GIS 15 MA/016: LDSS-639 Disability Team Review Certificate and the Care at Home Waivers III, IV and VI
To: All Local District Commissioners, Medicaid Directors, Care at Home Coordinators
From: Gregory Allen, Director, Division of Program Development and Management
Subject:LDSS-639 Disability Team Review Certificate and the Care at Home Waivers III, IV and VI
Effective Date: Immediately
Contact Person: OPWDD - Lynda Baum-Jakubiak - Statewide CAH Coordinator
518-486-6466
Form LDSS-639 "Disability Review Team Certificate" is a required element for admission/continuation in the Care at Home (CAH) III, IV and VI Waiver Programs. The Developmental Disabilities Regional Offices (DDROs), established by the Office for People with Developmental Disabilities (OPWDD), have the overall responsibility for overseeing all necessary steps for the LDSS-639 process. The case management agency and/or the local Department of Social Services are responsible to complete all necessary steps to obtain the initial and subsequent Disability Review Team Certificate (LDSS-639).
The NYS Medicaid Disability Manual can be accessed using the following link: http://www.health.ny.gov/health_care/medicaid/reference/mdm/index.htm
The Care at Home Disability Review Forms are available through CentraPort and can be accessed using the following link: https://ws04.nyenet.state.ny.us. A password is required. Click on "Centraport," double click on "Medicaid" under "Functional Areas," click on "ADMs," etc., click on "Forms," click on "LDSS Forms."
The Local Departments of Social Services (LDSS) are responsible for collecting all necessary information in order for the Disability Review Team (DRT) to conduct a Medical Assistance Disability Review Determination and complete the LDSS-639. The LDSS within New York City (NYC) conduct their own review and render disability determinations
For all other counties, the New York State Department of Health (NYSDOH) DRT performs the disability determination and completes the LDSS-639 disability certificate.
Special Note: The NYS Office of Mental Health (OMH) performs the disability determination and completes the LDSS-639 for clients served by OMH.
Each case record submitted for a disability determination must contain a medical report which contains a diagnosis(es) and sufficient medical and non-medical evidence to make a determination. The disability package must include the revised LDSS-1151 "Disability Questionnaire." For children, portions of this form pertaining to education and work history do not apply.
Documentation from providers and other agencies involved in the child's care are essential.
All progress notes from all treating physicians for the past year
Current evaluations from all involved therapies (Speech, OT, PT, etc
Special Note: The LDSS-486T form, "Medical Report for Determination of Disability" is an adult only form and is NOT used for CAH III, IV and VI Waiver Programs.
The forms listed below solicit the necessary information for the DRT to make a disability determination:
1. "Childhood Medical Report" completed by physician (OHIP 0005)
2. "Questionnaire of School Performance" completed by teacher (OHIP 0006), along with current IEP report
3. "Description of Child's Activities Report" completed by parent/guardian (OHIP 0007)
NYS DOH DRT Disability Determinations: The disability review determinations are sent to the submitting LDSS or OPWDD DDRO. The submitting LDSS or OPWDD DDRO is responsible for sending the disability notification to the family and the case management agency assigned to the child.
Special Note: For approved cases only, the district may send client notice form OHIP-0040, which contains standardized language and the approval dates, in lieu of the actual LDSS-639.
LDSS Disability Determinations: The disability review determinations are sent to the family in a notice. In addition, the completed LDSS-639 form and determination needs to be sent to the DDRO and the case management agency assigned to the child.
Special Note: The DDRO must ensure that all required forms and disability determinations are a part of the child's record.
For children classified as Group II on the LDSS-639, there is an expiration date and it requires a continuing disability review/determination prior to the expiration date listed on the form. All child cases should be a Group II, as disability must be re-determined at age 18 years as an adult, using adult criteria.
Upstate LDSS track the end date for Group II disability through Welfare Management System (WMS) by using an Anticipated Future Action (AFA) code 414 and entering the Group II disability end date in the date field. For New York City an Employability Code 74 is entered into WMS and the Group II disability end date entered into the associated date field.
Four months prior to the end date the WMS system will generate a report that will serve to notify the LDSS to begin the Continuing Disability Review (CDR) process. The DDRO should create and monitor a spreadsheet of expiration dates for those children classified as Group II by the DRT.
Approximately four months prior to the expiration date, the CAH Case Manager should begin to coordinate with the LDSS to facilitate obtaining the necessary documents needed by the DRT (either by the LDSS or the NYSDOH DRT) to issue a current disability determination LDSS-639.
Questions regarding this procedure may be directed to Lynda Baum-Jakubiak, OPWDD Statewide Care at Home Coordinator at 518-486-6466.
