209.01 Verification: APTD (AAM)

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Verify disability at the initial eligibility determination and verify the Disability Determination Unit (DDU) approval still exists at redeterminations.

For APTD financial determinations, send the following forms when forwarding the request to DDU:

•       DDU Form 177, Non-Medical Evaluation of Disability, completed by the individual or authorized representative;

•       DDU Form 915, Medical Evaluation Initial, completed by a licensed physician or doctor of osteopathy, if DDU has provided this form as part of a review; and

•       a separate DDU Form 900, Authorization for Release of Protected Health Information, for each provider/facility listed on DDU Form 177. As well as a DDU Form 900 for SSA.

Additional verification may include any of the following:

•       medical records, provided they are no older than 2 years;

•       any additional material which may bear on the decision; or

•       supplemental information requested by DDU such as additional evaluations, consultations, or second opinions.

Note:  A completed BFA Form 770, Reimbursement Agreement and Acknowledgment, (including all required signatures, dates, and notarized) must be received prior to financial assistance being approved.

References: He-W 601.01; He-W 642.03; RSA 167:6,VI; RSA 167:28