December 1973 Eligibility Requirements Manual

1060.005.05 Obtaining Medical Evidence For Medical Review Team

IM-163 December 02, 2020; IM-3 January 15, 2015; IM-44 September 04, 2014; IM-114 December 19, 2006

If the claimant does not receive SSDI, disability-based SSI, or Medicare under the conditions noted above in the months in which coverage is requested, medical evidence must be submitted to the Medical Review Team (MRT). 

All FSD offices must submit the MRT-PC packet immediately upon receipt to MRT- Processing Center (MRT-PC). The packet must contain sufficient information for the MRT-PC to request and obtain the medical information to determine eligibility. The MRT-PC is responsible for obtaining the medical documentation and/or setting any medical appointments.

Completed packets are submitted to the MRT – PC by scanning the information into the Work Site at ssmrt@ip.sp.mo.gov. Field staff CANNOT request medical records.  However, any medical documentation submitted by the applicant/participant or the Authorized Representative must be sent to the MRT – PC along with the completed packet.

The MRT – PC packet consists of:

  • MRT Checklist/Coversheet
  • IM61, Social Information Summary
  • IM61B, Disability Questionnaire
  • IM61C, Work History
  • IM61D, Facility/Doctor List
  • MO 650-2616, Authorization for Disclosure
  • If applicable to the specific case, it must also include:
    • IM365, Emergency Medical Care for Ineligible Aliens
    • IM6AR, Authorized Representative
    • IM68, Visual Disability Examination Report
      • Complete only the top and bottom of this form. The MRT- Processing Center staff will obtain the medical information.
    • Any medical documentation submitted by the applicant or authorized representative directly to the field office.

    NOTE: Medical information submitted to MRT containing reports restricted from disclosure (confidential reports) by the examining physician or issuing source must be called to the attention of MRT.

If the MRT – PC packet is incomplete or illegible and MRT-PC is unable to quickly correct the packet, it will be returned and not considered submitted.

  • Exception: If waiting on verification of earned income and/or medical expenses needed for employment, the form is considered complete if the ‘Pending’ box is checked. Email the verification to MRT.Personnel@dss.mo.gov  within 5 business days of the receipt of earned income and/or medical expenses needed for employment.

The MRT – Processing Center (MRT – PC) will:

  • Review the packet for completeness, correcting simple errors such as missing data that can be retrieved through FAMIS review and returning the packet immediately if it is missing signatures or vital forms.  MRT-PC will notify the ES’s manager about the incomplete packet and whether or not MRT-PC corrected the documents or if the field ES must resubmit the packet.
  • Contact the applicant/participant for clarification of information on the IM-61B, if needed (via MRT Specialists)
  • Obtain acceptable medical evidence consisting of written statements from acceptable medical sources that give enough information for the MRT to make a determination. The statement could consist of a copy of any portion of a case that records a discussion with a doctor, other medical source, hospital, or clinic related to the condition(s) claimed, and contains the physician’s diagnosis. The evidence may be the result of a current examination, or it may be from a record of previous examinations or treatment. The examination must include information related to the condition(s) being claimed by the applicant or recipient.

    Acceptable medical sources include (CFR §416.902):

    • Licensed physician (medical or osteopathic doctor)
    • Licensed psychologist, which include a licensed or certified psychologist at the independent practice level; or a licensed or certified school psychologist, or other licensed or certified individual with another title who performs the same function as a school psychologist in a school setting, for impairments of intellectual disability, learning disabilities, and borderline intellectual functioning only

      NOTE: A Licensed Professional Counselor is NOT an acceptable medical source.

    • Licensed optometrist for impairments of visual disorders, or measurement of visual acuity and visual fields only, depending on the scope of practice in the State in which the optometrist practices

      NOTE: For Blind Pension or Supplemental Aid to the Blind, state law requires a blindness certification to be from an “ophthalmologist, a physician skilled in disease of the eye, or an optometrist, designated or approved by the department of social services to make such examination.” (RSMo 209.040.2)

    • Licensed podiatrist for impairments of the foot, or foot and ankle only, depending on whether the State in which the podiatrist practices permits the practice of podiatry on the foot only, or the foot and ankle
    • Qualified speech-language pathologist for speech or language impairments only. For this source, qualified means that the speech-language pathologist must be licensed by the State professional licensing agency, or be fully certified by the State education agency in the State in which he or she practices, or hold a Certificate of Clinical Competence in Speech-Language Pathology from the American Speech-Language-Hearing Association
    • Licensed audiologist for impairments of hearing loss, auditory processing disorders, and balance disorders within the licensed scope of practice only
    • Licensed Advanced Practice Registered Nurse, or other licensed advanced practice nurse with another title, for impairments within his or her licensed scope of practice
    • Licensed Physician Assistant for impairments within his or her licensed scope of practice
  • Designate the physician, hospital, clinic, or other acceptable medical source to conduct the medical examination (RSMo 208.075.1), if a new examination is needed to obtain adequate medical information.
  • Submit the medical information to the MRT for a disability determination, when sufficient medical information has been obtained.

If the applicant/participant has failed to attend a scheduled medical evaluation and:

  • Other medical documentation is available; the MRT – P C will submit the available information to the MRT to make a determination.

    OR

  • There are no other medical documents available, the MRT- PC will close their action without submitting documentation to the MRT, and will notify the ES the applicant/participant did not cooperate.

    NOTE: Appointment letters include information about when and how to reschedule an appointment. Prior to closing the MRT-PC action, MRT-PC staff will review comments in the eligibility system to determine if there were extenuating circumstances related to the missed appointment. If there is a comment in the eligibility system regarding an allowable circumstance, such as a comment from the Customer Service Center that the participant had been attempting to reach someone to reschedule prior to the appointment, or comments regarding illness or hospitalization of the participant at the time of the appointment, then MRT-PC will reschedule the appointment rather than close their actions.