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MEDICAL SERVICES POLICY MANUAL,SECTION F

F 122 Medical Review Team (MRT)

F-122 Medical Review Team (MRT) MS Manual 01/01/22 When an individual applies for Heath Care and meets one (1) or more of the conditions below, required forms along with any medical records provided will be submitted to MRT, provided it appears that the other eligibility factors are met. Refer to Appendix I for required forms. MRT will determine disability if any one (1) of the following conditions exists: 1. The individual has NOT applied for Social Security Disability or SSI or Railroad Retirement (RR). 2. The individual has been found NOT eligible for Social Security Disability or SSI for reasons other than disability (for example, income). 3. The individual has applied for Social Security Disability or SSI, and SSA has NOT made a determination. EXCEPTION: Individuals applying for ARChoices, Living Choices, or PACE, who require a determination of physical disability, will be referred to MRT even if receiving Social Security Disability IF SSA does not verify a primary type of disability that is physical. Refer to MS B-312, B-313, and B-318. 4. The individual alleges a NEW disabling condition which is different from (or in addition to) the condition considered by SSA in its previous determinations. 5. More than twelve (12) months have elapsed since the most recent Social Security Disability or SSI denial decision, and the individual alleges that the condition upon which SSA made the decision is worse or has changed, and he or she has not reapplied. 6. Less than twelve (12) months have elapsed since the most recent Social Security Disability or SSI denial, and the individual alleges that the condition upon which SSA made the decision has changed or deteriorated, and a. They have asked SSA for a reconsideration or reopening of its previous determination and SSA has refused to consider the new allegations; or b. The individual no longer meets the non-disability Social Security Disability or SSI requirements (for example, income). Individuals who do not meet a criterion specified above will be denied without further development.

NOTE: When a family member of a deceased Health Care (ARChoices, Living Choices, DDS, Nursing Facility, or PACE) recipient has applied for a hardship for estate recovery and is stating they have a disability but does not receive SSA, RR, or SSI disability, a social report will be submitted to MRT for a disability determination.