MEDICAL CERTIFICATION FORM

A. Medical certification shall be completed on the State Department's prescribed medical certification form. 1. The county department shall provide the form to the client or the medical provider at the time of application or interview and prior to the re- examination due date. The client shall arrange for the medical exam with an appropriate medical provider of his or her choosing. a. It is the county department's responsibility to provide the medical form to the client or the client's provider of choice within ten (10) calendar days of application. b. If the client fails to submit the required medical examination within thirty (30) calendar days following the interview or with their redetermination, the client has failed to comply with the requirements for eligibility and the client’s participation in the program will be denied or discontinued following the policies outlined in Section 3.554. c. If the client requests a second opinion, the subsequent medical examination shall be at the client's expense. d. If the county department requests a second opinion, the subsequent medical examination shall be at the county department's expense. e. The county department shall review the medical certification form for completeness and to determine whether the information submitted is in conflict with other medical data, records, documentation, and information and/or observations received from the client, family, friends, professionals, community members, or the county department. The county department shall: 1) Ensure any incomplete forms are returned to the provider to be completed; and, 2) Consult and verify with the provider any questionable or contradictory information. 2. The medical certification shall be completed and signed by a medical provider as defined in Section 3.540. a. The client shall be allowed to choose a medical provider licensed in a bordering state when the nearest Colorado provider is more than one hour from the client's home. b. The medical certification must be dated no earlier than ninety (90) days before the application or recertification. 3. The medical certification form shall contain the disability limitations, including the length and scope of the disability, if any; and, 4. The medical re-examination date shall be based upon the date of the application or redetermination and the length of the disability, as documented by the medical provider, but shall not exceed twelve (12) months. However, if the client has been determined disabled by the State disability review contractor, the medical re-examination date shall be established by the review contractor. B. The medical examination determining the client’s disability and completion of the medical certification form shall be completed by a medical provider that accepts Medicaid whenever possible when the client is receiving Medicaid. If the client’s primary medical provider does not accept Medicaid or the client is not receiving Medicaid, the county department shall authorize payment for examinations for AND-SO medical certification examinations. 1. Fees and costs shall be reimbursed to the county department using the 80% State share, 20% county share reimbursement methodology described in Section 26-1-122(3)(B), C.R.S. 2. The county department shall set the provider fee and shall make such payments in a timely manner. 3. Providers shall accept fees for services as negotiated as payment in full. No client shall be assessed any additional or supplementary fee. 4. Providers may be excluded from completing medical certification examinations if there is adequate documentation that the provider: a. Is not completing a thorough examination on which to base his or her decision; or, b. Falsified a medical certification form. C. A determination of medical eligibility shall be completed by each medical re- examination date. The county department shall be allowed to request the client submit a medical re-examination at the time of financial redetermination or when the county has information that the client's medical condition may have changed. 1. Prior to the medical re-examination due date, the county department shall send a new medical certification form to the client. 2. If the client fails to submit the required medical re-examination by the redetermination due date, the county department shall terminate assistance following the policies outlined in Section 3.554.