115-9 DISABILITY DETERMINATION SERVICE
The Disability Determination Service (DDS ) is a part of the Department of Labor and Workforce Development, Division of Vocational Rehabilitation. DPA has an agreement with the DDS that requires them to make disability determinations for certain DPA applicants and recipients whom Social Security will not render a disability decision due to reasons not related to blindness or disability.
The DDS determines disability for DPA for:
Working Disabled
Medicaid;
Adults with
Physical and Developmental Disabilities (APDD) Medicaid Waiver;
Individuals
with Intellectual and Developmental Disabilities (IDD) Medicaid Waiver;
Children with
Medically Complex Conditions (CCMC) Medicaid Waiver;
State-only disability
determinations for Adult Public Assistance; and
Disabled Children Living at Home Medicaid (also known as TEFRA ).
The DDS makes state-only disability decisions for initial applications. They also review the disability for ongoing recipients, if needed. The DDS will, in their initial decision, recommend when a disability decision must be reviewed.
Note:
Under a separate agreement with the Social Security Administration, the
DDS
also makes disability decisions for Social Security disability programs.
115-9 A. DDS REFERRAL PROCESS
The DDS referral process must include the following steps:
The
DPA
caseworker asks the client to complete necessary forms and
provide related documentation.
Once
the client returns the requested information, the case worker
must sign off on the agency section of either the "Disability
and Vocational Report" (
APA 4) or the "Child's Medical History
and Disability Report" (MED 1) form.
The caseworker completes a Referral for Disability Determination (Gen 141) and attaches it to the information provided by the client. The case worker must also attach any documentation from the case file or other sources relating to the client's disability. This is the DDS referral packet. The following table describes the material that must be included in this DDS referral packet
Packet for Adult: |
Packet for Child |
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A request for DDS to review a decision must include the original DDS decision file. |
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The caseworker
sends the referral packet via certified mail to:
Disability Determination Services
619 East Ship Creek, Suite #305
Anchorage, AK 99501
The district
office will maintain a log of all disability determination requests
it sends to the DDS
including the certified mail tracking number.
The DDS office makes a disability
decision, and sends the decision file to the district office via certified
mail.
The district
office will log the DDS
decision and forward to the caseworker.
For Medicaid
Waivers or Disabled Child Living At Home (
TEFRA ) Medicaid cases, the caseworker must notify
the Division of Senior and Disabilities Services Case Manager or the
TEFRA Contractor
of the DDS
decision.
If the DDS referral packet is not properly completed, the DDS will return the packet to the referring DPA field office for corrective action and resubmission to DDS.
115-9 B. MEDICAL DOCUMENTATION AND DDS DECISION TIMEFRAMES
The DDS has 45 days to make a disability decision for children under the age of 18. If adequate documentation is not received within the 45-day time frame, disability will be denied due to the lack of adequate information. Extensions to the 45-day time frame must be approved by the DPA Long Term Care Coordinator.
Adult DDS decisions may take longer, and could exceed 90 days if additional medical examinations are required.
If a DDS decision is reaching or has surpassed the appropriate 45 or 90 day mark from date of the Medicaid application, DPA caseworkers designated as DDS liaisons may fax to DDS an inquiry request using the Disability Determination Services Claim Status Inquiry Form (MED 10). Portions of the form indicated for DPA to complete need to be completed in their entirety for DDS to reply accurately. DDS will respond with a status update by marking one of options listed on the MED 10 per the individual claim status and fax back to the requesting DPA office/staff member. It is the responsibility of the DPA caseworker to document the results of the inquiry properly and clearly in EIS per standard case note procedures. A system alert should also be set to check back on the status of the claim with DDS at the next appropriate interval.
115-9 C. COMPLETING NECESSARY FORMS
In order for the DDS to complete a timely disability decision, it is important that referrals sent by DPA caseworkers contain all of the necessary information. Sending a referral with incomplete forms results in a return of the referral without a decision and delays case processing. The following sections outline the information needed on the DDS referral forms for adults and children.
Prior to sending a DDS referral the DPA caseworker must review all the forms to ensure they are properly completed. If any forms are incomplete per the guidelines below, the caseworker must pend the case and return the forms for completion.
115-9 D. DDS REFERRALS FOR ADULTS AGE 18 OR OLDER
Required Forms:
Referral
for Disability Determination (GEN 141)
Disability
and Vocational Report (
APA 4)
Authorization for Release of Protected Health Information (MED 2)
1. REFERRAL FOR DISABILITY DECISION (GEN 141)
The caseworker completes this form using the following steps:
Check
all of the appropriate boxes.
Include
any additional information that the adjudicator may find helpful
under the "Special Notes" section.
Write
down the applicant’s name, date of birth, and Social Security
Number. Double check to ensure the date of birth and Social
Security Number are correct.
Clearly
write the office address in the box "Return Decision
File to DPA
Office at:" so the adjudicator knows where to return
the completed decision.
Clearly write the caseworker’s name and contact information.
2. DISABILITY AND VOCATIONAL REPORT ( APA 4)
The applicant or recipient must provide their name, Social Security Number, address, telephone number and answer all of the following questions on the APA 4 form:
Section I - Information about Your Condition
Parts A, B, and C of section I must be answered and cannot be left blank.
