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Effective: October 1, 2012 |
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12.10ar4 - State Medical Review Team (SMRT) Disability Determinations (Archive) |
Archived: April 1, 2013 |
The State Medical Review Team (SMRT) is a unit at DHS that determines disability in consultation with medical professionals appointed by the commissioner. A primary function of SMRT is certifying disability for people who are applying for (or appealing the denial of) Social Security Administration (SSA) disability benefits or Railroad Retirement Board (RRB) disability benefits.
Physical Examination Required.
SMRT for Current MA Enrollees.
For every referral to the State Medical Review Team, complete a State Medical Review Team Referral for Disability Determination (DHS-6123). Also include documentation to support the client's physical, psychological, or developmental disability (DD) condition.
l Documentation should generally be no more than one year old, unless otherwise noted in this chapter.
l Tax and income statements, medical bills, and EOMBs from other insurers are not needed, as they have no bearing on the SMRT determination.
There are some potentially disabling conditions that require a three-month waiting period before being referred to SMRT. See that section for further information.
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. You may use naturopathic and chiropractic exams as well, but only if submitted with results of an examination from a licensed physician.
In addition to the current physical examination, specific evidence is required for each type of disability referral (physical, psychological, or mental condition), as outlined on the Request for Adult Medical Examination (DHS-0161A).
Note: The Request for Adult Medical Examination is recommended for use as a release of, in addition to request for, medical information to complete the SMRT review process.
l If a discharge summary is sent as medical evidence, be sure to obtain the admission history, a physical evaluation, and the complete psychiatric evaluation done while in the facility.
Note: If the client is deceased, send a discharge summary from the last hospitalization and a death certificate from the Department of Health.
l If the client's application for RSDI or SSI has been denied, include the denial letter.
l There are different documentation requirements for the TEFRA option: See TEFRA Referrals.
Assist clients in obtaining necessary documentation in support of a SMRT referral. Counties can bill DHS for the cost of medical exams required for disability determinations; submit a claim for access services with procedure code 99456 (disability exam).
There are several methods for submitting SMRT referrals:
l Fax the referral to 651-431-7461. Submit the entire case as one fax if possible; when one case is submitted in multiple faxes, it is difficult for the SMRT staff to keep the case together.
l Mail a paper copy (send only one-sided copies) or a compact disc (CD) (in TIFF file format) of the case to:
State Medical Review Team
P.O. Box 64984
St. Paul, MN 55164-0984
Retain a copy of the materials submitted to SMRT in your agency's case file pending the outcome of the determination. In some cases the SMRT must request additional information.
Incomplete referrals will delay the SMRT determination. In case of questions about how to submit a referral, call the SMRT hotline at 651-431-2493.
Once the review is complete, SMRT will fax the decision to the county, indicating approval or denial (or a request for additional information).
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.
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.
For more information, see: