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Page 2 of 4 § 10:71-3.13 County social service agency responsibility and procedures the PA-6 that this is a Medicaid Only case. Records transmitted by the Medical Review Team on a given date shall be listed by registration number and name on an inventory sheet, prepared in duplicate, the cases being grouped by case status. One copy shall be attached to the submittal records, the duplicate retained as CSSA control. (f) The CSSA will prepare a similar inventory and attach cases returned to the CSSA on a given date. Attached to each will be Form PA-8 (Record of Action) containing the determination of eligibility by the Medical Review Team and any necessary instructions. (g) Upon receipt of records from the Medical Review Team, the CSSA shall examine the PA-8 (Record of Action) for the action of the Medical Review Team and for specific instructions or recommendations, and to note the review date. (h) Recommendations will be made by the medical consultant to alert the CSSA to the possibilities of adequate medical care for the client and to provide specific pertinent questions to be raised with the attending physician. The medical social work consultant will make recommendations to help the CSSA staff recognize the social problems indicated in the client's situation and the relationship between these problems and his or her physical and mental adjustment. (i) The following procedures shall be observed in respect to the Medical Review Team actions: 1. "Approved" cases: i. CSSA shall complete, as necessary, determination of eligibility in respect to other factors and, if applicant is eligible, take the necessary action to obtain Medicaid benefits. ii. When an applicant is not eligible in respect to any other factor, although "approved" for the disability or blindness factor, the application shall be denied. iii. The CSSA shall establish and maintain a control file for "approved" cases in order that the date for determination review by the Medical Review Team will be observed and considered according to N.J.A.C. 10:71-5. iv. The Medical Review Team (MRT) shall also maintain a control file in order to ensure appropriate and timely reevaluation by the MRT. The MRT will notify CSSA one month in advance of cases scheduled for such review. Cases also for reevaluation will be listed on Form PA-655. 2. "Undetermined" cases: i. If further medical and/or social information is required by the MRT for the initial determination of eligibility, the CSSA shall obtain the information promptly and resubmit the case. Reports from medical specialists shall be submitted on their own letterheads. ii. If the applicant fails or refuses to present himself/herself for required examinations or tests, the application shall be referred to the MRT for recommendations. 3. "Disapproved" cases: i. Any case determined as not medically eligible for "Medicaid Only" by the MRT shall be denied Medicaid Only by the CSSA. ii. Appropriate notification shall be given to the applicant as well as any specific recommendations for follow-up care and treatment. (j) When page 5 of Form PA-5 carries the signature of the medical consultant approving the payment of the examining physician, such payment shall be forwarded to the physician from administrative funds, regardless of whether the action on the record of action is "approved", "disapproved" or "undetermined". (In an "undetermined" case, if the request for additional information relates to an incomplete report from the examining physician, approval for payment will not appear on page 5 of the PA-5.) (k) Payment for special diagnostic reports shall likewise be forwarded to the medical specialist or clinic from administrative funds regardless of whether the case is "approved", "disapproved", or "undetermined".