Connecticut Department of Social Services Uniform Policy Manual: 2510.50P Deprivation of Parental Support or Care - Processing a Claim for Physical or Mental Incapacity

CONNECTICUT DEPARTMENT OF INCOME MAINTENANCEPRIVATE UNIFORM POLICY MANUAL ______________________________________________________________________________ Date: 1-1-88 Transmittal: UP-88-7 P-2510.50 ______________________________________________________________________________ Section: Type: Categorical Eligibility Requirements PROCEDURES ______________________________________________________________________________ Chapter: Program: Deprivation of Parental Support or Care AFDC _______________________________________________________________ Subject: Processing a Claim for Physical or Mental Incapacity ______________________________________________________________________________

P-2510.50 1. When physical or mental incapacity is the reason for deprivation, find out if the incapacitated parent is in receipt of SSI or SSA benefits on the basis of blindness or disability.

2. If incapacity is established as above, grant AFDC to the assistance unit, if otherwise eligible.

3. Set a tickler for redetermination of eligibility.

4. If incapacity is not established by receipt of SSI/SSA as provided for in policy, go on.

5. Obtain the information necessary for a determination of incapacity by the Department's Medical Review Team (MRT). To accomplish this, use the procedures which follow.

6. Give the assistance unit the following forms:

° "Instructions for Form WR-3A";

° "Medical Examination Report", Form W-R3;

° "Social Information and Disability Report", Form W-176.

° "Notice-Examination Report for Medical Eligibility Determination - Registration For WIN Program", Form W-513.

7. Explain to the assistance unit the use of Form W-R3 and encourage the unit to tell the examining physician the importance of returning the form in a timely fashion.

8. Advise the unit of the purpose of Form W-176 and emphasize the need for:

° returning the forms to the Department within the specified time standards;

° filling in all the blank areas on the form;

° giving special attention to the completeness of the "Education" and "Work History" sections of the W-176.

CONNECTICUT DEPARTMENT OF INCOME MAINTENANCE UNIFORM POLICY MANUAL ______________________________________________________________________________ Date: 7-1-87 Transmittal: UP-87-2 P-2510.50 page 2 ______________________________________________________________________________ Section: Type: Categorical Eligibility Requirements PROCEDURES ______________________________________________________________________________ Chapter: Program: Deprivation of Parental Support or Care AFDC _______________________________________________________________ Subject: Processing a Claim for Physical or Mental Incapacity ______________________________________________________________________________

P-2510.50 9. Inform the unit that you will provide assistance upon request if a problem arises with obtaining information or completing the W-176 form.

10. Obtain the signature of the incapacitated parent on Form W-149, "Request for Medical Records Information."

11. Send the W-149 to the designated medical facility if appropriate.

12. Set appropriate ticklers for the return of the W-R3, W-176 and W-149 forms.

13. Upon return of the appropriate forms, complete the following actions:

° complete and attach Form W-542, "Route Slip to MRT," to the medical information;

° arrange all medical information in chronological order, most recent first;

° submit the entire medical packet to MRT, Central Office.

14. If Form W-146, "Record of Action by Medical Review Team" returns from MRT marked, "Eligible," and all other factors of eligibility have been met, take the following actions:

° grant assistance to the assistance unit;

° set a tickler for the redetermination of the incapacity status, using the date specified on the W-146 form.

15. If Form W-146 returns from MRT marked, "Ineligible," take the following actions:

° determine if the assistance unit or any member of the assistance unit qualifies for MA.

° deny AFDC assistance to the family.

CONNECTICUT DEPARTMENT OF INCOME MAINTENANCE UNIFORM POLICY MANUAL ______________________________________________________________________________ Date: 7-1-87 Transmittal: UP-87-2 P-2510.50 page 3 ______________________________________________________________________________ Section: Type: Categorical Eligibility Requirements PROCEDURES ______________________________________________________________________________ Chapter: Program: Deprivation of Parental Support or Care AFDC _______________________________________________________________ Subject: Processing a Claim for Physical or Mental Incapacity ______________________________________________________________________________

P-2510.50 16. If Form W-146 returns from MRT marked "Undetermined," check for the specific supplementary medical data requested by MRT and take the following actions:

° advise the unit of the additional medical data needed and the type of medical specialist indicated;

° refer the unit back to the examining physician for a referral to the appropriate specialist, if necessary;

° give the unit the specialist referral letter provided by MRT;

° set a tickler for the return of the medical information.

17. If the incapacitated parent requests assistance in finding the appropriate specialist:

° help the parent make an appointment using the resources available;

° contact health services for the name of a specialist if all other resources have been exhausted.

18. Upon return of the specialist's report, follow the procedures in step #13.

19. If Form W-146 returns from MRT marked, "Eligible", follow the procedures in step #14.

20. If Form W-146 returns from MRT marked "Ineligible", follow the procedures in step #15.