State Medical Review Team (SMRT) Disability Determinations

The State Medical Review Team (SMRT) A unit at DHS that determines disability in consultation with medical professionals appointed by the commissioner. is a unit at DHS that determines disability in consultation with medical professionals appointed by the commissioner. A primary function of SMRT is determining disability for people who are applying for (or appealing the denial of) Social Security Administration (SSA) A federal agency which administers the SSI, RSDI and Medicare programs. disability benefits or Railroad Retirement Board (RRB) disability benefits. Contact SMRT staff at dhs.smrt@smrt.mn.us or 651-431-2493 or 800-235-7396.

Client Package

Referral Process.

Physical Examination Required.

Other Situations.

Exams and Transportation Services

Billing Process

Expedited Case Criteria

Submitting the Referral.

Response from SMRT.

SMRT for Current MA Enrollees.

Non-Cooperation.

Related Topics.

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Client Packet

Prior to making the referral to SMRT, send the following forms to the client:

l  Request for Disability Information (DHS-6349)

l  Request for Disability Information for Adults Without Children (DHS-6349B) (Medical Assistance for Adults Without Children clients only)

l  Authorization to Release Protected Health Information (DHS-6124)

l  Documentation Requirements (DHS-6349A)

l  State Disability Reviews for Adults (DHS-6125A) or State Disability Reviews for Children (DHS-6126A)

l  SMRT Adult Disability Worksheet (DHS-6125) or Children's Disability Worksheet (DHS-6126)

l  Disability Services Brochure (DHS-3546A)

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Referral Process

Complete a State Medical Review Team Referral for Disability Determination (DHS-6123) for each referral to SMRT. Include a signed Authorization to Release Protected Health Information (DHS-6124), the Adult Disability Worksheet (DHS-6125) or Children's Disability Worksheet (DHS-6126) and medical documentation to support the client's physical, psychological or developmental disability (DD) condition. Required information is outlined in Documentation Requirements (DHS-6349A).

Medical records should be less than one year old except:

l  Psychological evaluation results can be up to five years old.

l  Team evaluations from the school district can be up to three years old

l  IQ test results when tests were completed at age 16 or older.

Referrals for clients who have been hospitalized within the last three months should include:

l  Complete hospital records from a hospitalization within the last three months.

l  Complete hospital records from multiple hospitalizations over the last year.

Note:  Complete hospital records include an admission history, a physical exam and a discharge summary. If the client is currently hospitalized, include records of a complete physical exam, any tests performed and the treatment plan with prognosis.

If it is not possible to get an authorization signed because of the condition of a hospitalized patient, submit the referral to SMRT without it.

Tax and income statements, medical bills, health care applications, driver's licenses, birth certificates and EOMBs Explanation of Medical Benefits. A statement from DHS, an insurance company, or a health plan reporting amounts paid, reduced, or denied for the client's health care expenses. from other insurers are not needed, as they have no bearing on the SMRT determination.

The county or tribal agency must make an effort to collect medical evidence. Referrals submitted without any medical evidence must include an explanation of the efforts made to collect the evidence, including what providers were contacted.

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Physical Examination Required

All SMRT disability referrals require results from a current physical examination (no more than three months old) by a licensed physician. Acceptable medical sources are licensed physicians, osteopaths, psychologists and optometrists. Naturopathic and chiropractic exams may be used, but only if submitted with results of an examination from a licensed physician.

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Other Situations

If the client is deceased, send a discharge summary from the last hospitalization and a death certificate from the Department of Health.

There are different documentation requirements for the TEFRA option: See TEFRA Referrals.

Exams and Transportation Services

When an examination, evaluation or other test is required, SMRT works with the client and provider to schedule the appointment and provide transportation. SMRT schedules transportation services through Minnesota Non-Emergency Transportation (MNET) for clients residing in MNET counties. SMRT contacts the county or tribal agency to schedule transportation in a non-MNET county.

