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West Virginia Income Maintenance Manual Chapter 13

West Virginia Income Maintenance Manual Page ii Chapter 13 Determining Disability, Incapacity, and Blindness

13.6.1 INTRODUCTION .....................................................................................................12 13.6.2 WHEN THE APPLICANT HAS RECEIVED SSI BASED ON DISABILITY OR BLINDNESS ..........................................................................................................................12 13.6.3 GUIDELINES FOR PRESUMPTIVE MEDICAL DECISION OF BLINDNESS ..........13 13.6.4 GUIDELINES FOR PRESUMPTIVE MEDICAL DECISION OF DISABILITY FOR SSI-RELATED MEDICAID AND M-WIN, AGE 18 OR OVER .................................................13 13.6.4.A Definition of Disability .......................................................................................13 13.6.4.B Role of the Worker in the Presumptive Medical Approval Process ...................13 13.6.5 GUIDELINES FOR PRESUMPTIVE MEDICAL DECISION OF DISABILITY FOR SSI-RELATED MEDICAID AND M-WIN, UNDER AGE 18 ....................................................14 13.6.5.A Definition of Disability .......................................................................................14 13.6.5.B Role of the Worker in the Presumptive Medical Approval Process ...................14

OBTAINING MEDICAL REPORTS.............................................................................15 13.7.1 INITIAL MEDICAL REPORTS .................................................................................15 13.7.1.A General Information About Providers................................................................15 13.7.1.A.1 Providers Certified by DOHS ......................................................................15 13.7.1.A.2 Out-of-State Providers Certified by DOHS ..................................................15 13.7.1.A.3 General Information for Completion of Medical Request Forms ..................15 13.7.1.A.4 General Instructions for Completion ...........................................................17 13.7.1.A.5 Numbers Used on Medical Request Forms ................................................17 13.7.1.B Obtaining Initial Medical Reports ......................................................................18 13.7.1.B.1 DFA-PHI-1: Authorization for Information ...................................................18 13.7.1.B.2 Physician’s or Psychiatrist’s/Psychologist’s Summaries .............................18 13.7.1.B.3 Initial Medical Report – Blindness ...............................................................19 13.7.1.B.4 Initial Medical Report, Incapacity and Disability ..........................................19 13.7.1.B.5 DFA-RT-5 and DFA-RT-5a .........................................................................22 13.7.1.B.6 Known Source of Medical Information Does Not Respond to Request .......23 13.7.2 EXCHANGE OF MEDICAL INFORMATION WITH THE SSA ..................................23 13.7.2.A Providing Medical Information to the SSA ........................................................23 13.7.2.B Requesting Medical Reports from the SSA.......................................................23