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MANUAL TRANSMITTAL

Arkansas Department of Human Services

Division of County Operations

Executive Directive                                       Issuance Number: MS 91-28

Medical Services Policy Manual                  Issuance Date: 9/27/91

From: Kenny Whitlock, Director                     Expiration Date: Until Superseded

Subj:MRT Guidelines

  1. Purpose

    2. The purpose of this directive is to provide focus on the MRT process used to establish disability, now that we have reinstated the adult Medically Needy categories, and to provide information regarding the revised forms which have been developed as a corrective action.

  2. Background

    3. Following the reinstatement of the adult Medically Needy categories, the number of applications involving needed MRT determinations has risen dramatically. We therefore have decided to streamline the process for the field and for the Medical Review Team.

    The Medical Review Team unit must gather, evaluate, and organize the medical and social information pertaining to the applicant whose eligibility is in part based on disability. The Federal regulations stipulate specific criteria which must be documented in the medical and social information gathered. Subsequently the case is then submitted to the MRT physician for evaluation and a disability determination. Although every case is different, the general guideline, listed below, should help workers in submitting the necessary information to MRT to begin the disability determination process. Also you may want to refer to manual policy MS 3322.1 and FA 2243.3.

  3. Guidelines For County Offices
    4.

The following useful guidelines have been developed to assist workers and supervisors through the MRT process. Use of these guidelines on MRT cases will expedite processing of the case by MRT and reduce requests by MRT for additional information which necessitates repetitive handling of the case by the county workers.
    1. If the applicant has been hospitalized in the past year, a DHS-81 for the facility must be provided to MRT. If the applicant was hospitalized for an acute event or injury, such as a heart attach or motor vehicle accident, follow-up out patient medical treatment records will also be needed. Therefore, a DHS-81 must be provided for the physician(s) that the applicant is seeing for follow-up medical treatment.
    2. If the applicant has not been hospitalized in the past year and does not regularly see a physician, Form EMS-107 must be completed. If the applicant goes to a physician regularly, then a Form DHS-81 may be provided in lieu of another physical examination and MRT will request the applicant’s records from the physician. If the physician fails to provide the medical records in response to the MRT request, the applicant may later be required to have the EMS-107 completed by the physician. Form EMS-107 may also be completed if the applicant chooses to supply medical information in addition to that which can be obtained from a hospital. If the impairment involved is visual, a form EMS-701 must be completed instead of form EMS-107 or once again, if seen regularly by a physician, the records can be requested with a DHS-81. If the impairment involved is mental and the applicant is seen at a mental health clinic, a DHS-81 must be provided for MRT to obtain these records.
    3. If the applicant has seen medical specialists in the past year, a DHS-81 must be provided to MRT.
    4. If the applicant states that he/she does not have the funds for payment of a physician’s examination and the applicant is not seeing a physician regularly, the applicant should be informed that MRT can arrange and pay for an examination. In this case the Service Representative should report this on the EMS-108. Please do this only in those cases in which there is no other possible source of medical evidence as MRT’s funds are limited.
    5. The completed EMS-108, EMS-106, EMS-107, and/or DHS-81, any other medical information which the applicant wishes to provide or which is available in the County Office files, and other applicable forms should be submitted to the Medical Review Team all together in one package as soon as possible.
  1. Forms

The EMS-108 has been revised and a new MRT re-examination form has been developed, EMS-108A. The revised EMS-108 now includes the detailed questions which were contained in the EMS-108 instructions. The questions were added to the form so that the workers and supervisors would not have to reference the instructions constantly in order to be certain to cover all the pertinent information. Also the new format will assist the worker in obtaining all the necessary information by providing a structure for the interview. This should assist both the worker and MRT.

A new form, EMS-108A will be completed when the case is due for an MRT re-examination. The form requires about half as much information as the EMS-108. This should also be beneficial to the County worker since a great deal of the information which is listed on the EMS-108 need not be repeated.

Inquiries to Linda Nordin, 501-682-8262