INTERVIEW 201 Application And Rev 5 9 17
User Manual: 201 Application and interview rev 5-9-17
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DEPARTMENT OF HUMAN RESOURCES
FAMILY INVESTMENT ADMINISTRATION TEMPORARY DISABILITY
ASSISTANCE PROGRAM MANUAL
APPLICATION AND INTERVIEW Section 201
COMAR
07.03.05.04
Revised May 2017
1
201.1 Interview
A. To qualify for TDAP, an individual must have a face-to-face interview with a case
manager.
B. If the customer is incapacitated or is unable to represent him or herself, the
customer may appoint an authorized representative to assist on his or her behalf.
C. The customer must submit all requested verification needed to determine
eligibility.
D. During the interview the case manager explains and gives to the individual
information or material as described in 201.2 – 201.9 below.
201.2 Medical Evaluation – Medical Report form (DHR/FIA 500)
A. The customer must provide, on the required State form, DHR/FIA 500, medical
findings to support the application for assistance.
B. Case managers must give a DHR/FIA 500 for each of the customer’s treating
providers and explain that a licensed physician, psychiatrist, psychologist,
chiropractor, nurse practitioner, or licensed health practitioner must complete the
form.
C. The local department may:
1. If the applicant does not have Medical Assistance, fill out and sign the top
section of the Purchase Authorization and Invoice, DHR/FIA 312 (Revised
11/14), and give it, along with the DHR/FIA 500, to the applicant to give to
their health care provider, to supply the necessary medical findings to verify
the impairment; and
2. Give the applicant an envelope addressed to the case manager for the
provider to return the DHR/FIA 500 and DHR/FIA 312 forms. The case
manager forwards the 312 form immediately to the finance unit for payment.
D. Individuals who are certified for MA based on age only must provide a DHR/FIA
500 that demonstrates a disability, since age is not
• Such individuals must have a disability that is expected to last for 3 –11
months to meet eligibility for TDAP Type 1, Short Term TDAP, or a disability
that is expected to last for 12 months or more or result in death to meet one of
the eligibility requirements for TDAP Type 2, Long Term TDAP.
considered a disability under
TDAP regulations.
201.3 Purchase Authorization and Invoice form (DHR/FIA 312)
A. Give the customer the DHR/FIA 312 when the customer does not have the
resources to obtain the necessary verification of impairment.
B. Authorize payment to the health care provider completing the DHR/FIA 500.
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DEPARTMENT OF HUMAN RESOURCES
FAMILY INVESTMENT ADMINISTRATION TEMPORARY DISABILITY
ASSISTANCE PROGRAM MANUAL
APPLICATION AND INTERVIEW Section 201
COMAR
07.03.05.04
Revised May 2017
2
201.3 Purchase Authorization and Invoice form (DHR/FIA 312) (continued)
C. Payment may not exceed $60 for an examination that is provided on a completed
DHR/FIA 500, and $40 for testing when test results or other diagnostic evaluation
are provided with the completed DHR/FIA 500, or date provided when results will
be available
(testing includes laboratory work).
201.4 Verification of Application for Social Security benefits
Inform customers with a DHR/FIA 500 indicating they are unable to work and will be
disabled for 12 months or more, or if less than 12 months the disability is expected to
result in death, of the requirement to apply for SSI benefits. Let them know that SSI
benefits are much higher than TDAP and it is to their advantage to apply. Also advise
the customer to cooperate with the federal disability application assistance vendor
when they contact him or her offering to assist with the SSI application.
A. Acceptable verifications include:
1. A receipt from SSA showing the customer filed for SSI,
2. A receipt showing the customer has an appointment to file for SSI benefits, or
3. A pending SSI application date displayed on:
• The State Data Exchange (SDX, Screen 1);
• The State On-Line Query System (SOLQ, Response Screen 5), or
• The State Verification and Exchange System (SVES)
Reminder: Do not
B. If the customer has filed a claim with SSA, SVES or SDX shows an application
filing date, a date indicating when the customer filed an appeal, or whether a
decision is pending.
send customers to SSA unless claim status cannot be verified
by accessing the above systems.
C. SDX or SVES also provides information about the Interim Assistance
Reimbursement or IAR:
• In SDX, check screen 2 for the IAR code,
• In SVES, check screen 6 for the IAR Reimbursement code.
