Homeless and Helpless: How the United States has Failed Those With Severe and Persistent Mental Illness

The United States has failed its citizens who suffer from severe and persistent mental illness (SPMI). Homelessness is one of the most obvious manifestations of this failure. The combination of a lack of effective treatment, inadequate entitlement programs such as Social Security Disability Insurance (SSDI), and subpar housing options form systemic barriers that prevent people suffering from mental illness from being able to obtain adequate housing. Cultural beliefs within the United States regarding who is homeless and what homelessness means also play a significant role in the development of positively impactful social welfare programs. Part II of this Note reviews the history of treatment for persons with SPMI--specifically how that treatment has evolved, the history of federal policies regarding SSI, SSDI and housing, and societal beliefs regarding homelessness and mental illness that have impacted policymaking decisions. Part III looks at these same areas from a current perspective and addresses the current issues and some possible solutions. Part IV discusses how lack of effective treatment, poor disability programs, and the need for better housing options work together to form systemic barriers for people with SPMI. Part IV also address how the cultural beliefs in the United States regarding people who have SPMI and are homeless serve as an independent barrier to policy change. Ultimately, this Note argues that homelessness is a product of system failures rather than individual factors.

The Doctor - and Lawyer - Will See You Now: Medical-Legal Partnerships

Elderly woman. Low-income. Chronic pain. Needs to see a rheumatologist. Needs physical therapy. Struggling to pay rent. Has no insurance. Has no disability coverage. As a family physician at a federally qualified health center (FQHC) in Austin, Sharad Kohli, MD, sees a lot of cases like this. In similar health care settings, the patient might face two bad choices: wage bureaucratic war to obtain better health care benefits or simply give up. At People's Community Clinic, Dr. Kohli referred her to an in-house lawyer who successfully appealed her denial of disability insurance. "[The lawyer] got her a significant income, which allowed her to pay her rent and also helped her get insurance through Medicaid and Medicare," Dr. Kohli said. "And then she was able to see the rheumatologist and the physical therapist." This kind of success helps explain why medical-legal partnerships (MLPs) like the one at People's Community Clinic came about in 1993 and began expanding nationally after 2001. Texas has 10 MLPs - all in large or medium-size cities and all tied either to hospitals or FQHCs like People's Community Clinic, according to the National Center for Medical-Legal Partnership in Washington, D.C. Texas MLPs stand among 333 nationwide.

Department of Veterans Affairs. Eligibility for Supplemental Service-Disabled Veterans' Insurance. Final rule

The Department of Veterans Affairs (VA), in this final rule, amends its regulations governing the Service-Disabled Veterans' Insurance (S-DVI) program in order to explain that a person who was granted S-DVI as of the date of death is not eligible for supplemental S-DVI because the insured's total disability did not begin after the date of the insured's application for insurance and while the insurance was in force under premium-paying conditions.

Department of Veterans Affairs. Reimbursement of Qualifying Adoption Expenses for Certain Veterans. Interim final rule

The Department of Veterans Affairs (VA) amends its regulation to provide for reimbursement of qualifying adoption expenses incurred by a veteran with a service-connected disability that results in the inability of the veteran to procreate without the use of fertility treatment. Under the Continuing Appropriations and Military Construction, Veterans Affairs, and Related Agencies Appropriations Act, 2017, and Zika Response and Preparedness Act, VA may use funds appropriated or otherwise made available to VA for the "Medical Services" account to provide adoption reimbursement to these veterans. Under the law, reimbursement may be for the adoption-related expenses for an adoption that is finalized after the date of the enactment of this Act under the same terms as apply under the adoption reimbursement program of the Department of Defense (DoD), as authorized in DoD Instruction 1341.09, including the reimbursement limits and requirements set forth in such instruction. This rulemaking implements the new adoption reimbursement benefit for covered veterans.

Extension of Expiration Dates for Four Body System Listings. Final rule

We are extending the expiration dates of the following body systems in the Listing of Impairments (listings) in our regulations: Musculoskeletal System, Cardiovascular System, Digestive System, and Skin Disorders. We are making no other revisions to these body systems in this final rule. This extension ensures that we will continue to have the criteria we need to evaluate impairments in the affected body systems at step three of the sequential evaluation processes for initial claims and continuing disability reviews.

