115-9          DISABILITY DETERMINATION SERVICE

The Disability Determination Service (DDSDisability Determination Service) is part of the Department of Labor and Workforce Development, Division of Vocational Rehabilitation. DPADivision of Public Assistance has an agreement with the DDSDisability Determination Service that requires them to make disability determinations for certain DPADivision of Public Assistance applicants and recipients whom Social Security will not render a disability decision due to reasons not related to blindness or disability.

The DDSDisability Determination Service determines disability for DPADivision of Public Assistance for:

• Working Disabled Medicaid;
• Adults with Physical and Developmental Disabilities (APDD) Medicaid Waiver;
• Individuals with Intellectual and Developmental Disabilities (IDD) Medical 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 TEFRATax Equity and Fiscal Responsibility Act).

The DDSDisability Determination Service makes state-only disability decisions for initial applications. They also review the disability for ongoing recipients, if needed. The DDSDisability Determination Service will, in their initial decision, recommend when a disability decision must be reviewed.

Note:

Under a separate agreement with the Social Security Administration, the DDSDisability Determination Service also makes disability decisions for Social Security disability programs.

115-9 A.      DDS REFERRAL PROCESS

The DDSDisability Determination Service referral process must include the following steps:

1. The DPADivision of Public Assistance caseworker asks the client to complete necessary forms and provide related documentation.
2. Once the client returns the requested information, the caseworker must sign off on the agency section of either the "Disability and Vocational Report" (APA 4Disability & Vocational Report) or the "Child's Medical History and Disability Report" (MED 1) form.
3. The caseworker completes a Referral for Disability Determination (GEN 141) and attaches it to the information provided by the client. The caseworker must also attach any documentation from the case file or other sources relating to the client's disability. This is the DDSDisability Determination Service referral packet. The following table describes the material that must be included in this DDSDisability Determination Service referral packet.

4. The caseworker sends the referral packet via certified mail to:
   
   Disability Determination Services
   619 East Ship Creek, Suite #305
   Anchorage, AK 99501
5. The district office will maintain a log of all disability determination request it sends to the DDSDisability Determination Service including the certified mail tracking number.
6. The DDSDisability Determination Service office makes a disability decision, and sends the decision file to the district office via certified mail.
7. The district office will log the DDSDisability Determination Service decision and forward to the caseworker.
8. For Medicaid Waivers or Disabled Child Living At Home (TEFRATax Equity and Fiscal Responsibility Act) Medicaid cases, the caseworker must notify the Division of Senior and Disabilities Services Case Manager or the TEFRATax Equity and Fiscal Responsibility Act Contractor of the DDSDisability Determination Service decision.

If the DDSDisability Determination Service referral packet is not properly completed, the DDSDisability Determination Service will return the packet to the referring DPADivision of Public Assistance field office for corrective action and resubmission to DDSDisability Determination Service.

115-9 B.      MEDICAL DOCUMENTATION AND DDS DECISION TIME FRAMES

The DDSDisability Determination Service 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 DPADivision of Public Assistance Long Term Care Coordinator.

Adult DDSDisability Determination Service decisions may take longer, and could exceed 90 days if additional medical examinations are required.

If a DDSDisability Determination Service decision is reaching or has surpassed the appropriate 45 or 90 day mark from date of the Medicaid application, DPADivision of Public Assistance caseworkers designated as DDSDisability Determination Service liaisons may fax to DDSDisability Determination Service an inquiry request using the Disability Determination Services Claim Status Inquiry Form (MED 10). Portions of the form indicated for DPADivision of Public Assistance to complete need to be completed in their entirety for DDSDisability Determination Service to reply accurately. DDSDisability Determination Service will respond with a status update by marking one of the options listed on the MED 10 per the individual claim status and fax back to the requesting DPADivision of Public Assistance office/staff member. It is the responsibility of the DPADivision of Public Assistance caseworker member to document the results of the inquiry properly and clearly in EISEligibility Information System per standard case note procedures. A system alert should also be set to check back on the status of the claim with DDSDisability Determination Service at the next appropriate interval.

115-9 C.      COMPLETING NECESSARY FORMS

In order for the DDSDisability Determination Service to complete a timely disability decision, it is important that referrals sent by DPADivision of Public Assistance 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 DDSDisability Determination Service referral forms for adults and children.