D. Below is a listing for the meaning of the number codes for the IAR and IAR
Reimbursement fields in SDX and SVES:
0 = Essential person record. Applicant did not authorize reimbursement
1 = Total payment amount which is being sent or was sent to a locality. It is not
possible to determine from the data provided which payment was sent to the
locality
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DEPARTMENT OF HUMAN RESOURCES
FAMILY INVESTMENT ADMINISTRATION TEMPORARY DISABILITY
ASSISTANCE PROGRAM MANUAL
APPLICATION AND INTERVIEW Section 201
COMAR
07.03.05.04
Revised May 2017
3
201.4 Verification of Application for Social Security benefits (continued)
2 = Part of the payment amount that is being or was sent to the locality. It is not
possible to determine from the data provided which payment was sent to the
locality
3 = Reimbursement is not being made. Applicant is ineligible, or a retroactive
payment is not due
4 = Reimbursable assistance case is pending or denied
5 = Reimbursable check was returned
Note: When a number from 1 to 5 is entered, do not have the customer sign a
new Interim Assistance Reimbursement form, DHR/FIA 340.
E. When a 0 is entered, complete the DHR/FIA 340, have the customer sign and
date the 340, then:
• Give the Goldenrod copy to the customer,
• Batch the Yellow copy to your LDSS finance office,
• Retain the Pink and White copy in the permanent section of the case
record, and
• Enter the date the customer signed
• Scan the completed IAR 340 form into ECMS.
the 340 form in the IAR date field on the
DEM2 screen.
Note: The 340 form is sent to SSA via a system download. Do not send a
copy to SSA.
201.5 Authorization for Interim Assistance Reimbursement (IAR) DHR/FIA 340 form.
A. For customers with a DHR/FIA 500 indicating a disability of 12 months or more or,
if less than 12 months is expected to result in death, to be eligible for TDAP he or
she must agree to reimburse the State for any TDAP Assistance received.
B. Explain to the customer when determined eligible for SSI benefits, this agreement
authorizes the Commissioner of the Social Security Administration to send to the
State:
• The first retroactive payment of SSI benefits, or
• An amount equal to the amount of reimbursable TDAP benefits the
State paid to the individual.
• Remember, this IAR form is in effect until SSA makes the final SSI
determination. To be sure that the state is reimbursed for the full
amount of TDAP the SSI eligible customer receives, do not complete
another 340 form at redetermination.
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DEPARTMENT OF HUMAN RESOURCES
FAMILY INVESTMENT ADMINISTRATION TEMPORARY DISABILITY
ASSISTANCE PROGRAM MANUAL
APPLICATION AND INTERVIEW Section 201
COMAR
07.03.05.04
Revised May 2017
4
201.6 Federal Disability Benefit Application Assistance Service
1. Customers must cooperate with MAXIMUS, the vendor who provides assistance
to long term disabled (LTD) customers (TCA, PAA and TDAP) with applying for
and obtaining Federal disability benefits.
• MAXIMUS works under a pay-for-performance contract called the Disability
Benefits Advocacy Project to assist FIA’s LTD customers in their pursuit of
Federal disability benefits from the Social Security Administration (SSA). The
project is managed by FIA’s Bureau of Disability Services Operations (BDSO).
2. The contractor screens each customer to determine whether the medical
conditions meet the disability eligibility criteria for Federal benefits. MAXIMUS
provides direct service to customers who need to file claims, to appeal denied
claims and to obtain medical evidence to substantiate their claims.
1) FIA’s Bureau of Disability Operations (BDSO) sends MAXIMUS lists of TDAP
customers who have been coded as LTD in CARES.
2) MAXIMUS reaches out to the customer directly to obtain required information,
screen the medical evidence and provide services.
3) Results from the screenings – including “whereabouts unknown,” “non-
cooperative,” “already receiving federal benefits,” etc. – are reported to BDSO
weekly. Any notes or evidence related to the review findings or actions taken
by the contractor are scanned into ECMS into the State Review Team folder.
4) Monthly, each district office receives a DISABILITY GENERATOR V file in its
PIRAMID folder with the results of the contractor’s reviews and specific actions
to take.
5) Case managers must take the appropriate action. For non-cooperative
customers, close the case using code 566 after 10 days adverse action, for not
cooperating with MAXIMUS.
