MEMORANDUM

DATE:         January 17, 2006

TO:               Adult Public Assistance Manual Holders

FROM:         Policy and Program Development Team

                      Ellie Fitzjarrald, Chief

SUBJECT: Adult Public Assistance Manual Change #14

This manual change reinstates the medical review process for Interim Assistance ( IA ), and introduces a new Preliminary Examination for Interim Assistance ( AD #2 ) form.  A copy of the new AD #2 form is attached.

In September 2005, the medical review process for determining IAInterim Assistance eligibility was suspended because of litigation.  At issue was whether the Department was required to make a change to state regulations before implementing the medical review process.  State regulations were subsequently amended to clearly describe this review process, and a medical review must again be completed for all APAAdult Public Assistance applicants who wish to receive Interim Assistance while waiting for an SSISupplemental Security Income disability decision.  Only applicants who the Division determines are likely to meet Social Security disability requirements will be eligible for IAInterim Assistance .  

Doctors of patients applying for IAInterim Assistance will complete the new Preliminary Examination for Interim Assistance ( AD #2 ) form.   The APAAdult Public Assistance worker will then send this form and any supporting medical documentation to the Medical Reviewer in Anchorage.  DPA’s Medical Reviewer will assess an individual’s eligibility for IAInterim Assistance based on the results of the medical examination and other evidence.  The APAAdult Public Assistance worker will determine IAInterim Assistance eligibility based on the Medical Reviewer’s decision.

In some cases, the Medical Reviewer may need to ask a medical provider for information.  To assist in this process the caseworker should obtain an Authorization for Release of Protected Health Information (Gen 150) form from the applicant.  A copy of this release form is attached, with recommended language to be inserted on the form that supports the request.  

Implementation Date:  The policy is effective immediately.  The new AD #2 form must be obtained for APAAdult Public Assistance applications received on or after January 18, 2006, and sent to the Medical Reviewer.  Caseworkers may continue to use the doctor’s response on the old version of the AD #2 form when determining IAInterim Assistance eligibility for APAAdult Public Assistance applications received before January 18, 2006.

If you have any questions, please contact Jim Steele at 465-3201 or e-mail dpapolicy@health.state.ak.us.

Manual Change Filing Instructions