2010 Virginia Disability Law Blog. All Rights Reserved.