MEMORANDUM

DISCUSSION:

The purpose of this memorandum is to introduce manual and form updates related to the Medical Review Team - Processing Center (MRT - PC) in Springfield. This memorandum discusses the following:

• The procedure for gathering medical documentation necessary to determine eligibility for:
  • Individuals requesting/receiving MO HealthNet for the Aged, Blind, and Disabled (MHABD) on the basis of disability, including Emergency Medical Care for Ineligible Aliens (EMCIA) under MHABD criteria, and
  • Temporary Assistance (TA) participants requesting exemption from work requirement due to disability.
• Introduces the documents required for obtaining information for a medical determination or redetermination by the Medical Review Team (MRT) in Springfield.
• Clarifies responsibilities of the field Eligibility Specialists (ES) and of the MRT - PC staff.

NOTE:  An MRT determination is not required when an applicant or participant is receiving Social Security Disability (OASDI-Disability) for their own disability or Supplemental Security Income (SSI) in the months that benefits are needed or if the applicant is over age 65.

THE MRT - PC PACKET

FIELD ES RESPONSIBILITIES

MRT - PC RESPONSIBILITIES

The MRT - PC unit was created to increase efficiency in processing applications requiring an MRT determination. This unit provides support to assist field ES by scheduling appointments and obtaining medical information. ES were trained in the MRT - PC procedures in 2013. 

The following procedures for MRT-PC relate only to MRT cases processed in the Springfield MRT office, which includes all locations within the state of Missouri except St Louis City. St Louis City maintains its own Medical Review Team and procedures.

THE MRT - PC PACKET

ES continue to obtain appropriate signatures on the MO 650-2616—Authorization for Disclosure form, complete the Social Information Summary and the Disability Questionnaire, and now complete additional forms for the  MRT - PC. These forms are referred to as the MRT - PC ‘packet’.  Current forms have been revised to reduce duplication of information and to streamline the application process.

• For an MHABD only application, with no Blind Pension/Supplemental Aid to the Blind (BP/SAB) requested:
  • MRT Checklist
  • IM-61—Social Information Summary
    • Instructions are attached
  • IM-61B(Informational)—Disability Questionnaire
    • Instructions are attached

    NOTE: The IM-61B (Informational) must be sent to the applicant but it does not have to be returned.  This information form includes a cover letter detailing the medical review process and instructions for the applicant. If the applicant does return it with the rest of the documentation, scan it to include in the applicant’s MRT-PC packet. 

  • IM-61C—Work History Form
    • Instructions are attached
  • IM-61D—Hospitals, Medical Facilities and Doctors Seen within the Last Year Form
    • Instructions are attached
    • If none, the ES is to check the “NONE” box on the form so that MRT-PC will be immediately aware of the need to schedule a medical appointment
  • MO 650-2616—Authorization for Disclosure
  • If needed:
    • IM-365—Emergency Medical Care for Ineligible Aliens
    • IM-61 from any prior determination
    • IM-6AR—Authorized Representative Form
    • Any medical records submitted with the application
• For MHABD with  BP/SAB requests:
  • All of the forms above, and
  • IM-68—Visual Disability Examination Report Form
• For a BP/SAB request without MHABD:
  • IM-61D OPTH—Ophthalmologist/Optometrist Information Request
    • Instructions are attached
    • NOTE: If the applicant is requesting both MHABD and BP/SAB determinations, the IM-61D should be used rather than the IM-61 D OPTH because medical information other than visual information will be needed
  • MO 650-2616
  • IM-6AR, if appropriate
  • IM-68

NOTE: If any BP/SAB medical records include the Visual Field exam, do not scan, email, or fax the packet to MRT-PC. Visual Field exam images do not effectively transfer by these methods. If a Visual Field exam record is included with the packet, mail the entire packet to:

MRT-Processing Center
101 Park Central Square
Springfield MO 65806

FIELD ES RESPONSIBILITIES:

• Correctly determine if the MRT-PC packet is necessary.
• Complete and submit the MRT - PC packet documents.
  • If mailing the packet to the applicant to complete and return, send the following:
    • The Disability Applicant Cover letter
    • The IM-61B Informational
    • The IM-61C
    • The IM-61D or IM-61D OPTH, as appropriate
    • The MO 650-2616
    • Notice of Privacy Practices Regarding Your Protected Health Information
    • An IM-31A Request for Information instructing the applicant to complete the forms and return them by the due date.
    • NOTE:  Field staff accepting MRT packets from participants should pay special attention to individuals declaring homelessness.  If an applicant does not have the ability to call the FSD Info Center from his/her own phone, (s)he should be allowed to use FSD telephones, usually in interview areas, to make this contact.  The Disability Applicant Cover Letter also provides this information.
  • Obtain the signature on the MO 650-2616 prior to submitting to the MRT – PC;
  • Submit the packet to the MRT - PC upon receipt of the completed packet forms.
    • Scan to ssmrt@ip.sp.mo.gov unless there is a Visual Field exam record included. Future WorkSite integration will include changes in the submission process.  Staff will be notified when this change occurs.
    • Mail, to the address listed above, any packet including a Visual Field exam record.
    • Email to MRT.Personnel@dss.mo.gov if the determination is a rush.
      • Include “RUSH determination needed” in the subject line to make it easily identifiable.
      • RUSH eligible submissions are (not limited to):
        • Early Release Department of Corrections (DOC) application
        • Department of Mental Health (DMH) related applications
        • Missouri’s Children with Developmental Disabilities (MOCDD) applications
        • Vendor applications
        • Medical necessity

