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.

Hospitals often give patients a health care power of attorney (health care proxy) form to sign on being admitted.   While signing a generic health care power of attorney form is better than not signing one at all, these documents vary in the amount of care that has gone into their drafting, and having one that is specifically tailored to your needs can be important. 

A health care power of attorney allows you to appoint someone else to act as your agent for medical decisions. In general, a health care power of attorney takes effect only when you require medical treatment and a physician determines that you are unable to communicate your wishes concerning what that treatment should be.   Appointing someone to serve as your agent helps ensure that your medical treatment instructions will be carried out.

While a health care power of attorney serves to appoint an agent to speak for you, you can also use it to give the agent guidance about your medical wishes.  Following are some issues that can be addressed in a health care proxy:

•The name of the person authorized to act for you. It is good to appoint an alternate as well.
•Whether or not you want to be kept alive by machines if you are in a persistent vegetative state.
•Under what circumstances you want pain medication to be administered.

Whatever choices you make, you should take time to consider your health care wishes before signing a health care power of attorney.  For this reason, signing a generic hospital form may not a good idea, as many of these forms will not take your individual wishes into account.

Also bear in mind that if you already have a health care power of attorney as a part of your estate plan, the generic form will revoke your more personal health care power of attorney.

A qualified attorney, such as Sheri Abrams, can help you create a health care power of attorney that addresses your particular situation. You can then take this document with you to the hospital and have it made part of your medical records.

Individuals with various health conditions are often reluctant to leave jobs because they are afraid pre-existing condition clauses will limit coverage of any such conditions under a new insurance plan. HIPAA (Health Insurance Portability and Accountability Act of 1996) limits the amount of time an insurer can refuse to cover pre-existing conditions to twelve months. HIPAA also ensures that in some cases there is no waiting period for new coverage. However, an insurer is still not required to cover every condition and disability. In some cases, they can still deny coverage altogether for certain conditions as long as the decision is based on sound actuarial data.State laws may offer more generous protections than HIPAA. You may want to contact your state insurance commissioner’s office to ask about the law where you live. A good place to start is the Web site of the National Association of Insurance Commissioners at www.naic.org.

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.