Claims Procedure for Plans Providing Disability Benefits; 90-Day Delay of Applicability Date. Final rule; delay of applicability date

This document delays for ninety (90) days--through April 1, 2018--the applicability of a final rule amending the claims procedure requirements applicable to ERISA-covered employee benefit plans that provide disability benefits (Final Rule). The Final Rule was published in the Federal Register on December 19, 2016, became effective on January 18, 2017, and was scheduled to become applicable on January 1, 2018. The delay announced in this document is necessary to enable the Department of Labor to carefully consider comments and data as part of its effort, pursuant to Executive Order 13777, to examine regulatory alternatives that meet its objectives of ensuring the full and fair review of disability benefit claims while not imposing unnecessary costs and adverse consequences.

Department of Veterans Affairs. Extension of the Presumptive Period for Compensation for Gulf War Veterans. Final rule

The Department of Veterans Affairs (VA) is issuing this final rule to affirm its adjudication regulations regarding compensation for disabilities resulting from undiagnosed illnesses suffered by veterans who served in the Persian Gulf War. This amendment is necessary to extend the period during which disabilities associated with undiagnosed illnesses and medically unexplained chronic multi-symptom illnesses must become manifest in order for a Veteran to be eligible for compensation. The intended effect of this amendment is to provide consistency in VA adjudication policy, preserve certain rights afforded to Persian Gulf War (GW) veterans, and ensure fairness for current and future GW veterans.

Department of Veterans Affairs. Schedule for Rating Disabilities; Dental and Oral Conditions. Final rule

This document amends the Department of Veterans Affairs (VA) Schedule for Rating Disabilities by revising the portion of the schedule that addresses dental and oral conditions. The effect of this action is to ensure that the rating schedule uses current medical terminology and to provide detailed and updated criteria for evaluation of dental and oral conditions for disability rating purposes.

Claims Procedure for Plans Providing Disability Benefits. Final rule

This document contains a final regulation revising the claims procedure regulations under the Employee Retirement Income Security Act of 1974 (ERISA) for employee benefit plans providing disability benefits. The final rule revises and strengthens the current rules primarily by adopting certain procedural protections and safeguards for disability benefit claims that are currently applicable to claims for group health benefits pursuant to the Affordable Care Act. This rule affects plan administrators and participants and beneficiaries of plans providing disability benefits, and others who assist in the provision of these benefits, such as third-party benefits administrators and other service providers.

Ensuring Program Uniformity at the Hearing and Appeals Council Levels of the Administrative Review Process. Final rule

We are revising our rules so that more of our procedures at the hearing and Appeals Council levels of our administrative review process are consistent nationwide. We anticipate that these nationally consistent procedures will enable us to administer our disability programs more efficiently and better serve the public.

World Trade Center Health Program; Amendments to Definitions, Appeals, and Other Requirements. Final rule

In 2011 and 2012, the Secretary, Department of Health and Human Services (HHS), promulgated regulations designed to govern the World Trade Center (WTC) Health Program (Program), including the processes by which eligible responders and survivors may apply for enrollment in the Program, obtain health monitoring and treatment for WTC-related health conditions, and appeal enrollment and treatment decisions, as well as a process to add new conditions to the List of WTC-Related Health Conditions (List). After using the regulations for a number of years, the Administrator of the WTC Health Program identified potential improvements to certain existing provisions, including, but not limited to, appeals of enrollment, certification, and treatment decisions, as well as the procedures for the addition of health conditions for WTC Health Program coverage. He also identified the need to add new regulatory provisions, including, but not limited to, standards for the disenrollment of a WTC Health Program member and decertification of a certified WTC-related health condition. A notice of proposed rulemaking was published on August 17, 2016; this action addresses public comments received on that proposed rulemaking, as well as three interim final rules promulgated since 2011, and finalizes the proposed rule and three interim final rules.

