426-2 ELIGIBILITY REQUIREMENTS FOR INTERIM ASSISTANCE
To be eligible for Interim Assistance, an individual must:
Meet all APA
eligibility criteria except for receipt of SSI
;
Apply for SSI
;
Appear likely to meet Social Security
disability requirements and be determined disabled by the Division,
or be age 65 or older; and
Agree to repay Interim Assistance from retroactive SSI benefits by completing an Interim Assistance Reimbursement (IAR) authorization form.
These eligibility requirements are explained below.
426-2 A. APPLICANTS MUST BE ELIGIBLE FOR APA EXCEPT FOR A FINAL ELIGIBILITY DECISION BY SSI
With the exception of a final eligibility decision by SSI, all other APA eligibility requirements apply to the determination of eligibility for IA. This means that the caseworker must make a full eligibility determination before Interim Assistance can be approved. For blind or disabled applicants who are not eligible for Social Security disability benefits, a temporary disability or blindness decision must be made in accordance with the procedures described in this chapter.
426-2 B. CONCURRENT SSI APPLICATION
Interim Assistance is available only to APA applicants who are required to apply for SSI benefits; IA payments will not be made to APA applicants who have countable income or resources in excess of SSI program limits and are therefore not required to apply for SSI benefits.
To receive Interim Assistance, proof must be obtained that the applicant has submitted a signed SSI application to the Social Security office.
Because of the similarity between SSI and APA eligibility criteria, the identification of potentially SSI -eligible applicants is relatively simple. If the client appears to be APA eligible, and to have countable income within the applicable SSI limit, the client may be eligible for SSI and must file for SSI if he or she does not already have an active claim. If an applicant has income which changes from month to month and which is in some months within SSI limits, he or she must apply for the SSI program and may receive IA payments until Social Security makes a final decision on the SSI application.
When an APA applicant is identified as potentially SSI -eligible, the applicant has 30 days from the APA application filing date to contact SSA and file an SSI claim. The contact establishes a ”protected filing” date for SSI benefits, and consists of an oral or written request for benefits. This request for SSI benefits may be made in person, by mail, or by telephone.
The SSI application process requires that an SSI applicant must have an interview with an SSA Field Office Claims Representative before a signed application for SSI benefits can be accepted. Once the interview is completed, an applicant must submit a signed application to a SSA office within 60 days of the date of the SSI interview, unless SSA determines there is good cause for a delay.
If, without good cause, an APA applicant does not submit a signed SSI application to a Social Security office within SSA's 60-day time limit, the APA application will be denied. If the individual wishes to reapply once the application has been denied, he or she must complete a new APA application.
426-2 C. INTERIM BLINDNESS OR DISABILITY DETERMINATION
The APA program uses the same definitions of disability and blindness as SSI . The Division will obtain and use medical and other information to determine whether an applicant is likely to meet the SSI disability/blindness criteria, and is eligible for Interim Assistance.
If an individual becomes ineligible for IA for any reason other than a final SSI decision, a new AB 3 AD 2 , APA 4 or disability assessment by the Division’s Medical Reviewer is not required as long as the SSI application has remained active during the individual’s period of ineligibility. IA benefits may be authorized again once the reason for the ineligibility ends. If the applicant received a final SSI decision during the period of ineligibility, the individual must reapply for assistance and meet the criteria listed In APA MS 426-2 before IA benefits are again approved.
Note:
If SSA determines that
the applicant is disabled before the Medical Reviewer’s decision is received,
do not issue IA back
to the date the IAR was
signed. Since IA
is not approved in this situation, the applicant has no IAR obligation. The APA benefit start date is the first
day of the month after SSA
issues written notice of the applicant’s eligibility for SSI or Disability Insurance benefits,
or the first day of the month after the DDS
notifies DPA that the
applicant is disabled. The client would not be issued any
IA payments.