  NOTE: To ensure timely decisions, it is imperative that ES submit the MRT-PC packet quickly and that the forms in the packet are completed.  Even if the MRT-PC packet is mailed to the applicant, it is the field eligibility specialist’s responsibility to ensure that it is complete prior to submitting the packet to MRT-PC. Failure to follow this instruction may result in corrective actions.  If the packet is incomplete (illegible is considered incomplete), an email will be sent to the field ES who submitted the packet and their manager.  If possible, MRT-PC will update/complete the packet information for expediency. If the packet is missing vital information that MRT-PC would be unable to quickly correct, they will delete the incomplete packet and the field staff must re-submit the packet for consideration when the appropriate forms and/or signatures are received. The email sent to the field ES and their manager will state whether or not MRT-PC was able to correct the packet.  Managers are responsible for ensuring that their staff submits correct packets.

• Notify MRT - PC via  MRT.Personnel@dss.mo.gov immediately when:
  • Income or work-related medical expense verifications are received after the packet is submitted.
  • The MHABD,EMCIA, BP/SAB, and/or TA application is rejected for a reason other than disability.
  • The individual has been approved by Social Security Administration for disability benefits for the time period when MO HealthNet coverage was requested.
• Email MRT - PC at MRT.Personnel@dss.mo.gov  within 24 hours of submitting a hearing request, if the hearing is requested because of a disability determination and the medical section will be needed as evidence for the hearing:
  • Include “Hearing requested, medicals needed” in the subject line of the email.
• Email MRT - PC at MRT.Personnel@dss.mo.gov immediately upon the conclusion of a hearing if the hearing officer requests further medical tests or that FSD obtain more medical information.
  • Include “Hearing officer request, medicals needed” in the subject line of the email.
  • In the body of the email, provide as much information as possible, including the name of the Agency Witness (ES) and any specific medical test or medical specialty that the hearing officer is requesting.

  NOTE: While MRT-PC will schedule the appointment and/or request further medical information in this situation, the medical documentation will be sent to the ES for submission to the administrative hearings unit.

MRT - PC RESPONSIBILITIES:

• Complete the interactive contact with the applicant to fill out the full IM-61B

  NOTE: The IM-61B instructions continue to require that an ES conduct an interactive contact with the applicant/participant to complete this form.  This activity is conducted by telephone by ten (10) designated MRT-PC ES, known as MRT Specialists.  The IM-61B (Informational) will be provided to the applicant with the rest of the MRT-PC packet. The Disability Applicant Cover Letter will instruct the applicant to call the FSD Info Center at 1-855-FSD-INFO to be connected with the MRT Specialists after providing the MRT Packet to their local office.

• Respond to, and follow up on, emails from FSD Info Center staff regarding missed IM-61B contacts.
• Send and monitor IM-31A Request for Information forms requesting contact from the applicant to complete the IM-61B.

  NOTE:  If the applicant fails to make contact and the MRT Specialist is unable to make contact, the MRT Specialist must comment on this at EUMEMROL.  If there is sufficient information contained in the rest of the MRT Packet to gather medical information (i.e., medical records included and/or the IM-61D is completed < and the MO 650-2616 is signed), the application should not be rejected for failure to cooperate.  An MRT determination should be pursued without the IM61-B.  The MRT Specialist’s EUMEMROL comment is vital to establishing that the medical determination is being made based upon information available without the IM-61B and must document the MRT Specialist’s attempts to gather the IM-61B information.

• Review incoming packets for completeness upon receipt, and email field ES who submitted the packet and their manager when a packet is incomplete or illegible;
• Request medical records;
• Schedule medical appointments as necessary;

  NOTE: The MRT - PC will schedule appointments and obtain/submit medicals when they are requested by the hearings officer during, or as a result of, a hearing.

• Follow up on medical appointments as necessary;
• Monitor MRT.Personnel@dss.mo.gov for emails from field staff regarding verifications received, rejection notifications, RUSH and/or requests for the MRT determinations section for administrative hearings and take appropriate actions;
• Prepare medical documentation for submission to the Medical Review Team (MRT);
• Submit documentation to the MRT;
• Notify field staff of the outcome of the MRT determination.
• Provide requested medical documentation or notify field staff of a delay, within 24 hours of notification of a hearing request
• Send medical records that were received as a result of a hearing to the field ES for submission to the Hearings Unit.

Manual sections relating to the disability determination process have been updated to reflect the inclusion of the MRT - PC.

The same guidelines should be followed by both field staff and MRT-PC when conducting a medical redetermination.  Field staff is reminded to begin collection of the MRT-PC packet sixty (60) days prior to the expiration of the current medical determination to allow MRT-PC sufficient time for processing.

NECESSARY ACTIONS:

• Review this memorandum with appropriate staff.
• Implement timeframe requirements immediately, for both current applications and redeterminations.
• Use MRT-PC forms with a revision date of 07/2014 or later.
• Provide homeless individuals with access to FSD telephones to contact the FSD Info Center for completion of the IM-61B.

ATTACHMENTS:

• Disability Applicant Cover Letter
• MRT Checklist
• IM-61 and instructions
• IM-61B (Informational) and instructions
• IM-61B and instructions
• IM-61C and instructions
• IM-61D and instructions
• IM-61D OPTH and instructions

AC/df/lh