PM 03-08-01

The Client Assessment Unit (CAU) completes disability determinations for:

  • persons who do not receive SSA, SSI, or Railroad Disability, and
  • AABD Cash applicants under age 65 who have been denied SSI due to income and for whom SSA did not make a disability determination.

Obtain a CAU determination as follows:

  1. (FCRC) Complete Medical Evaluation - Social Information (Form 183B) based on the client's statements, worker's observation, and other available information. new textA completed Form G, attachment to the Mail-In Application for Medical Benefits (Form 2378H), may be used in place of Form 183B.
  2. (FCRC) Request medical information to support the disability claim.
    1. Identify the medical providers the person has used in the past 12 months. Complete the top section on page 1 of Medical Evaluation - Physician's Report (Form 183A); use a separate Form 183A for each provider. If the client has medical reports from the provider, attach the reports. If the client does not have medical reports from a provider, ask the client or person legally responsible for the client to sign a Consent to Release Medical Records (Form 4701H) for each provider. Make a copy of the consent form for the case record. Send Form 183A and Form 4701H to each provider.
    2. If the client was treated at a Veteran's Administration facility, also ask the client to sign Request to Veteran's Administration (Form 1301). Check the box to specify that Medical Data is being requested. Attach Form 1301 to Form 4701H and send to the VA.
    3. If the client was recently incarcerated in an Illinois Department of Corrections facility, also ask the client to sign one or both DOC release of information forms, as needed. For medical information, use Authorization for Release of Offender Medical Health Information (Form DOC 0241). For mental health or substance abuse treatment information, you must use Authorization for Release of Offender Mental Health or Substance Abuse Treatment Information (Form DOC 0240). Specify the type of information being requested. Attach Form DOC 0240 and/or Form DOC 0241 to Form 4701H and send to DOC.
    4. If the client has not received treatment within the past 3 months, set up an appointment for a medical examination with the person's physician or physician of their choice who is an approved Medicaid provider. If the client has mental health issues, set it up with an approved Medicaid psychiatrist. Go to step 4a.

      Example: Ms. A applies for AABD(D) and is interviewed on 06/01. Her last visit to a doctor was on 01/15. Since she has not received treatment within the last 3 months, set up an appointment for Ms. A with her physician. 

  3. (FCRC) If the medical information has not been received within 30 days from the date the forms were sent to the provider, contact the provider to determine the status of the request.
  4. (FCRC) If the information is not received within 45 days from the date the forms were sent to the provider, set up an appointment for a medical examination with the person's physician or physician of their choice who is an approved Medicaid provider. If the client has mental health issues, set it up with an approved Medicaid psychiatrist.

    Example: Mr. B applies for AABD(D) and is interviewed on 06/15. He was seen by his physician on 06/01. The caseworker completes the top section of Form 183A; Mr. B signs Form 4701H. The forms are sent to Mr. B's physician.

    On 07/31, the forms have not been returned. Set up an appointment for Mr. B with his physician. 

    1. Complete Referral for Medical Examination (Form 1864) in triplicate. Give or send the original and first copy to the client to be given to the medical provider. Attach Form 183A, a copy of signed Form 4701H, and Instructions to Physician for Completing Form 183A (Form 654). File the 2nd copy of Form 1864 in the case record.
    2. Set a control to follow up after the appointment.
    3. If the client misses the appointment without good cause, deny the application or cancel the case for failure to provide verification (TA05/TAR 40 for denial; TA 22/TAR 88 for cancellation). No additional action is needed.
    4. If the client misses the appointment and claims good cause, help them reschedule it.
    5. If the client keeps the appointment, wait for the provider's report.
  5. (Provider) Completes a medical exam and enters the findings on Form 183A. If client was referred by Form 1864, keeps the first copy of Form 1864 for the provider's records.
  6. (Provider) Returns the completed Form 183A to the sending office. If client was referred by Form 1864, also returns the original Form 1864 and completed Health Insurance Claims Form (Form 2360).
  7. (FCRC) When the medical information is received, complete Invoice Voucher (Form C-13) to pay the provider (see step 14). .
  8. When the medical information is received, check SOLQ.
    1. If SSA has determined the client disabled, a CAU decision is not needed. Take appropriate case action.
    2. If there has not been a favorable SSA decision, complete Client Assessment Unit (CAU) Memorandum (Form 183F) requesting the appropriate determination. If a CAU decision is being made for a child based on the SSA disability standards in effect before 08/22/96, write SSI CHILD in red on the top of Form 183F.
  9. (FCRC) Prepare a packet with Form 183F, Form(s) 183A and related medical records, Form 183B, Form(s) 4701H, and all medical information from previous CAU determinations. new textForm G of Application for Medical Benefits (Form 2378H) may be used in place of Form 183B. Make and keep a copy of the packet. Mail the original packet to:

    Client Assessment Unit
    PO Box 19492
    Springfield, IL 62794-9492

    If a decision is urgently needed, call CAU at (217) 524-8190 for permission to fax the packet. CAU

  10. (CAU) Completes Form 183C showing:
    • the decision regarding the applicant's disability or a request for more information, and
    • if approved, a medical review date, when needed.
  11. (FCRC) Returns the entire packet with Form 183C to the FCRC.
  12. (FCRC) When CAU requests more information, attempt to obtain it. Set up additional appointments or request test results, as needed. Resubmit the entire packet to CAU with the additional information. (See steps 2 - 8.)
    1. If the client does not provide the required additional information, do not resubmit the packet to CAU. Deny or cancel for failure to provide verification (TA 05/TAR 40 for denial; TA 22/TAR 88 for cancellation).
  13. (FCRC) When CAU makes a decision, take appropriate case action. If the CAU approval provides a medical review date, enter code 156 DRD in Item 80 on Form 552 with the 4-digit month and year of review under PERSONS or enter the review date in AIS or VCM where requested.
  14. (FCRC) When Form 1864 and/or Form 2360 are received with Form 183A or copies of medical records, complete Invoice-Voucher (Form C-13). Enter the client's name, case number, and a statement that the exam or records were needed to determine AABD Cash or Medical eligibility due to disability. Leave the payment amount and signature areas blank.
  15. (FCRC) Attach Form 1864 and/or Form 2360 to the Form C-13 and send to:

    Healthcare and Family Services
    Bureau of Claims Processing - Pricing Unit
    PO Box 19106
    Springfield, IL 62794-9106 

  16. (HFS) Handles pricing and payment to the provider.