During the screening interview of a P3 applicant, request medical information. Ask the client to sign a consent to release medical records for each provider or agency to be contacted (See WAG 03-08-01). Issue Form 183A with consent form attached for the applicant to have completed by their source of medical care. Advise the applicant to return the completed form at the eligibility interview.
Advise the applicant that failure to provide medical information will result in denial of assistance.
If the client returns for the eligibility interview with no medical information and states that they are unable to obtain medical documentation without payment, assist the applicant in finding a doctor and scheduling an appointment. Use the Instructions to Physician for Completing Form 183A (Form 654) to confirm the appointment and advise the doctor to submit a bill to the FCRC. The medical provider's bill must contain the appropriate procedure code(s) which identifies the service rendered and/or a clear description of each service provided.
Upon receipt of the medical bill, prepare Form C-13, Invoice Voucher. Enter in the description area the case name, case number, the date the examination was performed, and the notation "CAU Determination." Do not enter the amount of payment authorized. Attach the original copy of the medical bill to Form C-13 and submit to:
Illinois Department of Healthcare and Family Services
Bureau of Claim Processing - Pricing Unit
PO Box 19106
Springfield, IL 61794-9106
If the applicant requests medical transportation to the doctor, authorize payment in accordance with procedures in WAG 20-22-00.
If the client does not cooperate with obtaining medical information, deny the P3 application.
When a completed Form 183A or other medical information is received, complete Form 183B and Client Assessment Unit (CAU) Memorandum (Form 183F). If a detailed medical report is received instead of Form 183A, staple the medical report to Form 183A. Form G of Mail-In Application for Medical Benefits (Form 2378H) may be used in place of Form 183B. Forward Form 183A, Form 183B or Form G, Form 183F, and copies of signed consent(s) to release information, along with any medical reports submitted by the applicant, to:
Client Assessment Unit
PO Box 19492
Springfield, IL 62794-9492
If CAU returns Medical Evaluation - Client Assessment Unit (CAU) Decision (Form 183C) to the FCRC requesting further information, notify the applicant of CAU's request. If the applicant states that they are unable to obtain the information without payment, follow the procedures outlined for the applicant who states at the eligibility interview that they are unable to obtain medical information without payment.
If CAU finds the client disabled, review the status of the client's SSI application. Compare the client's countable monthly income to the appropriate MANG Income Standard. If the client is eligible for P3 MA, approve benefits (see WAG 25-08-02-a). Process the approval using Zero Grant Reason 5.
If CAU finds the client disabled and the client meets all eligibility requirements except their countable income exceeds the MANG Income Standard, change the category to 93 and approve as a 93 spenddown case.
If CAU finds the client "not disabled," or if the client does not meet one of the other nonfinancial requirements, deny the application using the TAR that applies.