Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 20 - Division of County Operations › Rule 016.20.00-004 - Medical Services Policy MSP 3323.7: Substantial Gainful Activity - the guidelines for determining when earnings demonstrate the ability to engage in substantial gainful activity (SGA) have been revised from $500 to $700

Current through Register Vol. 49, No. 6, June, 2024
The pay status code series beginning with "N"s are the denial
				codes on WTPY. A brief description of the .denial code is included on the query
				response.
3322.5
Dual
			 Applications
When an individual applies for both Medicaid and Social
				Security Disability or SSI, and the application with SSA is still pending, the
				county should initiate an MRT determination of disability if the individual
				appears to meet all other eligibility requirements. The Agency will have 90
				days from the date of Medicaid application to make this determination. While an
				MRT decision is pending, the county office worker should check the Social
				Security Disability or SSI status of the applicant 30 days after the Medicaid
				application has been made, and again at certification, if found eligible by
				MRT. If MRT finds that the individual meets the disability requirements and SSA
				has not yet made a decision, the county may certify the case for Medicaid. To
				verify that no SSA decision has been made, the WASM screen will be checked, if
				appropriate, and the individual or authorized representative will be contacted
				by mail or telephone prior to certification.
Additional case action is indicated as follows:
If application for Social Security Disability is approved
				first:
Notify MRT
Approve Medicaid application (if all other requirements have
				been met)
If application for SSI is approved first:
Notify MRT
Deny Medicaid application, except for LTC, which may be
				approved for. facility payment on WNHU (if all other requirements have been
				met)
If SSA determines the applicant is NOT disabled:
Notify MRT
Deny Medicaid application
If the county certifies a case based on an MRT disability
				decision and later learns the individual has been denied by SSA, the Medicaid
				case will be closed after appropriate notice, unless the recipient appeals the
				closure. If the appeal is made within the 10-day time frame, the Medicaid case
				will remain open pending the outcome of the DHS appeals process. In no case,
				will the Medicaid case remain open pending the outcome of the SSA appeals
				process if the recipient has appealed the SSA decision. If an approved Medicaid
				recipient is approved for SSI, the system will automatically convert the
				Medicaid case to an SSI category and no further action will be required of the
				county, except to notify MRT that no future reexamination is required, if
				appropriate.
3323
Procedure for Verification by Medical Review Team
The following procedures will be followed for verification of
				blindness or disability through the Medical Review Team.
3323.1
For Blindness
1. The county office worker will give the
			 applicant or his representative a DCO-701, Report on Eye Examination, for
			 completion by the ophthalmologist or optometrist who is to conduct the eye
			 examination. In addition, a self-addressed envelope with the County Office
			 address will be provided for return of the DCO - 701 after
			 completion.
2. Upon receipt of the
			 completed DCO-701, the county office worker will check it to assure that all
			 items of identifying information are completed. If necessary, the worker will
			 complete the name, address, race, sex, and date of birth blanks on the form
			 before forwarding to MRT; In addition to checking the DCO-701 for completeness,
			 the worker will complete the DCO-108 and attach it to the DCO-701 and forward
			 it to MRT. A notation of the date that the forms are forwarded to. MRT will be
			 made in the case narrative.