201.7 SSI/SSDI Outreach, Access, and Recovery (SOAR)
SSI/SSDI Outreach, Access, and Recovery (SOAR) is a federal initiative that expedites
and improves access to Supplemental Security Income (SSI) and Social Security
Disability Insurance (SSDI) for individuals experiencing homelessness or at risk of
homelessness and diagnosed with a mental illness, medical impairment and/or co-
occurring disorder. Although this program is not a FIA-administered program (it is funded
by the federal Substance Abuse and Mental Health Services Administration (SAMHSA),
some community-based organizations in Maryland participate by helping these SSI/SSDI
applicants navigate the complex and difficult application process.
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DEPARTMENT OF HUMAN RESOURCES
FAMILY INVESTMENT ADMINISTRATION TEMPORARY DISABILITY
ASSISTANCE PROGRAM MANUAL
APPLICATION AND INTERVIEW Section 201
COMAR
07.03.05.04
Revised May 2017
5
201.7 SSI/SSDI Outreach, Access, and Recovery (SOAR) (continued)
1. A case manager at a local department of social services (LDSS) will view and
handle an application, interim change or redetermination from someone working
with SOAR as he or she would any request from someone who has a disability
with a few additions:
(a) Ask the TDAP applicant or customer if a community organization is helping
him or her apply for SSI or SSDI.
(b) If the applicant or customer is working with a SOAR case manager at a
community organization, ask him or her to bring in a SOAR Consent for
Release of Information form from the community organization. This form
authorizes SOAR to release information regarding the SSI/SSDI application to
the local department.
(c) Help the customer obtain the form, if it is difficult for him or her to get it.
2. Complete the Interim Assistance Reimbursement (IAR) process as you would for
any applicant who is applying for SSI, having the applicant sign the IAR form if he
or she has not already signed it. The date of the IAR is the date of the TDAP or
PAA application.
3. The SOAR Consent for Release of Information is acceptable proof that SSI was
applied for and that the applicant or recipient is working with a SOAR case
manager until the SSI application can be verified on SVES, SDX or SOLQ.
• As with many systems, updates to Social Security Administration records are not
always immediate.
• When a customer submits a SOAR consent form but there is no record of an
application in the SSA system, the case manager must set a 60-day alert in the
customer’s case as a note to follow-up to ensure the customer has followed
through with SOAR and his or her SSI application is at SSA.
• Do not submit SOAR applicants to the disability assistance program at MAXIMUS.
201.8 Medical Assistance
A. Applicants approved for TDAP who are not yet eligible for MA should be helped
immediately to apply for MA on the Maryland Health Connection.
B. Under the Modified Adjusted Gross Income (MAGI) rules in Medicaid, eligibility is
based on income (under 138% of the Federal Poverty Level) and single adults no
longer must be disabled to receive MA.
C. Recipients can choose a Managed Care Organization (MCO).
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DEPARTMENT OF HUMAN RESOURCES
FAMILY INVESTMENT ADMINISTRATION TEMPORARY DISABILITY
ASSISTANCE PROGRAM MANUAL
APPLICATION AND INTERVIEW Section 201
COMAR
07.03.05.04
Revised May 2017
6
201.9 Rehabilitation Requirements
A. As a condition of eligibility for benefits, the local department may require that the
individual:
1. Participate in appropriate medical treatment as determined by the local
department, consistent with the medical findings on the medical report form
(DHR/FIA 500), or
2. Participate in screening for substance abuse by a certified addictions
specialist to:
a) Determine the need for substance abuse treatment; and
b) If found to be in need of substance abuse treatment to participate in
appropriate treatment when available.
B. Inform the customer that failure to comply with these requirements without good
cause will result in denial or termination of benefits (See Section 700.7).
201.10 Request for Information to Verify Eligibility form (DHR/FIA 1052)
The form is used to list the additional information that is needed to determine the
individual’s eligibility.
A. Explain, complete, review, and give the form to the individual with a date the
additional verification and or information should be returned.
B. Explain the importance of timely return of the required verifications.
201.11 Required Verifications
A. Citizenship status,
B. Social Security number (SSN),
• Use the State Data Exchange (SDX), State Verification Eligibility System
(SVES), or State On-Line Query (SOLQ) to verify the individual’s SSN, or
• When the customer does not have an SSN, have the individual apply for one
and provide a receipt from SSA verifying the application.
C. Resources and/or assets reported by the customer or that become known to the
local department,
D. Social Security application status for long term disabled applicants,
E. Income, including gross income of a spouse or sponsor, and
F. Any information that is unclear or questionable.