DAP participants include CAO staff, Central Office staff, and the Medical Review Team (MRT).
The DAP Advocate is a CAO caseworker assigned to help a cash assistance, Medicaid, or SNAP eligible recipient in the SSI/SSDI application and appeal process. The advocate provides various social services to help the recipient through this process. He may become involved at any step in the application or appeal process, and may represent a recipient at an Administrative Law Judge (ALJ) hearing.
The CAO eligibility worker identifies recipients who may be disabled and refers them to the DAP advocate.
The Central Office staff consists of the Program Director and DAP field representative. Central Office staff is responsible for statistical reporting on the progress of the DAP program, as well as program development and evaluation.
A Liaison is an individual in a CAO without its own DAP advocate who works with the advocate assigned to that county.
The Medical Review Team (MRT) consists of a physician and a social worker under contract to DHS. The MRT will:
review medical, employment, and social information to determine disability based on SSA regulations; and
provide expert medical advice to the advocate in pursuing SSI/SSDI benefits for recipients.
Other participants in the DAP process include the following:
A recipient of cash, Medicaid, or SNAP. The cash or Medicaid recipient must, as a condition of eligibility for those benefits, cooperate with the CAO and SSA in applying for federal benefits. For DAP purposes, cooperate includes appealing a denial of SSI/SSDI, for medical reasons, at least to the ALJ level. The cash or Medicaid recipient must appeal an initial denial through the ALJ step, unless the DAP worker and/or lawyer determines the recipient does not have a reasonable chance of being determined disabled. A SNAP recipient may receive DAP services, but is not required to pursue benefits.
The Social Security Administration (SSA). SSA takes the initial application for DAP recipients, notifies the DAP advocate if the recipient fails to keep an appointment, and informs the advocate of the initial SSI/SSDI determination, either approved or denied.
The SSA entities involved in the appeal process are:
The Bureau of Disability Determination (BDD). This is an agency of the Pennsylvania Department of Labor and Industry which is under contract with SSA to make disability determinations. BDD is responsible for the medical determination of disability at the initial application.
The Administrative Law Judge (ALJ). This is an SSA official who is also an attorney. The ALJ conducts the first step of the appeal process, a face-to-face hearing.
The Appeals Council. This is a review unit of SSA which reviews the decisions of the ALJ.
The following entities are also involved in the appeal process:
The United States District Court. The US District Court, which reviews the decisions of the Appeals Council, is the last level of the appeal process.
The Office of Mental Health and Substance Abuse (OMHSAS). OMHSAS coordinates services with the DAP advocate to help recipients with mental disabilities in the SSI/SSDI application and appeal process.
The Office of Medical Assistance Programs (OMAP). OMAP reviews requests for prior authorization of services, and inpatient and outpatient hospitalization to identify clients who may be disabled but are not receiving benefits in a disability related category. OMAP provides information to the Central Office staff who forward it to the appropriate CAO.
Reissued September 20, 2006, replacing July 26, 2005; reviewed March 16, 2012