DHS Introduces the “Physician Certification for Child with Special Needs” Form

Last month, DHS announced it will immediately begin using a new form entitled the Physician Certification for Child with Special Needs (PA 1960). County Assistance Office (CAO) caseworkers will use this form to verify disability or special health care needs in children applying for or renewing Medical Assistance (MA) coverage.  

Previously, when a child applied for MA and indicated a disability or special health care need, the CAO would request disability verification forms geared towards verifying disability in adults.  The new form makes it possible for doctors to verify a child’s health conditions and/or disability in a way that is geared towards the unique needs of children.  Specifically, the new form states that a disability in a child under 18 is defined as “[a] medically determinable physical or mental impairment, which results in marked and severe functional limitations and which can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less than 12 months.”   

The new PA 1960 form must be completed by a licensed physician, psychologist, or medical professional. The completed form must list the child’s diagnoses, ICD-10 code(s) and description(s), expected duration of any temporarily disability or diagnosis, and specifics about the child’s functional limitations and their impact. If the CAO finds that a child’s disability is indicated on the PA 1960, the CAO will authorize presumptive MA, refer the child to the Social Security Administration (SSA) or the Medical Review Team (DHS), and follow up with requests for additional medical documentation where appropriate.