These determinations are made as follows:
1. APA applicants who are eligible to receive Social Security disability insurance benefits
Persons who receive SSA disability payments, and persons who have been determined eligible to receive SSA disability benefits but are serving their five-month waiting period, meet the blindness/disability criteria for IA. These individuals are not required to have a medical exam or an assessment by the Division’s Medical Reviewer, as described below.
2. Blind APA applicants required to submit an AB 3 form
An individual who is blind must be examined by a physician skilled in diseases of the eye or an optometrist, as specified in Manual Section 425-2A. The results of this examination must be provided on a Review Report on Aid to the Blind (AB 3) form. If a medical provider refuses to complete the AB 3 form, the caseworker should advise the applicant to go to a different provider for completion of the form.
The AB 3 form must be checked ”Yes” or ”No.” A ”Yes” is evidence of blindness for Interim Assistance. A ”No” shows ineligibility for Interim Assistance. When determining blindness for Interim Assistance, only the AB 3 form needs to be completed. The caseworker will accept the judgment of the medical provider as noted on the AB 3. It is not reviewed by any other authority.
If Interim Assistance is not approved, the APA application must be pended for an eligibility decision from the SSI program so that eligibility for regular APA and Medicaid can be determined.
3. Disabled APA applicants required submit an AD 2 form
An individual who has a disability other than blindness must be examined by a physician, licensed clinical psychologist with a PhD, or psychiatrist, as specified in Manual Section 425-2A. The results of this examination must be provided on an, Preliminary Examination for Interim Assistance AD 2 form. If a medical provider refuses to complete the AD 2 form, the caseworker should advise the applicant to go to a different provider for completion of the form.
In some cases, the Medical Reviewer may need to ask a medical provider for information. To assist in this process the caseworker should obtain a completed Authorization for Release of Protected Health Information (GEN 150 IA) form. See section 4 below for instructions on how to complete this form.
The Medical Reviewer will assess the individual’s disability using the examination results reported on the AD 2 form and any supporting documents or information, and decide whether the applicant meets SSI disability criteria.
When making a disability assessment, the Medical Reviewer will consider whether the:
Applicant’s
condition meets the SSI presumptive
disability criteria or another impairment category used by Social
Security to determine a person’s disability status;
Medical information
provided by the applicant or received by the Department documents
the applicant’s impairment;
Impairment
affects the individual’s activities of daily living;
Applicant
can work, including sedentary work;
Impairment has lasted, or is expected to last, for a continuous period of at least 12 months.
Once the assessment is completed, the Medical Reviewer will document the disability decision on the AD 2 form and advise the caseworker of the approval or denial by fax or e-mail.
• IA Disability Approved
If approved, the caseworker will open an Interim Assistance case if the individual meets all other factors of eligibility for IA . The APA application is pended for an eligibility decision from the SSI program so that eligibility for regular APA and Medicaid can be determined. EIS notice P105, IA Approved - APA Held, may be used for this purpose.
• IA Disability Denied
If denied, the caseworker will pend the APA application for an eligibility decision from the SSI program so that eligibility for regular APA and Medicaid can be determined. EIS notice P304, APA Held - IA Denied, may be used for this purpose.
In some situations, an applicant may choose to submit additional medical information after the Medical Reviewer determines the applicant is not disabled. When this happens, the Medical Reviewer will consider the new information and re-determine the applicant’s disability status. New medical information may be submitted at any time.
4. Authorization for Release of Protected Health Information (GEN 150 IA)
The GEN 150 IA form must be properly completed before it is sent to the Medical Reviewer. If information is being requested from more than one medical provider, a separate form must be completed for each provider.
The information requested on the front page of the form must be filled in before the applicant signs the form. The form is not valid if the applicant signs the form before it is filled out. The form should be completed as follows:
Name: The applicant’s printed name.
SSN: The applicant’s Social Security Number.
Case # or Client ID: The applicant’s EIS case number or Client ID.
Date of Birth: The applicant’s date of birth.
Other Names Under Which Records Might Be Filed: If applicable, enter any other names under which medical records might be filed.
