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West Virginia Income Maintenance Manual Chapter 13

West Virginia Income Maintenance Manual Page 48 Chapter 13 Determining Disability, Incapacity, and Blindness

APPENDIX B: PRESUMPTIVE MEDICAL APPROVAL – SSI-RELATED MEDICAID AND M-WIN, UNDER AGE 18 When the individual’s medical condition or diagnosis is not listed in this Appendix, refer to Section 13.6 regarding the presumptive approval process. B.1 MUSCULOSKELETAL SYSTEM DISORDERS This must be confirmed by a pediatrician or orthopedist with x-rays. The following are examples of musculoskeletal system disorders that would result in a presumptive medical approval: • Juvenile rheumatoid arthritis with joint inflammation, significant limitation of motion of two major joints or severe deformity of two major weight-bearing joints. • Congenital deformities of the musculoskeletal system, such as dislocation of the hip, in that walking is possible only with crutches or a walker. B.2 DISORDERS OF THE SPINE This must be confirmed with reports from an orthopedist or pediatrician. The following are examples of disorders of the spine that would result in a presumptive medical approval: • Fractured vertebra with spinal cord involvement, resulting in paralysis. • Scoliosis with spinal curve measuring 60 degrees or greater, established by physical examination and x-ray. • Chronic osteomyelitis, as confirmed by x-ray, with persistent drainage, despite treatment. B.3 RESPIRATORY IMPAIRMENTS This must be confirmed by physical examination, x-ray, and/or pulmonary function studies. The following are examples of respiratory impairments that would result in a presumptive medical approval:

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Page 1201

Official source

West Virginia Income Maintenance Manual Chapter 13

West Virginia Income Maintenance Manual Page 48 Chapter 13 Determining Disability, Incapacity, and Blindness

APPENDIX B: PRESUMPTIVE MEDICAL APPROVAL – SSI-RELATED MEDICAID AND M-WIN, UNDER AGE 18 When the individual’s medical condition or diagnosis is not listed in this Appendix, refer to Section 13.6 regarding the presumptive approval process. B.1 MUSCULOSKELETAL SYSTEM DISORDERS This must be confirmed by a pediatrician or orthopedist with x-rays. The following are examples of musculoskeletal system disorders that would result in a presumptive medical approval: • Juvenile rheumatoid arthritis with joint inflammation, significant limitation of motion of two major joints or severe deformity of two major weight-bearing joints. • Congenital deformities of the musculoskeletal system, such as dislocation of the hip, in that walking is possible only with crutches or a walker. B.2 DISORDERS OF THE SPINE This must be confirmed with reports from an orthopedist or pediatrician. The following are examples of disorders of the spine that would result in a presumptive medical approval: • Fractured vertebra with spinal cord involvement, resulting in paralysis. • Scoliosis with spinal curve measuring 60 degrees or greater, established by physical examination and x-ray. • Chronic osteomyelitis, as confirmed by x-ray, with persistent drainage, despite treatment. B.3 RESPIRATORY IMPAIRMENTS This must be confirmed by physical examination, x-ray, and/or pulmonary function studies. The following are examples of respiratory impairments that would result in a presumptive medical approval: