Expanding Foundations: Non-MAGI Disability Expanding Foundations: Non-MAGI

Disability Objectives: Goal: To gain further understanding of Disability, and the associated business processes to meet this requirement Objectives: After this module, participants will be able to: Perform data entry on the Disability Determination screen in CBMS Identify when the disability requirement is met, and when the disability app is necessary Gather, complete and submit a disability application Page 13

Disability Definition Resulting in multiple ‘markedly’ or at least one ‘severely’ limited functional domain Resulting in an Inability to perform substantial gainful activity Lasting 12 months or more, Medically Determinable Impairment, Adults Children *****Note: This is supplemental and non-required information only, Disability Determinations are not made by the eligibility worker***** Medically Determinable impairment Must be ‘more than not severe’ (cause limitations) ‘Medically determinable’ as in meeting a diagnostic criteria 12 months or more Can be expected to last 12 months or more Resulting in death or expected to result in death negates the 12 months requirement Resulting in an Inability to perform substantial gainful activity Assessed based on actual limitations Looks at all jobs in the country Age and work history are increasingly considered from age 50 to 64 Resulting in multiple ‘markedly’ or at least one ‘severely’ limited functional domain On a scale of: not, mildly, moderately, markedly, severely (limited) Limitations compared to average child of the same age 6 broad domains used by SSA to describe childhood functioning (1) Acquiring and using information, (2) Attending and completing tasks, (3) Interacting and relating with others, (4) Moving about and manipulating objects, (5) Caring for yourself, and (6) Health and physical well-being

Disability Criteria Age 65+ SSA Determination State Contractor Determination Page 14

Disability Determination Process Check for age then SSA disability determination: State Verification and Exchange System (SVES) for SSDI State Data Exchange (SDX) for SSI Award letter from SSA verifying SSI, SSDI or future diary date

Title XVI Page 15

Title II Page 17

Disability Determination Process If there is no disability determination from SSA: State Disability Contractor Complete Disability application and Medical Release Form 08/18/2014 Dated medical release form Page 18

Disability Application

Comments Page Page 19 Required: App date, program, Your contact information Helpful but not required: Your observations related to the conditions claimed in the application. (If you had contact with them) Page 19

Release Form Signature needed

ARG Contact Information Mailing Address: Arbor E&T, Action Review Group P.O. Box 340 Olyphant, PA 18447 Application Status (pending, new or in appeal): Email address: actionreviewgroupmrt@arboret.com Phone number: (877) 265-1864 Fax number: (877) 672-2077 Page 20

Auto-Mail CBMS will mail the app for you! Page 22, 23

Determination Notice Page 24

Full vs. Limited Disability Disability Criteria Full vs. Limited Disability Full Disability (All Programs) Meets the SSA disability criteria All waivers Limited Disability (WAwD) Meets the SSA disability criteria without consideration of substantial gainful activity WAwD clients: CMHS and EBD waivers only Full disability is for LTC Limited is for WawD **WawD is eligible for EBD and CMHS waivers only Page 25

Data Entry Info Page 27

Disability Data Entry Page 28

Medical Conditions Screen Required info only to open tabs Page 29

Disability Determination Screen EBD: Retro date Onset date: Retro date for ARG, Onset date for SSA. Status date: Date status was last changed Result date: Date the last decision on disability was made. Diary Date: Date case will be re-reviewed for ongoing disability. Page 30

Data Entry Practice Page 32-35

Disability Wrap-up Re-visit Objectives: Can you? Perform data entry on the Disability Determination screen in CBMS Identify when the disability requirement is met, and when the disability app is necessary Gather, complete and submit a disability application Goal: To gain further understanding of Disability, and the associated business processes to meet this requirement Page 36