Note:
Section A must include alleged impairments, not just symptoms
Section II - Information about Treating Sources
Beginning with the most recent medical or mental health provider, the applicant or recipient must:
Write down the full name of the provider or facility along with address information, and
Include the month and year for the "Date Last Treated."
Section III - Information about Your Past Work
Parts A and B in section III must be answered and cannot be left blank.
It is very important that the applicant or recipient completes Part A: Job Title, Type of Business, and Dates Worked (The dates worked must include the month and the year).
Note:
Section A must clearly state the applicant’s or recipient’s employment
status, including if he or she has never worked.
3. AUTHORIZATION FOR RELEASE OF PROTECTED HEALTH INFORMATION (MED 2)
The applicant or recipient must complete at least six (6) MED 2 forms by filling in his or her:
Name
Social Security Number
Date of Birth
Signature
Printed Name
The section *For use only by the Disability Determination Services* must remain blank and the form undated.
Note:
A guardian may sign the forms for an applicant or recipient. If a
guardian signs, then a copy of the guardianship papers must accompany
the MED 2 forms.
115-9 E. DDS REFERRALS FOR CHILDREN UNDER AGE 18
The parent or guardian is responsible for completing all forms for children under the age of 18. In situations of custody or guardianship with the Office of Children’s Services, the custody or guardianship papers must be included with the referral.
Required Forms:
Referral
for Disability Decision (GEN 141)
Child’s
Medical History and Disability Report (MED 1)
Authorization for Release of Protected Health Information (MED 2)
1. REFERRAL FOR DISABILITY DECISION (GEN 141)
The caseworker completes this form using the following steps:
Check all
the appropriate boxes.
Include
any additional information that the adjudicator may find helpful
under the ”Special Notes” section.
Write down
the applicant’s name, date of birth, and Social Security Number.
Double check to ensure the date of birth and Social Security
Number are correct.
Clearly
write the office address in the box ”Return Decision File
to DPA
Office at:” so the adjudicator knows where to return the completed
decision.
Clearly
write the caseworker’s name and contact information.
Complete the case manager and care coordinator contact information fields. This information is very important when processing child disability claims.
2. CHILD’S MEDICAL HISTORY AND DISABILITY REPORT (MED 1)
It is important that the parent or guardian answer all questions and give as much detail as possible.
Section I - Information about Your Condition
Parts A, B, C, and D are required, and date of onset must include the month and year.
Section II - Information about Your Treatment
Beginning with the most recent providers, the parent or guardian must list all people or agencies involved in the child’s treatment. The complete address and contact phone numbers must be included in this section. The ”Dates first/last treated” must include month and year.
Section III - Other Agencies
If the child is being served by programs such as the Infant Learning Program, this information must be included in this section.
Section IV, V, and VI:
The parent or guardian must include both the month and year when filling in the information in these sections. For Section VI, the school address must be included, especially if the child attends a charter school, private school, or pre-school. If the child receives Special Education Services at school, the parent must also note this in Section VI.
Section VII - Activities
It is important that the parent or guardian provide as much detail as possible when completing this section. If more room is needed, the parent or guardian can attach additional pages to the form.
3. AUTHORIZATION FOR RELEASE OF PROTECTED HEALTH INFORMATION (MED 2)
Have the parent or guardian complete at least six (6) MED 2 forms by filling in the child’s:
Name
Date of Birth
Social Security Number
Signature of parent or guardian
Printed Name of parent or guardian
The section *For use only by the Disability Determination Services* must remain blank and the form undated.
Note:
A guardian may sign the forms for an applicant or recipient. If a
guardian signs, then a copy of the guardianship papers must accompany
the MED 2 forms.
115-9 F. DDS DECISION AND DECISION FILE
The DDS disability decision is documented on a cover letter that is included in the DDS decision file. In some cases, the DDS will recommend a review of the disability. The caseworker must set an EIS or case file alert to monitor when that review must be done.
The DDS decision file is kept at the district office and is considered a part of the DPA case file. If the case file is transferred, the DDS decision file must accompany it.
Occasionally, the DDS may request that a disability decision file be returned. When this happens, the district office will forward the DDS file to DOST with a note explaining it was requested by DDS .
Questions regarding the status of state-only disability decisions should be directed to designated DDS liaisons in each field office/region. Consult the office supervisor or lead for the name of the liaison in the office.
If a DDS decision is reaching or has surpassed the appropriate 45 or 90 day mark from date of the Medicaid application, DPA caseworkers designated as liaisons may fax to DDS an inquiry request using the Disability Determination Services Claim Status Inquiry Form (Med 10). Portions of the form indicated for DPA to complete need to be completed in their entirety for DDS to reply accurately. DDS will respond with a status update by marking one of options listed on the Med 10 per the individual claim status and fax back to the requesting DPA office/staff member. It is the responsibility of the DPA caseworker to document the results of the inquiry properly and clearly in EIS per standard case note procedures. A system alert should also be set to check back on the status of the claim with DDS at the next appropriate interval.
DPA caseworkers can contact the DPA Long Term Care Coordinator for further follow up if there are unusual circumstance surrounding a DDS claim or if a claim is severely delinquent from DDS.
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