Human Services

Arc Guide to State Medical Review Team (SMRT)

The State Medical Review Team (SMRT) is a group of medical professionals and staff at the Minnesota Department of Human Services (DHS) who complete disability determinations for healthcare eligibility for Medical Assistance (MA). The SMRT uses the Social Security Administration’s disability criteria to certify disabilities. These certifications last from one to seven years, based on an individual’s age and diagnosis. There are three disability categories that SMRT certifies: developmental disabilities, physical disabilities and mental health.

 

A SMRT disability certification is required when:

  • applicants are seeking specific county services and programs that require disability certification, or;
  • applicants are applying for disability-based MA (MA-TEFRA) for a child under age 19, or;
  • applicants are applying for MA for Employed Persons with Disabilities (MA-EPD), or;
  • applicants are applying to be excluded from Managed Care MA

 

How Social Security and the SMRT process impact each other

  • While SMRT uses the same disability certification criteria as the Social Security Administration (SSA), SMRT disability certifications do not establish eligibility for federal Social Security benefits.
  • If applicants have already been certified disabled by SSA, they do not need to go through the SMRT process. These individuals apply for MA using the DHS 3876 “Application for Certain Populations” and provide a copy of their Social Security award letter.
  • Applicants who go through the SMRT process may be required to apply for Social Security benefits if they appear to be eligible for them.

 

SMRT Determination Process

  1. Applicants submit initial MA applications to their county indicating that they have a disability.
  2. The county financial unit processes the application, reviews initial eligibility for a MA healthcare program and completes the “Referral for Disability Determination” form before submitting it to SMRT
  3. Applicants receive a SMRT “welcome letter” in the mail acknowledging the referral. The mailing also consists of:
  4. The Children’s or Adult Disability Worksheet
  5. Release of information form to allow SMRT to collect medical and educational records on behalf of the applicant
  6. The applicant’s unique Person Master Index (PMI) number, which is also called an MA number.
  7. Applicants complete and return both forms to SMRT with the PMI number written on each.
  8. An assigned SMRT case manager contacts the applicant by letter or phone and requests any required documentation (see list below). SMRT case manager may request documents directly from medical providers or a school district. They may also work with applicants to schedule assessments or evaluations as needed for the disability certification.
  9. Applicants receive a disability certification letter in the mail with SMRT’s decision and length of certification. The county also receives notification of the decision.
  10. If certified disabled:
  11. Applicants should follow up with county financial worker or team to confirm. County opens MA case.
  12. Applicants receive a Minnesota Health Care Programs Member ID card and county approval notice in the mail within a few weeks.
  13. If not certified disabled:
  14. Applicants may appeal the decision following the information listed on the SMRT denial notice. Applicants may contact The Arc Minnesota for more information about their rights, important timelines and the appeal process.

 

Please note: the SMRT process can take at least 3 months from the date the SMRT receives the county referral.

 

SMRT documentation required for Developmental Disabilities based on age

  • Completed & signed Children’s or Adult Disability Worksheet
  • Completed & signed Authorization to Release Protected Health Information form
  • Most recent Individualized Education Plan (IEP) or Individual Family Service Plan (IFSP) if in school
  • Most recent Evaluation Summary Report from the school district if in school
  • Results of a physical exam no more than 3 months old performed by a medical doctor
  • Reports, assessments or evaluations from any consulting medical specialists, therapists or psychologists
  • For children enrolled in a full time Applied Behavior Analysis (ABA) therapy program: current Individual Treatment Plan (ITP) and any updated progress notes

Recertification

SMRT disability recertification is required for ongoing disability-based MA healthcare eligibility. About a month before the disability certification is set to expire, the county completes the “Referral for Disability Determination” form and sends it to the SMRT. Applicants follow the process listed above (starting with step 3). If the SMRT recertifies the disability, the individual continues eligibility for the MA program through the end of the new certification period. If SMRT does not recertify, the county is required to check for other possible bases of eligibility for MA before closing coverage.

 

Additional information

Expedited SMRT reviews may only be requested by the county in the following situations:

  • For disabilities included on SSA’s “Compassionate Allowance List”. This list includes disabilities so severe that SSA will quickly certify the disability
  • For someone who is awaiting discharge from a facility (like a nursing home or hospital)
  • For potentially life threatening situations (where lack of treatment/medication could result in harm or death)

 

Tips

  • Provide detailed information when completing the Children’s or Adult Disability Worksheet. Remember that SMRT does not get to meet the person with the disability and makes their decision from the paperwork submitted to them.
  • Provide additional information in a separate letter and attach to the worksheet. Consider writing about a tough day and highlighting how the person’s disability/needs impact them and family members.
  • Notify the SMRT case manager about any scheduled appointments or upcoming testing related to the applicant’s disability or diagnosis.
  • Start gathering documentation from within the past year. Sending the most recent information is preferred by the SMRT.
  • Waiting periods can be reduced by providing the SMRT with all required documents (listed above) within a few weeks of receiving the welcome letter. If the SMRT case manager has to request disability documentation or arrange for evaluations, the wait time will increase.
  • Write the applicant’s PMI number on the front page of each document sent to the SMRT. Do not send originals to the SMRT, only send copies.

 

SMRT Contact Information Phone: (651) 431-2493

Fax: (651) 431-7457

Mailing Address:

Minnesota Department of Human Services State Medical Review Team

P.O. Box 64248

Saint Paul, MN 55164-0248

 

For further information or advocacy services, contact The Arc Minnesota at 952-920-0855 or toll-free at 833.450.1494 or visit www.arcminnesota.org. (Please note: This document is not legal advice, and should not be construed as such. Thus, no information herein should replace the sound advice of an attorney.)

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