County of San Diego Health and Human Services Agency HHSA General Relief Program Guide GRPG Medical Number Page 902501 1 of 2 Revision Date January 2 2018 A Background This section provides the medical verification requirements for the GR Program This section is updated to include the license information for the provider completing medical verification Purpose To provide the medical verification requirements for the GR Program B Policy The GR Program has three components which are Employable Incapacitated and Interim Assistance The Employable component has two subcomponents AbleBodied and Unemployable Presume all individuals to be ablebodied unless verification to the contrary is presented Base the determination of AB or UE status solely upon medical evidence of the customers inability to perform a work project Unless an appointment has been scheduled with a County contracted provider the applicantrecipient is responsible for providing acceptable verification of hisher inability to perform a work project When verification of inability to perform the work project is provided evaluate whether the individual will be aided under the UE or Interim Assistance Program IAP component Individuals aided under the UE or IAP component will not be subject to a work project requirement Note Individuals aided under the Incapacitated Program IP are not required to provide a medical statement proving incapacity Receipt of disabilitybased income is sufficient proof of incapacity C Acceptable Types of Verification Acceptable verification of inability to perform the work project will include the following Completion of a Verification of PhysicalMental Incapacity General Assistance CSF 24 a GR Medical Statement 1145 HHSA a GR Employability Evaluation GREE form 1145G HHSA or other written statement from a physician psychiatrist dentist chiropractor psychologist nurse practitioner physicians assistant or other State licensed medical practitioner which includes o The expected length of inability to perform the work project o The practitioners name address telephone number license number and signature A CSF 24 or 1145 HHSA completed and signed by a County Medical ServicesBehavioral Health Services CMSBHS Case ManagerCare Coordinator for hisher case managed patient A CMSBHS Case ManagerCare Coordinator is a physician nurse social worker clinician or therapist who operates under the direction of a licensed physician psychologist or psychiatrist Court documents which appoint a Conservator or medical records indicating the applicant recipient is a danger to himselfherself or others or is gravely disabled Other medical evidence or written verification including but not limited to recent hospital records statements from health and life insurance companies statements from the State Department of Rehabilitation letters of conservatorship etc These types of verification require approval by the Supervisor and may require additional followup to a GREE provider County of San Diego Health and Human Services Agency HHSA General Relief Program Guide GRPG Medical Number Page 902501 2 of 2 D Questionable or Unacceptable Verification The table below shows how to handle questionable or unacceptable verification If the Then medical verification provided is questionable or unacceptable call the individual who completed the verification to clarify questionable information questionable or inconsistent information cannot be clarified through a call allow the applicantrecipient must choose whether to be aided as ablebodied if otherwise eligible or obtain new medical verification E Expiration of Medical Verification Forms CSF 24 1145 HHSA 1145G HHSA and other medical evidence which indicates a specific date when inability to perform the work project will stop are acceptable through such date or one year from the date signed by the doctor whichever is earlier This includes letters of conservatorship Forms CSF 24 1145 HHSA 1145G HHSA and other medical evidence which indicates that the applicantrecipient is permanently unable to perform the work project are acceptable for one year from the date signed by the doctor Procedure Follow the actions in the policies above to verify the medical status of GR applicantsrecipients Impacts Other Programs Impacted None References County Policy Sunset Date This policy will be reviewed for continuance by January 31 2021 Authorization to Release Rick Wanne Director Eligibility Operations