AAFP Guides Federal Agency in Revising Disability Evidence Rules

October 26, 2016 01:36 pm News Staff

The AAFP recently gave the Social Security Administration (SSA) pointed feedback as the agency mulls new rules for considering medical evidence in disability and blindness claims, including who can serve as medical and psychological consultants.

[Man filling out electronic health history form]

In a letter dated Oct. 19,(2 page PDF) AAFP Board Chair Wanda Filer, M.D., M.B.A., of York, Pa., gave SSA Acting Commissioner Carolyn Colvin suggestions for improving a proposed rule(www.federalregister.gov) on the screening process to determine eligibility for individuals seeking disability benefits.

Filer first raised concern about the SSA's desire "to make every reasonable effort" to seek input from a psychologist or a psychiatrist when determining whether an applicant has a mental health disability that qualifies for benefit coverage.

"Due to the shortage of psychiatrists and psychologists and as more individuals seek mental health care, the demand for this care will outweigh the supply of psychiatrists or qualified psychologists," Filer wrote.

Filer also cited an Aug. 19 letter(56 page PDF) to CMS calling for a massive educational campaign on the importance of selecting a primary care physician to coordinate care. Such a campaign would address the fragmentation of health care that undermines the concept of a patient-centered medical home, and it would help the SSA collect the medical evidence needed to process claims.

The SSA's proposed rule acknowledged that the changing nature of primary care means the agency should begin evaluating an individual's medical history based on the persuasiveness of medical opinions and previous administrative findings instead of assigning specific weight to each piece of these data. An explanation in the proposed rule notes how difficult it is to evaluate claims from individuals who seek care from a variety of sources without developing a relationship with one treating physician.

"We applaud the SSA for discussing challenges expressed by family physicians with patients who sought care with multiple health care providers in various settings," Filer wrote. "This uncoordinated approach, especially for those individuals with chronic conditions, is an example of fragmented care, which results in higher health care costs. This is in direct contrast to the national effort for high-quality, cost-effective care."

Under the proposed rule, the SSA would attempt to obtain all relevant medical records going back 12 months, including records held by the patient's primary care physician, before making a determination about disability. An exception would be made when there is reason to file a claim less than 12 months after a disability begins. Filer wrote that a medical practice should have 20-25 calendar days to gather and release the records before the SSA makes its single followup request for the information, rather than 10-20 days, as detailed in the proposed rule.

"While the AAFP appreciates the additional effort to request information from a medical source, we are concerned that the time frame of 10-20 calendar days after the initial request is not a reasonable amount of time for a medical practice to gather and release the requested information," Filer stated in her letter.

More From AAFP
American Family Physician: Disability Evaluations: More Than Completing a Form
(1/15/2015)