Forms

There are several forms used by SMRT. The SMRT Authorization to Release Protected Health Information (DHS-6124) is requested for all cases. You will receive a letter with the forms that are needed for your case. People who provide SMRT with timely, accurate and complete information can help the timely processing of their request for a disability determination.

Forms for all ages

Forms for adults (18 and older)

Forms for children (under age 18)

Policies

Continuing disability review

At the end of the certification period, SMRT may complete a continuing disability review (CDR). Following SSA criteria, SMRT collects and reviews current medical evidence to determine if the severity of the person’s impairment has gotten better since the last review. Your county or Tribal Nation sends the CDR referral to SMRT when the end of the certification period is getting close.

Social Security Administration (SSA) decision impact on SMRT determinations

SMRT must follow SSA final medical decisions. SMRT can only make a separate decision if there is new medical information or a new condition that SSA has not considered. An SSA final medical decision overrides a previous SMRT certification, even if there is a certification with SMRT in place when the final medical decision is issued by SSA. A SSA denial is considered final if a person does not appeal the decision or until an adverse ruling is issued by a SSA administrative law judge (ALJ).

Age 18 redetermination

A new SMRT determination must be made when a person turns 18 years old. This is because disability criteria changes at age 18.

SMRT criteria to expedite disability determination

SMRT may be able to quickly process (“expedite”) disability determinations in certain situations. Applicants and enrollees in the following high-risk categories may qualify for an expedited disability determination if they are:

• in a facility and cannot be discharged without Home and Community-Based Services or long-term care supports in place;
• experiencing a life-threatening medical condition requiring urgent access to treatment or prescription medication;
• diagnosed with a condition listed on the Social Security Administration's Compassionate Allowance List;
• children under the age of two who have screened positive for a rare disease recognized by national medical registries or evidence-based standards.

SMRT is unable to process requests for an expedited determination if SMRT forms are not on file. A welcome packet with required forms gets sent when a referral is submitted. See the Forms section if you need another copy of a form.

For providers

Each person who requests a disability determination is responsible for providing medical evidence showing they have an impairment(s) and the severity of the impairment(s). With authorization, SMRT will help get medical evidence from medical professionals who have evaluated, examined or treated a person for their impairments. SMRT also requests copies of medical evidence from hospitals, clinics or other health facilities when necessary.

Minnesota Statutes establishes certain requirements for health care providers in relation to SMRT:

• Minnesota Statutes, 256.01, subd. 29 (b) requires Medical Assistance providers to grant SMRT access to electronic health records held by the providers, when available, to support efficient and accurate disability determinations.
• Minnesota Statutes, 256.01 subd. 29 (c) requires Medical Assistance providers to accept electronically signed authorizations to release medical records provided by the SMRT.

Minnesota Statute establishes expedited disability determination criteria for SMRT and requirements for hospitals to follow when an expedited disability determination is requested:

• Minnesota Statutes, 256.01, subd. 29a (a) establishes an expedited disability determination process for applicants in certain high-risk categories.
• Minnesota Statutes, 256.01, subd. 29a (b and d) requires:
  • Hospitals requesting an expedited disability determination to help submit an application for medical assistance before the expedited request is made. They must help applicants with returning required documents needed for a disability determination.
  • Hospitals requesting an expedited review for an applicant must comply with Minnesota Statutes, 256.01, subd. 29. If electronic health records are not available, the provider must coordinate with SMRT to obtain the medical records needed for the disability determination.

Providers can submit records to SMRT using the secure upload portal if providers do not have electronic health records.

SMRT Upload Portal:

SMRT fax: 651-431-7457

For Medicaid disability program information: Minnesota Health Care Programs Eligibility Policy Manual 2.3.2.2 Certification of Disability.

How to get help with your MnCHOICES assessment (DHS-7283) (PDF)

More information about how to request a MnCHOICES assessment

Learn about current Social Security Administration information at the SSA.gov Communications Corner