Prior to sending a DDSDisability Determination Service referral, the DPADivision of Public Assistance 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.      DDSDisability Determination Service REFERRALS FOR ADULTS AGE 18 OR OLDER

Required Forms:

• Referral for Disability Determination (GEN 141)
• Disability and Vocational Report (APA 4Disability & Vocational Report)
• 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:

1. Check all of the appropriate boxes.
2. Include any additional information that the adjudicator may find helpful under the "Special Notes" section.
3. 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.
4. 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.
5. Clearly write the caseworker's name and contact information.

2. DISABILITY AND VOCATIONAL REPORT (APA 4Disability & Vocational Report)

The applicant or recipient must provide their name, Social Security Number, address, telephone number, and answer all of the following questions on the APA 4Disability & Vocational Report 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 MED 2Authorization for Release of Information form forms by filling in his or her:

• Name
• Social Security Number
• Date of Birth

• Provider/Organization Releasing Information

• Provider's Address, City, State, Zip, and Phone

• Signature
• Printed Name

• Date signed

All sections of the MED 2Authorization for Release of Information form form must be completed by the applicant for each provider.

If any of the sections of the form is blank or incomplete, DPADivision of Public Assistance staff will contact the applicant to complete the form prior to submitting it to DDSDisability Determination Service.

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 2Authorization for Release of Information form 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:

1. Check all the appropriate boxes.
2. Include any additional information that the adjudicator may find helpful under the "Special Notes" section.
3. 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.
4. 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.
5. Clearly write the caseworker's name and contact information.
6. 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 child's parent or guardian complete MED 2Authorization for Release of Information form forms for each provider, school, or school district by filling in the child's:

• Name
• Date of Birth
• Social Security Number

• Provider/Organization Releasing Information

• Signature of parent or guardian
• Printed Name of parent or guardian

• Date Signed

All sections of the MED 2Authorization for Release of Information form form must be completed by the child's parent or guardian for each provider, school, or school district. If any of the section of the form is blank or incomplete, DPADivision of Public Assistance staff will contact the child's parent to complete the form prior to submitting it to DDSDisability Determination Service.

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 2Authorization for Release of Information form forms.

115-9 F.      DDSDisability Determination Service DECISION AND DECISION FILE

The DDSDisability Determination Service disability decision is documented on a cover letter that is included in the DDSDisability Determination Service decision file. In some case, the DDSDisability Determination Service will recommend a review of the disability. The caseworker must set an EISEligibility Information System or case file alert to monitor when that review must be done.

The DDSDisability Determination Service decision file is kept at the district office and is considered a part of the DPADivision of Public Assistance case file. If the case file is transferred, the DDSDisability Determination Service decision file must accompany it.

Occasionally, the DDSDisability Determination Service may request that a disability decision file be returned. When this happens, the district office will forward the DDSDisability Determination Service file to Field Services with a note explaining it was requested by DDSDisability Determination Service.

Questions regarding the status of state-only disability decisions should be directed to designated DDSDisability Determination Service liaisons in each field office/region. Consult the office supervisor or lead for the name of the liaison in the office.

If a DDSDisability Determination Service decision is reaching or has surpassed the appropriate 45 or 90 day mark from date of the Medicaid application, DPADivision of Public Assistance caseworkers designated as liaisons may fax to DDSDisability Determination Service an inquiry request using the Disability Determination Services Claim Status Inquiry Form (MED 10). Portions of the form indicated for DPADivision of Public Assistance to complete need to be completed in their entirety for DDSDisability Determination Service to reply accurately. DDSDisability Determination Service will respond with a status update by marking one of the options listed on the MED 10Disability Determination Services Claim Status Inquiry Form per the individual claim status and fax back to the requesting DPADivision of Public Assistance office/staff member. It is the responsibility of the DPADivision of Public Assistance caseworker member to document the results of the inquiry properly and clearly in EISEligibility Information System per standard case note procedures. A system alert should also be set to check back on the status of the claim with DDSDisability Determination Service at the next appropriate interval.

DPADivision of Public Assistance caseworkers can contact the DPADivision of Public Assistance Long Term Care Coordinator for further follow up if there are unusual circumstances surrounding a DDSDisability Determination Service claim or if a claim is severely delinquent from DDSDisability Determination Service.