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Disability Advocacy Program Requires Information
June 1, 2007

Medical Assistance (MA) Bulletin 99-07-08 was issued May 18 to remind providers of their responsibility to provide health information to Disability Advocacy Program staff when requested. The Disability Advocacy Program was established to assist MA recipients with physical and/or mental impairments to obtain federal disability benefits, such as Supplemental Security Income (SSI) and Social Security Disability Insurance (SSDI). In order to obtain benefits certain clinical information must be provided, such as history of the impairment, reports of clinical and laboratory findings that support the diagnosis and indicate physical or mental changes, prognosis, and a medical assessment describing the ability to do work-related activities. For persons with mental impairments a description of the individual’s ability to reason or make occupational, personal, or social adjustments is needed. Providers must give clinical information to disability advocacy staff as required by 55 PA Code § 1101.51(e):

(e) Record keeping requirements and onsite access. Providers shall retain, for at least 4 years, unless otherwise specified in the provider regulations, medical and fiscal records that fully disclose the nature and extent of the services rendered to MA recipients and that meet the criteria established in this section and additional requirements established in the provider regulations. Providers shall make those records readily available for review and copying by State and Federal officials or their authorized agents. Readily available means that the records shall be made available at the provider’s place of business or, upon written request, shall be forwarded, without charge, to the Department. Providers who are subject to an annual audit shall submit their cost reports within 90 days following the close of their fiscal years. If the Department terminates its written agreement with a provider, the records relating to services rendered up to the effective date of the termination remain subject to the requirements in this section.)

MA recipients who apply for federal disability benefits sign an authorization for release of information form that allows for release of private financial and medical information. Information that should be provided includes psychological evaluations and testing, progress summaries, therapy progress notes, and other relevant information. Providers that do not supply requested information to the Disability Advocacy Program may be subject to sanction. The complete bulletin is available on the Department of Public Welfare web site (www.dpw.state.pa.us/General/Bulletins/003673169.aspx?BulletinDetailId=4069).

PCPA members should contact Betty Simmonds with questions about this bulletin.

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