DISCUSSION:
Pursuant to 13 CSR 40-2.200, if an applicant or participant is under age 65 and not receiving Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI) benefits, the Medical Review Team (MRT) must gather medical information to determine whether or not the person meets the disability or visual criteria for MO HealthNet for the Aged, Blind, or Disabled (MHABD), including the blind programs—Supplemental Aid to the Blind (SAB) and Blind Pension (BP) and the vendor programs—Vendor and Supplemental Nursing Care (SNC). If the participant does not have current medical records or if those records are insufficient, MRT must schedule a medical evaluation based upon the participant’s declared disability to obtain records.
To notify the participant of the appointment, the IM-66MAN Medical Appointment Notification and the IM-66MAR Medical Appointment Notification for Authorized Representative have been created. These forms notify the participant of
- Why an appointment is needed
- What will happen if the appointment is not kept
- Times when the appointment may be rescheduled.
The Medical Review Team Processing Center (MRTPC-Springfield) is responsible for scheduling and rescheduling all appointments for MRT determinations and redeterminations.
If the participant requests a reschedule:
- If the call is received at the FSD Information Call Center
- The call center will follow their established scripts and inform the participant that the request to reschedule will be submitted to the MRTPC. The FSD Information Call Center should not tell the participant that the appointment will be rescheduled as there are protocols in place for when an appointment is eligible to reschedule. MRTPC will make this determination and will place a comment on EUMEMROL for the Call Center to share with the participant if they call back in before receiving any written notification.
- If the call is received at a Resource Center, or the participant goes in to a Resource Center
- The resource specialist should obtain the following information from the participant
- When was/is the appointment scheduled
- Why can the participant not attend
- The resource specialist should send this information to MRTPC using the current protocols and should tell the participant that they may check back in at the Resource Center or at the FSD Information Center after 48 hours for MRTPC’s determination.
- If the call is received at MRTPC
- MRTPC staff is encouraged to work with participants when reschedules are needed, provided the participant has a valid reason for needing a new appointment date and time, especially when the request is made in advance of the appointment.
- The participant should be informed that the delay in attending the original appointment may result in a delay in processing their application or redetermination.
- Reschedules may be authorized by an Eligibility Specialist, who must make a comment at EUMEMROL regarding the reschedule
- Any denial of a reschedule must be reviewed by the Eligibility Specialist’s supervisor and the supervisor must make a comment in FAMIS indicating the discussion and reasoning for denying of the reschedule.
- If a participant is not eligible for reschedule, the medical determination should be made on the records available.
- MRTPC must notify the participant in writing of the rescheduled appointment date and time. The IM66MRN Medical Appointment Reschedule Notification and the IM66MRR Medical Appointment Reschedule Notification for Authorized Representative should be used for this.
NECESSARY ACTION:
- Supervisors at the MRTPC should discuss this memo with all staff, but particularly with those staff responsible for appointments
- All IM Field supervisors should review with any staff that may answer calls from participants regarding MRT scheduled appointments
- Begin using the IM66MAN, IM66MAR, IM66MRN, IM66MRR immediately.
- FSD Information Call Center staff should immediately refer any requests to reschedule medical determination appointments to MRTPC.
- MRTPC ES must immediately begin reviewing requests for reschedule, determine whether or not the situation is eligible for reschedule, and make FAMIS comments reflecting this determination.
- If there is no eligibility for a reschedule, a supervisor must review and make comments reflecting this determination.
PL/mah