UPM P-2530.05 - Establishing Eligibility

CONNECTICUT DEPARTMENT OF INCOME MAINTENANCEPRIVATE UNIFORM POLICY MANUAL ______________________________________________________________________________ Date: 2-1-93 Transmittal: UP-93-2 P-2530.05 ______________________________________________________________________________ Section: Type: Categorical Eligibility Requirements PROCEDURES ______________________________________________________________________________ Chapter: Program: Disability AABD _______________________________________________________________ MAABD Subject: Establishing Eligibility ______________________________________________________________________________

P-2530.05 1. Consider the individual disabled if the individual is considered disabled by SSA.

2. Take action to determine disability in the following situations:

° if the applicant has not applied to SSA or if the application is still pending;

° if the applicant was denied by SSA for a reason other than disability, (e.g. excess income for SSI purposes).

3. If SSA has previously denied disability, make a separate determination whenever the applicant alleges a condition which is different from or in addition to the one SSA evaluated.

4. Refer the applicant to SSA if within 12 months of the latest SSA denial the applicant alleges that the same condition has changed or deteriorated.

Make a separate determination only if SSA refuses to reconsider the new allegations, or denies the application without making a new disability determination, e.g. the application is denied for excess assets.

5. Take action to determine disability if more than 12 months after the latest SSA denial the applicant alleges the same condition has changed or deteriorated and SSA has not made a new determination based on the allegations.

6. If a separate determination is required, obtain the information necessary for the Department's Medical Review Team (MRT) to determine disability.

7. Give the assistance unit the following forms:

° "Instructions for Forms WR-3A";

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

° "Notice-Examination Request for Medical Eligibility Determination," Form W-513;

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

CONNECTICUT DEPARTMENT OF INCOME MAINTENANCE UNIFORM POLICY MANUAL ______________________________________________________________________________ Date: 2-1-93 Transmittal: UP-93-2 P-2530.05 page 2 ______________________________________________________________________________ Section: Type: Categorical Eligibility Requirements PROCEDURES ______________________________________________________________________________ Chapter: Program: Disability AABD _______________________________________________________________ MAABD Subject: Establishing Eligibility ______________________________________________________________________________

P-2530.05 8. Explain Form W-R3 and encourage the unit to advise the examining physician of the importance of promptly returning the form.

9. Explain Form W-176 and emphasize the need to do the following:

° return the form within the specified time standard;

° fill in all the blank areas;

° complete the "Education" and "Work History" sections.

10. Inform the applicant that you will provide assistance upon request if help is needed in obtaining information or completing the W-176 form.

11. Obtain the signature of the assistance unit on Form W-149, "Request for Medical Records Information," and send it to the designated medical facility if it is appropriate.

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

13. Take the following actions upon return of the forms;

° 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.