Extension of the Expiration Date for State Disability Examiner Authority To Make Fully Favorable Quick Disability Determinations and Compassionate Allowance Determinations. Final rule

We are extending, until December 28, 2018, the expiration date of our disability examiner authority (DEA) rule, which authorizes State agency disability examiners to make fully favorable determinations without the approval of a State agency medical or psychological consultant in claims that we consider under our quick disability determination (QDD) and compassionate allowance (CAL) processes. This is our last extension of this rule because we will phase out the use of DEA during the extension period under section 832 of the Bipartisan Budget Act of 2015 (BBA). This extension provides us the time necessary to take all of the administrative actions we need to take in order to reinstate uniform use of medical and psychological consultants. The current rule will expire on November 11, 2016. In this final rule, we are changing the November 11, 2016 expiration or "sunset" date to December 28, 2018, extending the authority for 2 years and 1 month. This is the final extension of our DEA rule. On December 28, 2018, at the conclusion of this extension, the authority for this test will terminate. We are making no other changes.

Extension of Expiration Dates for Four Body System Listings. Final rule

We are extending the expiration dates of the following body systems in the Listing of Impairments (listings) in our regulations: Musculoskeletal System, Cardiovascular System, Digestive System, and Skin Disorders. We are making no other revisions to these body systems in this final rule. This extension ensures that we will continue to have the criteria we need to evaluate impairments in the affected body systems at step three of the sequential evaluation processes for initial claims and continuing disability reviews.

PART II: Case Law, Best Practice and the Post-104 Week IRB Disability Test

The following is Part II of a three-part paper presenting holistic models of determining impairment and occupational disability with respect to common "own occupation" and "any occupation" definitions, especially in the motor vehicle accident (MVA) context. This segment of the paper is for the purpose of educating readers regarding pertinent case law and related evolving judicial/arbitral interpretations surrounding the Post 104-week income replacement entitlement within the Ontario MVA insurance system. Best practices in disa- bility assessment methodology and analysis are supported in the context of holistic occupational disability assessment models in relation to the relevant case law. Comparative analysis was also utilized to inform the reader of the emphasis upon the quality of activity engagement across pre- and post- 104 week spheres. Beyond the MVA sphere, medically-legally, the reviewed case law and related clinical best practices are fully germane to the long term disability and WSIB (workers' compensation) sectors. A specific area emphasized by authors is that the assessment of pain is more complex than is generally acknowledged in many disability assessments. Research on the impact of pain on individuals with disabilities and impairments arising from injuries sustained, clearly demonstrates that traditional pain measurements are often inadequate to fully determine the disability arising from pain. Finally, particularly in the context of In- surance Examinations (lEs and Independent Medical Assessments for LTD), the principle of competitive employability is often not considered as it should be in accordance with the existing case law.

Revised Medical Criteria for Evaluating Neurological Disorders. Final rule

We are revising the criteria in the Listing of Impairments (listings) that we use to evaluate disability claims involving neurological disorders in adults and children under titles II and XVI of the Social Security Act (Act). These revisions reflect our program experience; advances in medical knowledge, treatment, and methods of evaluating neurological disorders; comments we received from medical experts and the public at an outreach policy conference; responses to an advance notice of proposed rulemaking (ANPRM); and public comments we received in response to a Notice of Proposed Rulemaking (NPRM) and a Federal Register notice that reopened the NPRM comment period.

Penalty Inflation Adjustments for Civil Money Penalties. Interim Final Rule

In accordance with the Federal Civil Penalties Inflation Adjustment Act of 1990, as amended by the Debt Collection Improvement Act of 1996, and further amended by the Bipartisan Budget Act of 2015, section 701: Federal Civil Penalties Inflation Adjustment Act Improvements Act of 2015, this interim final rule incorporates the penalty inflation adjustments for the civil money penalties contained in the Social Security Act

Revised Medical Criteria for Evaluating Respiratory System Disorders. Final rule

We are revising the criteria in the Listing of Impairments (listings) that we use to evaluate claims involving respiratory disorders in adults and children under titles II and XVI of the Social Security Act (Act). The revisions reflect our program experience and advances in medical knowledge since we last comprehensively revised this body system in 1993, as well as comments we received from medical experts and the public.

