Expanding Foundations LongTerm Care Disability Disability Expanding Foundations

Expanding Foundations: Long-Term Care Disability

Disability Expanding Foundations: Non-MAGI

Disability 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

Disability Definition Medically Determinable Impairment, Lasting 12 months or more, Adults Children Resulting in an Inability to perform substantial gainful activity Resulting in multiple ‘markedly’ or at least one ‘severely’ limited functional domain

Disability Criteria ▪ Age 65+ ▪ SSA Determination ▪ State Contractor Determination

Disability Determination Process If there is no disability determination from SSA and the customer is under 65: ▪ Complete Disability application and Medical Release Forms ▪ State Disability Contractor will make determination

Title XVI

SDX/Bendex

Title II

Disability Application

Comments Page

Release Form

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. c om � Phone number: (877) 265 -1864 � Fax number: (877) 672 -2077

Determination Notice

Disability Criteria Full vs. Limited Disability Full Disability (All programs) Limited Disability (WAw. D) Meets the SSA disability criteria without consideration of substantial gainful activity All LTC waivers WAw. D clients: CMHS and EBD waivers only

Full or Limited FULL Limited

Data Entry Info

Disability Data Entry

Medical Conditions Screen

Disability Determination VCL CBMS will mail the disability app for you when a VCL is generated!

Once Received, send to ARG immediately

ARG Approval 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.

Data Entry Practice Let’s enter the ARG approval

ARG Decision Data Entry

Disability Wrap-up Goal: To gain further understanding of Disability, and the associated business processes to meet this requirement Re-visit Objectives: After this module you can: ▪ 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