# Presentation: 004363

## The Medical Review Process 

**Annie Polcari, RN, MPH**
**Region 1 Nurse Consultant**
**David P. Kraft, MD, MPH**
**Region 1 Mental Health Consultant**
**Region 1 Health & Wellness Conference**
**May 15, 2004**

## Medical Services Provided by Job Corps

- Center operators are responsible for the management and delivery of services at the centers
- Basic health services are provided to all students through a health and wellness program that coordinates medical, dental, and mental health care
- In accordance with Job Corps requirements and in agreement with the Health Care Finance Administration, every student must receive a cursory medical and dental inspection for obvious signs of disease, followed by a definitive medical examination
- Various laboratory tests and immunizations are also required of entering students

## Center Medical Chart Review Process

- Approximately 8 years ago, centers established a center chart review process to assess the charts of new applicants
- Committee consists of the HWM; disability coordinator; managers from the education, career, and behavioral departments; and at some centers, the center director
- The committee meets 1-2 times per week and reviews the ETA 6-53 health questionnaire “yes” responses to questions 8, 9, and 10, as well as relevant documents obtained by the career advisor (the provision of ETA 6-53 information is voluntary)

## Center Medical Chart Review Process (continued)

- The application is reviewed for completeness
- When necessary, the applicant is contacted with follow-up questions regarding medical, emotional, and/or educational concerns
- At times, consultation with the center physician and center mental health consultant are indicated to make the determination to accept or reject the career advisor’s recommendation of acceptance

## Center Medical Chart Review Process (continued)

- Rejected applications are forwarded to the regional office for further review by the regional health consultants (career advisors are notified when this occurs)
- Applications not recommended by career advisors bypass the center of assignment and are forwarded to the regional health consultants per regional policy
- When regional health consultants recommend approval of an application, these applications are forwarded to the regional office for final determination

## Regional Medical Review Process of Rejected Applications

**The regional nurse consultant will:**
- Review rationale for rejection submitted by center staff
- Review chart using a consistent format and record observations
- Determine the needs of the applicant
- Counseling sessions, frequency
- Psychotropic medications, current dosages
- Dietary restrictions
- Classroom accommodations
- Insurance coverage, in what state(s)

## Regional Medical Review Process of Rejected Applications (continued)

**The regional nurse consultant will:**
- Determine if there is sufficient information to make a decision
- Approximately 5% of rejected folders are incomplete; others may require additional information
- Applicants living in shelters might not have the opportunity of receiving a telephone call to clarify center staff or consultant questions

## Regional Medical Review Process of Rejected Applications (continued)

**The regional nurse consultant will:**
- Contact the applicant
- Changes that can occur during the review process include the following:
- The applicant returned to school; has completed counseling sessions; stopped taking his/her medication without medical advice; no longer sees a mental health provider; completed a detox program successfully; is gainfully employed; is recovering from surgery; is pregnant; or is in jail

## Career Advisors—What Can You Do To Expedite the Folder Review Process?

- When a career advisor is reviewing an applicant’s reports from school, medical institutions, health care providers, and court:
- Review for completeness
- Ensure that documents belong to the applicant
- Check to see if the physician wrote the dosage of medications
- If client is receiving ongoing counseling, frequency of visits are necessary

## Career Advisors—What Can You Do To Expedite the Folder Review Process? (continued)

- When a career advisor is reviewing an applicant’s reports from school, medical institutions, health care providers, and court:
- Ensure that client did not leave any answers on ETA 6-53 blank, especially the insurance question
- If a 2-page mental health form has been completed and the client is on medication(s) and attending counseling/therapy session(s), but the report is 3 or more months old, obtain an update before sending the application to center of assignment
- Contact regional health consultant via e-mail with questions or suggestions