Billing Process

Bill DHS for the cost of all exams and transportation services provided and records obtained. Private insurance must be billed before submitting a claim to DHS. Submit claims through Minnesota Information Transfer System (MN-ITS) using the Common Procedural Terminology (CPT) code 99456.

100% of the claim is paid if the authorization number is included. The authorization number allows for payment for an applicant with no active Minnesota Health Care Programs (MHCP) eligibility span, and the cost of obtaining medical records.

The SMRT Authorization Team issues an authorization number for the scheduled service when the client has no current MHCP or private coverage, or when MHCP does not normally cover the service provided. Include this authorization number on the request for payment.

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Expedited Case Criteria

SMRT expedites the disability determination process in three situations which are considered severe. Write "EXPEDITE CASE" on the referral form (DHS-6123) so SMRT sees it immediately when an expedited determination is needed.

Expedited referrals are accepted in the following circumstances:

l  Compassionate Allowance Listing (CAL)

Social Security has identified specific conditions that are so severe SMRT can approve with minimal verification. An impairment summary and verification requirements for each condition is located under the Section Number link on the CAL list. Identify the disabling condition listed on the CAL. If possible, determine from the list what documentation is needed to verify the condition. Secure the verification and submit the referral to SMRT immediately.

l  Awaiting Discharge from a Facility

Notify SMRT if a client is in a facility awaiting discharge. SMRT verifies that the client is likely to meet disability criteria and can be discharged immediately if MA is approved and there is a place willing to accept the client upon discharge.

l  Faced with a Potentially Life-Threatening Situation

Notify SMRT if a client does not have access to treatment or medication that could lead to a life-threatening situation. SMRT verifies that the client is likely to meet disability criteria, has a condition requiring treatment or medication and could be in a life-threatening situation without treatment or medication.

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Submitting the Referral

There are two options for submitting SMRT referrals:

l  Fax the referral to 651-431-7461 or 800-311-3137. Submit the entire case as one fax if possible. It is difficult for SMRT to keep a case together if it is submitted in multiple faxes.

l  Send the referral via secure SIR email to dhs.smrtcases@state.mn.us in one file in portrait orientation. The forms should be in the following order:

1. State Medical Review Team Referral for Disability Determination (DHS-6123)

2. Authorization to Release Protected Health Information (DHS-6124).

3. State Disability Worksheet (DHS-6125/DHS-6126).

4. Medical documentation.

Incomplete referrals are rejected and will delay the SMRT determination. Call the SMRT hotline at 651-431-2493 with questions about how to submit a referral.

SMRT sends a confirmation to the referring agency on all referrals submitted by SIR email or by fax. Include a SIR email address with faxed referrals to receive a confirmation. Contact SMRT if confirmation of the referral is not received within three days of submission.

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Response from SMRT

SMRT enters a MAXIS case note when they determine that additional evidence or an exam is needed. The case note includes details of what is needed or the scheduled date of an exam. Check the status of a SMRT referral in MAXIS prior to contacting SMRT.

Once the review is complete, SMRT faxes the decision to the county, indicating approval or denial.

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SMRT for Current MA Enrollees

Submit a SMRT referral if an MA enrollee who may meet the criteria for a disability certification:

l  Is eligible under another basis that is ending,

l  Is currently enrolled in MA for adults without children and has indicated that he or she may have a disability, or

l  Has a SMRT certification period that is ending.

Leave MA open under the original basis until the SMRT determination is completed.

See Change in Basis of Eligibility for further information.

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Non-Cooperation

Clients who do not cooperate in the process cannot use disability as a basis of eligibility. Check for other bases of eligibility. Terminate or deny eligibility if none exists.

Clients who are enrolled in MA for adults without children and have been referred to SMRT for a disability determination must continue to cooperate with SMRT to remain eligible for MA. Terminate MA eligibility with a 10-day notice if the client fails to cooperate with SMRT.

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Related Topics

For more information, see:

TEFRA Referrals to SMRT.

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