Department of Veterans Affairs. Health Care for Certain Children of Vietnam Veterans and Certain Korea Veterans--Covered Birth Defects and Spina Bifida. Final rule

This rule adopts as final a proposed rule of the Department of Veterans Affairs (VA) to amend its regulations concerning the provision of health care to birth children of Vietnam veterans and veterans of covered service in Korea diagnosed with spina bifida, except for spina bifida occulta, and certain other birth defects. In the proposed rule published on May 15, 2015, VA proposed changes to more clearly define the types of health care VA provides, including day health care and health-related services, which we defined as homemaker or home health aide services that provide assistance with Activities of Daily Living or Instrumental Activities of Daily Living that have therapeutic value. We also proposed changes to the list of health care services that require preauthorization by VA. This final rule addresses comments received from the public and adopts as final the proposed rule, without change.

Extension of the Expiration Date for State Disability Examiner Authority To Make Fully Favorable Quick Disability Determinations and Compassionate Allowance Determinations. Final rule

We are extending the expiration date of our rule that authorizes State agency disability examiners to make fully favorable determinations without the approval of a State agency medical or psychological consultant in claims that we consider under our quick disability determination (QDD) and compassionate allowance (CAL) processes. The current rule will expire on November 13, 2015. In this final rule, we are changing the November 13, 2015 expiration or ``sunset'' date to November 11, 2016, extending the authority for 1 year. We are making no other substantive changes.

Extension of Effective Date for Temporary Pilot Program Setting the Time and Place for a Hearing Before an Administrative Law Judge. Final rule

We are extending for one year our pilot program that authorizes the agency to set the time and place for a hearing before an administrative law judge (ALJ). Extending of the pilot program continues our commitment to improve the efficiency of our hearing process and to maintain a hearing process that results in accurate, high-quality decisions for claimants. The current pilot program will expire on August 10, 2015. In this final rule, we are extending the effective date to August 12, 2016. We are making no other substantive changes.

Revised medical criteria for evaluating hematological disorders. Final rules

We are revising the criteria in the Listing of Impairments (listings) that we use to evaluate cases involving hematological disorders in adults and children under titles II and XVI of the Social Security Act (Act). These revisions reflect our adjudicative experience, advances in medical knowledge, diagnosis, and treatment, and public comments we received in response to a Notice of Proposed Rulemaking (NPRM).

Revised listings for growth disorders and weight loss in children. Final rule

This rule adopts, with one change, the rule for evaluating growth disorders in children we proposed in a notice of proposed rulemaking (NPRM) published in the Federal Register on May 22, 2013. Several body systems in the Listing of Impairments (listings) contain listings for children based on impairment of linear growth or weight loss. We are replacing those listings with new listings for low birth weight (LBW) and failure to thrive; a new listing for genitourinary impairments; and revised listings for growth failure in combination with a respiratory, cardiovascular, digestive, or immune system disorder. These revisions reflect our program experience, advances in medical knowledge, and comments we received from medical experts and the public.

Submission of evidence in disability claims. Final rule

We are clarifying our regulations to require you to inform us about or submit all evidence known to you that relates to your disability claim, subject to two exceptions for certain privileged communications. This requirement includes the duty to submit all evidence that relates to your disability claim received from any source in its entirety, unless you previously submitted the same evidence to us or we instruct you otherwise. We are also requiring your representative to help you obtain the information or evidence that we require you to submit under our regulations. These modifications to our regulations will better describe your duty to submit all evidence that relates to your disability claim and enable us to have more complete case records on which to make more accurate disability determinations and decisions.

Recent Developments in Health Insurance, Life Insurance, and Disability Insurance Law

This year's article covers key recent developments in life, health, and disability insurance law, including Supreme Court decisions on the constitutionality of the Affordable Care Act's contraception coverage provisions and on the enforceability of legal actions limitations period provisions in Employee Retirement Income Security Act (ERISA) plan documents; an alarming (but potentially short-lived) expansion of restitution as a form of "equitable relief" under ERISA; the latest battles in the stranger originated life insurance (STOLI) wars; and perennial issues arising out of disability and accident insurance cases.

[INAIL recourse in occupational diseases]

The following paper examines the issue of the specific action of recourse brought by the National Insurance Accidents at work (INAIL) for occupational diseases by examining the regulatory framework and the diachronic evolution of the Court's legitimacy in the matter. The authors focus on the most frequent cases and highlight the orientation adopted by the administrative office in the matter.