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Treatment history for the previous 12 months must be thoroughly discussed during the interview and recorded on the social summary. If the applicant does not have any medical services to list in the “Treatment History Section”, eligibility workers are to enter “none” in this section. Leaving it blank or entering “N/A” is not sufficient for an MMRT decision. Medical Evidence: A complete 12-month medical history on the individual is needed unless the documented impairment began less than 12 months prior to application. The eligibility worker is to request copies of all medical records from physicians, clinics, and/or hospitals indicated by the applicant as having treated/examined the applicant for his/her documented impairment(s) since the onset of the condition(s) or 12 months prior to the date of application, whichever is longer. Evidence must include medical history, clinical findings, laboratory findings, diagnosis, treatment, and medical assessment.

The applicant, who is not under the care of a physician, is to be examined by a physician licensed to practice medicine in Indiana or another state. The requirement to have a medical examination is applicable even for the applicant or, in the case of a child, the guardian or parent, who objects on religious grounds. For an applicant who has no physical impairment at all, but whose disability is based solely on mental status, an examination is required by a psychiatrist, psychologist, or mental health professional holding HSPP certification. If a current physical examination is needed, the Local Office is to forward the Form 251, Authorization for Physical Examination to Determine Disability for Medical Assistance form to the examining physician:

The applicant, if able to do so, and agrees to do so, may take the forms to the doctor. Caseworkers should follow up to be sure the doctor received the forms.

Failure to receive medical evidence is not an acceptable reason for denial of an application if the disabled person is still interested in obtaining Medicaid coverage. As it is the joint responsibility of the applicant and the caseworker to make every effort to obtain the medical information, caseworkers must monitor a pending application closely for receipt of the medical information in accordance with the following guidelines: • Give the applicant a 30-day deadline to arrange for an examination and inform the eligibility worker of the appointment date, with a follow-up 10-day deadline if the applicant does not respond. • When requesting medical records from a provider, give a 20-day deadline; with another follow-up 20-day deadline if the records are not received after the first letter. Telephone contact should be made to the provider with a 3rd 20-day deadline given if the provider indicates intention to submit the records. • When a provider does not respond to any of the requests for medical records, the eligibility worker is to notify the applicant or authorized representative to contact the provider. A 10-day deadline is to be given for the applicant/representative to contact the worker. This step in the process is not a condition of eligibility being imposed on