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West Virginia Income Maintenance Manual Chapter 13

West Virginia Income Maintenance Manual Page 25 Chapter 13 Determining Disability, Incapacity, and Blindness

13.7.4.A Initial Medical Examination If the DFA-RT-5, 5a, or DFA-B-13 is the only available medical information, and the applicant fails, without good cause, to keep the appointment, another appointment is not made. The application is denied using the appropriate reason code. If the applicant who is making his own appointment fails to do so, without good cause, within two working days from the date he receives the DFA-RT-6, the application is denied. If the physician does not schedule appointments, the application is denied if the client fails, without good cause, to go to the physician's office within one week from the date he received the DFA-RT-6. 13.7.4.B Appointments for Medical Examinations Requested by the MRT If the MRT requests an additional medical examination, and the client fails to keep the appointment, without good cause, the application is denied, or the case is closed if it was a presumptive approval. If the client has good cause, the Worker schedules another appointment. When the Worker denies the application or stops the benefit, he must notify the MRT of the action. The Worker must record the action taken in the case record. In addition, if the individual qualifies for Medicaid under a different coverage group that does not require a disability determination, his eligibility for that coverage group is not affected by his failure to keep a medical appointment.

NOTE: Failure of one person to keep medical appointments does not affect the eligibility of any other assistance group (AG) member, for example, completion of an SSI-Related Medicaid application for two people.