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Pages 1-10

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From page 1...
... They require an applicant to have, for a particular medical condition or combination of conditions, "exacerbations or complications requiring three hospitalizations within a 12-month period and at least 30 days apart" of which "each hospitalization must last at least 48 hours, including hours in a hospital emergency department immediately before the hospitalization." The committee sought to understand the SSA programs and disability-determination process: SSA tasked the committee with providing an analysis of health-care utilizations as they relate to impairment severity and SSA's definition of disability. The committee sought to identify types of utilizations that might be good proxies for listing-level severity, that is, what represents an impairment, or combination of impairments, severe enough to prevent a person 1 There is no federal role in state worker compensation.
From page 2...
... The SSA Office of the Inspector General noted in 2015 that "the Listings help ensure that disability determinations are medically sound, claimants receive equal treatment based on the specific criteria, and disabled individuals can be readily identified and awarded benefits, if appropriate." Applicants whose impairments do not meet or medically equal a Listing can still be determined to be disabled at step 5 on the basis of the combination of their residual functional capacity, age, education, and work experience. Although an established "listing of medical impairments" has existed since the disability program began in 1956, SSA did not publish the Listings in its disability regulations until 1968.
From page 3...
... Explain how types of utilizations are more or less probable for particular medical conditions or combinations of medical conditions; 6. Describe how factors such as poverty and urbanization level affect health care utilizations; and 7.
From page 4...
... Other differences in health-care utilization reflect differential access, such as access to health insurance coverage or to income needed to obtain services, ease of obtaining services, or discriminatory practices by providers. A few examples are discussed below.
From page 5...
... People who have lower family income typically have higher rates of heart disease, stroke, diabetes, or hypertension. People in families that have income less than 200 percent of the federal poverty level are more likely to be obese and to smoke cigarettes than wealthier people.
From page 6...
... Adults who were living under the poverty level reported greater rates of not receiving or of delaying seeking medical care, obtaining prescription drugs, and receiving dental care because of cost than adults who were living at 400 percent of the poverty level. Geography Level of urbanization has been shown to be associated with health-care utilization in several ways, including correlation of residents' sociodemographic characteristics with need and risk factors and with differential access to care.
From page 7...
... A major goal of the ACA was to extend health insurance coverage to 32 million uninsured people in the United States. The plan had two major components: expansion of the Medicaid program and new structures to support the individual and small-group health insurance markets.
From page 8...
... For example, denial of coverage because of pre-existing conditions is no longer allowed, and the expansion of health insurance coverage through the Medicaid program, the health insurance exchanges, and the dependent-coverage provision will allow many Americans who have disabilities to obtain health insurance coverage without having also to qualify for SSDI or SSI. HEALTH-CARE UTILIZATIONS AS PROXIES FOR LISTING-LEVEL SEVERITY The committee's extensive literature review found no studies that addressed the usefulness of health-care utilizations in determining disability or impairment severity and few that addressed the association of health-care utilization with disability.
From page 9...
... and chronic kidney disease, there is some evidence that increased hospitalizations, ED visits, and outpatient physician visits might predict disease severity for some specific diagnoses. However, their relevance to the committee's task is limited in that disease severity does not fit SSA's definition of impairment severity and statistical modeling in the supporting papers involved more factors than health-care utilization, such as individual and societal factors that influence the use of health care.
From page 10...
... People with disabilities face a number of barriers to access to health care that are specific to their individual limitations in function, including physical access -- lack of working elevators or ramps, automatic doors, hallways and doors wide enough to accommodate wheelchairs, and accessible parking -- and lack of accommodation for barriers to communication, such as staff willing to try to communicate with impaired patients during scheduling or other interactions. There have been many changes in the health-care system, for example, movement away from hospitalizations, movement toward outpatient settings or ambulatory care centers, and discouragement of rehospitalizations; thus, utilization might be a poor marker of disease severity and disability.


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