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Effective: December 1, 2006 |
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12.10.05ar1 - SMRT Disability Determinations Three Month Waiting Period (Archive) |
Archived: June 1, 2015 |
For referrals to the State Medical Review Team (SMRT) , there are some conditions that require a three-month waiting period from the date of onset according to Social Security Administration (SSA) guidelines. They include:
l Stroke.
l Heart attack.
l Traumatic injury.
l Accident.
l Surgery.
l Initial treatment to control seizures.
l Initial cancer chemotherapy.
Documentation for All Conditions.
Additional Documentation for Some Conditions.
Documentation for All Conditions
After a three-month waiting period, submit the referral to SMRT with the following documentation for any of the conditions noted above:
l A copy of the admission history, physical evaluation, and discharge summary (not discharge instructions) from the hospitalization during which the episode was treated.
l All rehab evaluations and progress notes from the type of therapy that the client is involved in including: physical therapy, occupational therapy, speech therapy, and cardiac rehabilitation.
l All outpatient follow-up visits with the treating and consulting physicians.
Additional Documentation For Some Conditions
For conditions other than stroke, heart attack, or surgery for traumatic injury, also include any supporting documentation that is specific to the client's condition. This evidence may include:
l Current rehabilitation evaluation and progress notes from physical therapy, speech therapy, occupational therapy, or cardiac rehabilitation.
l Reports from any other consulting medical specialists. The report should include:
n Client's major medical complaint.
n A detailed description within the area of specialty of the examination.
n Results of laboratory tests, blood tests, x-rays, MRI scan, and other tests.
n Pulmonary function studies if the client has emphysema, cystic fibrosis, or related respiratory diseases.
n Copies of any emergency room reports or hospital discharge summaries in the past year if the client has asthma or similar respiratory problems. The SMRT needs to know the number of visits to the emergency room or hospital stays the client has had in the past year.
n HIV/AIDS test (CD4 count) and history of pneumocystis pneumonia.
l A complete neurological exam if the client has a confirmed or suspected neurological disease, head trauma or seizure disorder. If head trauma is an issue, has a coma persisted 30 days or more? If seizures are present, the exam should include:
n Information on the number of seizures in a given period of time.
n Medication used to control seizure activity.
n Seizure activity after at least a three-month trial of anti-seizure medication.
l A diagnosis of cancer requires:
n The date of diagnosis.
n A description of the cell-type of cancer (adenocarcinoma, squamous cell).
n Stage or grade of cancer.
n Any indication if the disease has spread.
n Type of therapy the client is receiving.
n The response to treatment.
A diagnosis of leukemia requires all the information listed, as well as a copy of the original bone marrow biopsy establishing the diagnosis.
l Growth charts from the pediatric medical provider for the last year. Include heights and weights.
l If the client is morbidly obese, include current height and weight.
l A copy of the Social Security letter of denial.
l A copy of the discharge summary (not discharge instructions) from the most recent hospital stay.
In case of questions about a waiting period or appropriate documentation for a given condition, call the SMRT hotline at 651-431-2493.
For more information, see: