2662.3 Referral to Disability Determination Services (DDS)

When the Social Security Administration (SSA) has not made, or will not make, a disability determination for reasons unrelated to disability, a referral may be made to Disability Determination Services (DDS) to determine whether the individual meets the applicable disability criteria. Eligibility staff are responsible for gathering the required information and submitting the referral to DDS. DDS may request additional information prior to rendering a decision. Refer to the KanCare KDHE- External Forms for copies of the forms referenced in this section.

Referral Requirements Eligibility staff must complete the required forms and provide available information regarding the individual’s medical providers and disability history when submitting a referral to DDS. DD-1104 – Disability Determination Referral Sections I and II of the DD-1104 must be completed to provide general identifying information about the individual. If the individual does not have a Social Security number (SSN) (e.g., undocumented individuals applying for SOBRA coverage only), this must be indicated on the form. The requested onset date must be noted Section II. This is typically the month of application or up to three months prior to the application month when prior medical coverage is being determined. If available, a copy of the Social Security denial notice indicating denial for a reason other than disability should be included with the referral. DD-1105 – Social and Medical History Sections I, II, and III of the DD-1105 must be completed to provide social, employment, and medical history. The individual, medical representative, or another knowledgeable party (such as a case manager) may assist in completing the form. If someone other than the individual completes the form, the name and relationship of the person must be included on the form. Medical providers who have treated the individual since the alleged onset date must be identified on the form. Additional pages may be attached if necessary. DD-1103 – Authorization for Release of Medical Information The DD-1103 is used to obtain authorization for the release of medical information. The client must sign the form unless unable to do so due to the person's medical condition. If the individual is unable to sign, a person authorized to act on the individual’s behalf may sign the form. The reason the individual is unable to sign must be documented. If the form is signed by a mark, a witness must attest to the signature. The form must also be dated at the time of signature. Eligibility staff must complete the appropriate section of the form. The completed DD-1103 , DD-1104 , and DD-1105 forms must be submitted to DDS for review and completion of Section III of the DD-1104 . Submission must occur through approved agency transmission methods in accordance with established procedures. Copies of submitted forms must be retained in the case file.

DDS Determination Process DDS is responsible for obtaining additional medical evidence necessary to make a disability determination, provided the applicant and agency have supplied available information regarding medical providers who have treated the individual. DDS will document the following on the DD-1104 : Disability determination (approval or disapproval) Decision date Disability onset date Review date (diary date) Pertinent diagnosis DDS will return the completed original DD-1104 and DD-1105 with copies of any pertinent medical information to the agency. The agency will monitor pending DDS referrals and follow up as necessary in accordance with established agency procedures. Upon receipt of the DDS determination, eligibility staff shall complete the eligibility determination using the DDS decision documented on the DD-1104 .

Specific Referrals The following types of referrals require the inclusion of additional information. SOBRA Referrals A non-qualifying alien may be eligible for emergency medical services under the SOBRA program (see 2691 ). When eligibility for a disability-based program must be determined, a DDS referral using the DD-1104 form is required. The referral must clearly indicate that it is a SOBRA referral and include any medical records obtained through the MS-2156 process. Deceased Applicant An application for assistance may be submitted on behalf of a deceased individual (see 1411.3(1) ). When eligibility must be determined under a disability-based program, a referral to DDS may be required. The referral must clearly indicate that the individual is deceased and include the date of death. Available supporting documentation, such a death certificate and medical records, should be included. Child In some instances, a child claiming a disability may not qualify under other medical programs, such as poverty level or Caretaker Medical. In these cases, a referral to DDS may be necessary to determine eligibility under the Medically Needy program. The referral must clearly indicate that this is a child referral. Referrals may also be required when the disability status of a non-applicant/recipient child affects the eligibility determination of another individual. Example : An elderly individual applying for long term care coverage establishes a special needs trust for a minor grandchild. To determine whether the trust is exempt from transfer of property penalty provisions (see 5720 ), the grandchild must meet disability criteria. If the child has not been determined disabled by SSA, a DDS determination may be required.

Reconsideration and Appeal If DDS issues an unfavorable disability determination, the individual has the right to request a reconsideration of the decision. The agency must submit a new DD-1104 to DDS clearly identifying the request as a reconsideration. DDS will review the original record along with any additional medical evidence provided. Favorable Reconsideration If disability is approved through the reconsideration process, eligibility must be determined based on the disability finding. Unfavorable Consideration If the reconsideration decision remains unfavorable, the individual may request a fair hearing. When a fair hearing is requested: The agency will submit the required appeal documentation to the Administrative Hearing Office (AHO). DDS will represent the disability determination during the hearing process. If the hearing decision upholds the DDS determination, no further action by the agency is required. If the hearing decision overturns the DDS determination, the application must be reinstated and processed based on the disability finding. See also 1614.1(4) and (5) and (5) and 1614.3(9) for additional guidance.

Continuation Review When DDS makes a favorable disability determination, the DD-1104 returned to the agency will include a review date, also referred to as a “diary date”. The diary date indicates when the individual’s disability status must be reviewed to determine continued eligibility. When a review is required, a referral is submitted to DDS to reassess the individual’s disability status. The referral must include all the previous information used to make the original decision, including the returned DD-1104 and DD-1105 forms. DDS will then review the individual's disability status to determine if the individual continues to meet disability criteria. DDS will document the review determination on the DD-1104 and return the decision to the agency. If the determination remains favorable, eligibility may continue and a new diary date is established. If the determination is unfavorable, the individual no longer meets disability criteria, and adverse action may be required.