Disability Terms and Definitions

ADA Title I: Employment Title I requires employers with 15 or more employees to provide qualified individuals with disabilities an equal opportunity to benefit from the full range of employment-related opportunities available to others. Work Incentives/Employment Support SSA policies that help disability beneficiaries go to work and receive benefits in an attempt to become more independent. DHO Disability Hearing Officer. Conducts in person hearings. Next appeal is to a federal Administrative Law Judge (ALJ). Own Occupation (Own Occ) Under this definition, an insured will be considered disabled only if he or she is unable to perform the duties of his or her occupation. Maximum Benefit Period (Benefit Duration) This is the maximum length of time for which benefits are payable under the plan as long as the employee remains continuously disabled. Representative Payee Individual appointed by the Social Security Administration (SSA) to manage the cash benefits of a recipient of SSI or Social Security benefits, or both. PD Presumptive Disability. Only for SSI claims. Enables an early (presumptive) allowance of benefits for 6 months based on a substantial probability of a final allowance when all required documentation is obtained. A PD can be reversed to a denial, but the claimant does not return the PD benefits. Continuing Disability Review (CDR) An evaluation of an individual's impairment(s) to determine whether the person is still disabled within the meaning of the law for purposes of eligibility for SSI and OASDI benefits. Medicaid provider A professional or medical facility who is enrolled as a provider for the Medicaid Program by entering into a contract with the Medicaid Program to provide medical services to Medicaid eligible recipients. By entering into this contract the professional has agreed to abide by all rules and regulations governing the Medicaid Program. Reasonable Accommodation Any change in the job application process, work environment or work process, or modification to the benefits or privileges of employment, that results in equal employment opportunity for an individual with a disability.

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	Did You Know?
	SHMO means Social Health Maintenance Organization A managed system of health and long-term care services geared toward an elderly client population. Under this model, a single provider entity assumes responsibility for a full range of acute inpatient, ambulatory, rehabilitative, extended home health and personal care services under a fixed budget which is determined prospectively. Elderly people who reside in the target service area are voluntarily enrolled. Once enrolled, individuals are obligated to receive all SHMO covered services through SHMO providers, similar to the operation of a medical model health maintenance organization (HMO).