COMBINED MANUAL ISSUE DATE 08/2008
STATE MEDICAL REVIEW TEAM (SMRT) 0012.15.06
The State Medical Review Team (SMRT) determines disability as required by specific programs. See 0010.18.05 (Verifying Disability/Incapacity - Cash), 0010.18.06 (Verifying Disability/Incapacity - FS), 0012.15 (Incapacity and Disability Determinations), 0012.15.06.03 (SMRT - Specific Program Requirements) for more information on specific program requirements.
Refer cases to SMRT when there has been no disability determination by the Social Security Administration and the disability is expected to last 12 months or longer.
Clients must provide complete vocational histories and medical information. The county agency must help gather the information as needed, and must pay for costs the client incurs for medical examinations and reports necessary to complete the SMRT review using MA administrative account funds. This also applies to the SMRT's requests for additional tests to make a determination of disability.
Complete a State Medical Review Team Determination of Disability (DHS-1467A) for every submission to the SMRT. Attach documentation to support the client's physical, psychological, and/or MR/DD condition.
ALL disability referrals require results from a current physical examination (no more than 3-6 months old) by a licensed physician. Acceptable medical sources are licensed physicians, osteopaths, psychologists, and optometrists. You may use naturopathic and chiropractic exams as well, but ONLY IF submitted with results of an examination from a licensed physician.
A PHYSICAL DISABILITY REFERRAL requires a CURRENT diagnosis supported by objective medical evidence. This evidence includes:
● / Clinical findings (results of a physical examination by a licensed physician).
● / Laboratory findings (such as blood tests, x-rays, EKGs).
● / A diagnosis of the medical and/or psychological condition.
● / Treatment plan with response and prognosis.
● / A statement providing an opinion about what the client can still do despite his or her impairments, based on the medical source's findings on the above factors. This statement should describe, but is not limited to, the client's ability to perform work-related activities, such as sitting, standing, walking, lifting, carrying, handling objects, hearing, speaking, and traveling.
● / For a child, the statement should describe the child's ability to function independently, appropriately, and effectively in an age-appropriate manner.
A PSYCHOLOGICAL DISABILITY REFERRAL requires a complete psychiatric, psychological evaluation (no older than 12 months) by a licensed psychologist or psychiatrist. The evaluation must contain the following:
● / A history of the person's current mental health problem, including important developmental incidents, strengths, and vulnerabilities.
● / The current function and symptoms.
● / A diagnosis including whether or not a person has a serious and persistent mental illness and diagnosis on all 5 axes with GAF scores including AXIS III.
● / Information about required mental health services.
● / Treatment plan, therapy goals, and progress the client is making in therapy.
The psychological evaluation submitted may be up to 12 months old, but if it is more than 3 months old, provide an updated progress note. The progress note must include the following:
● / Medication management.
● / Change in or failure of medications.
People who have a mental condition (either mental illness or mental retardation) as a possible referral basis must provide the SMRT with both a physician's statement describing the current results of a physical exam and a description of their mental impairment(s). If the person has a physical condition that could be the basis of a disability determination, the physician should describe that condition, including current medical findings.
A MENTAL RETARDATION/DEVELOPMENTAL DELAY REFERRAL requires a full scale IQ score, or any other evaluation from a health care professional that assesses mental functioning if the client is unable to be tested.
If the client is deceased, send a discharge summary from the last hospitalization and a death certificate from the Department of Health.
Provide the status of the client's application for SSI/RSDI. If it has been denied, include the denial letter.
Fax or send on DISK in TIFF format, all disability referrals to:
Department of Human Services
Purchase and Delivery Systems
Attn: SMRT
P.O. Box 64984
St. Paul, MN 55164-0984
Fax: 651-431-7461
Clients who do not cooperate in the process cannot use disability as a basis of eligibility. Check for other bases of eligibility. Terminate or deny cases if none exist.
Additional information will be requested via fax if the disability application is incomplete. Incomplete information will delay the SMRT determination.
Retain the original materials submitted to SMRT in your agency's case file pending the outcome of the determination by the SMRT. The SMRT returns a determination by fax to your agency. A SMRT decision is binding on your agency, although clients may appeal. See 0027 (Appeals).