Organization Releasing Information: Provide the name of the medical provider from whom we may request information. The provider must be clearly identified with a complete name. For example, "Providence” is not enough information because there are numerous providers with that name, such as Providence Mat-Su, Providence Behavioral Health, Providence Family Practice, etc.
Spell out acronyms on the release form. If the provider does not accept an acronym, then we must get a new release form - creating a delay for both the caseworker and the applicant.
If the applicant comes from another state, ask the applicant for identifying information for any out-of state providers, such as a valid phone number, fax number, or mailing address. The release form is useless if the Medical Reviewer is unable to contact the provider.
Organization Receiving Information: This section is pre-filled with: "Division of Public Assistance".
Description of Information To Be Released: This section is pre-filled with: ”All medical records supporting disability or incapacity due to mental illness, physical illness, and/or substance abuse.”
Signature: The applicant or their personal representative must sign the form.
Date: The date the form is signed.
Revocation Date(s): If the applicant enters a revocation date on either the front or back of the form, please review that date. An applicant may sometimes enter a revocation date that is the same as the signature date. When this happens, a new release form will be needed because the applicant has essentially revoked the current form.
5. Disability and Vocational Report (APA 4)
The APA 4 asks the client to give information about their disability, their medical provider's name and contact information, and information about past work and education. The information provided on the form will help the Medical Reviewer determine IA eligibility.
The APA 4 must be completed to the extent possible before it is sent to the Medical Reviewer. Sending incomplete documentation to the Medical Reviewer may result in a delay in the disability decision. For additional guidance on how to complete the APA 4 see Administration Manual section 115-9D(2).
Processing times for SSI applications based on age are usually much faster than for individuals applying based on disability or blindness. In most cases, the SSI decision for old age cases will be made within the 30-day APA application processing timeframe, and eligible cases can be opened in regular APA coverage. If, however, no SSI decision is reached within the APA application processing timeframe, aged applicants may receive Interim Assistance pending the SSI eligibility decision. An interim blindness or disability determination is not required for aged applicants.
426-2 E. IAR AUTHORIZATION REQUIREMENT
APA applicants must sign an Interim Assistance Reimbursement (IAR) authorization form to receive Interim Assistance benefits. The IAR authorization is not, however, an eligibility requirement for regular APA benefits. The signed IAR authorization is necessary only if the applicant wishes to receive IA benefits while waiting for a decision on his or her SSI application. APA applicants who appear eligible for Interim Assistance must be given the choice of either signing or not signing the IAR authorization form.
The IAR authorization may be provided to the APA applicant during the interview process, or if this is not possible, the caseworker may send EIS notice, P021, IAR Authorization Needed, and mail the IAR authorization form separately to the client at the same time.
When a signed IAR authorization is received, the caseworker must:
Complete and
sign the "State Representative Signature" and "Date
Received by State" fields at the bottom of the form and send
the original copy to the appropriate SSA
office within 30 calendar days of the date the signed authorization
was received by DPA . (The date
the authorization was received by DPA
is entered on the form as the date received.) If these fields
are not completed, the SSA office
will return the form to DPA .
Enter the date the authorization was received by DPA into EIS on the APAS screen. (The Claims Unit will use this date when calculating an IA recipient's reimbursement obligation.)
If otherwise eligible, Interim Assistance under this provision begins the month a signed IAR authorization is received in a DPA office. APA applicants who do not sign an IAR authorization are not eligible for Interim Assistance.
426-2 F. CONTACTING THE MEDICAL REVIEWER
Once all the necessary forms are complete, the caseworker will immediately fax the AD 2, APA 4, any completed release forms, and any other supporting documents to:
Medical Reviewer
Division of Public Assistance
3601 C Street, Suite 460
Anchorage, AK 99503
Phone: (907) 269-0064
Fax: (907) 269-0962
All IA review inquiries from the caseworker should be emailed to the Medical Reviewer at: DPAInterim.Assistance@alaska.gov.
|
||
|
|