Code of Massachusetts Regulations
106 CMR - DEPARTMENT OF TRANSITIONAL ASSISTANCE
Title 106 CMR 703.000 - Transitional Cash Assistance Programs: Nonfinancial Eligibility
Section 703.192 - EAEDC Medical Standards

1. pain;

2. swelling;

3. tenderness;

4. warmth;

5. redness;

6. stiffness; or

7. limitation of motion; and

1. positive serologic test for rheumatoid factor; or anti-nuclear antibody or HLAB antigen;

2. elevated sedimentation rate;

3. positive joint fluid culture;

4. elevation of white blood count;

5. significant anatomical deformity; or

6. x-ray evidence of significant joint space narrowing or bony destruction.

1. pain and significant limitation of motion in the spine; and

2. appropriate radicular distribution of significant sensory, motor, or flex abnormalities; or

1. significantly diminished exercise tolerance corroborated by results of ETT;

2. significant ischemic changes on resting EKG;

3. EKG evidence of myocardial infarction at some time and symptoms if EKG evidence is more than six months old;

4. development of significant arrhythmia;

5. angiographic evidence (obtained independently) of coronary artery disease; or

6. development of left bundle branch block.

1. symptoms lasted at least 15 days; or

2. substantial work activity is precluded by a physician's orders for at least 90 days.

1. pain;

2. nausea;

3. vomiting;

4. diarrhea;

5. bloody stools; or

6. abdominal distension.

1. abscess or fistula formation;

2. hematocrit of 30% or less;

3. serum albumin of 3.0 g per deciliter (100 ml) or less;

4. serum calcium of 8.0 mg per deciliter;

5. fat in stool of 7.0 m or greater per 24-hour specimen;

6. nitrogen in stool of 3.0 g or greater per 24-hour specimen;

7. evidence of pancreatic dysfunction; or

8. systemic manifestations such as arthritis, iritis, or liver dysfunction not attributable to other causes.

1. bleeding from esophageal varices; or

2. hepatic cell necrosis or inflammation;

3. hepatic encephalopathy.

1. To 20° or less from the point of fixation; or

2. So the widest diameter subtends an angle no greater than 25°; or

3. To 25% or less visual field efficiency; or

1. Activities of daily living including adaptive activities such as cleaning, shopping, cooking, taking public transportation, paying bills, maintaining a residence, caring appropriately for one's grooming and hygiene, using telephones and directories, using a post office, etc. In the context of the individual's overall situation, the quality of these activities is judged by their independence, appropriateness and effectiveness. It is necessary to define the extent to which the individual is capable of initiating and participating in activities independent of supervision or direction.

"Marked" is not the number of activities which are restricted but the overall degree of restriction or combination of restrictions which must be judged.

2. Social functioning refers to an individual's capacity to interact appropriately and communicate effectively with other individuals. "Marked" is not the number of areas in which social functioning is impaired, but the overall degree of interference in a particular area or combination of areas of functioning.

3. Concentration, persistence and pace refer to the ability to sustain focused attention sufficiently long to permit the timely completion of tasks commonly found in work settings. In activities of daily living, concentration may be reflected in terms of ability to complete tasks in everyday household routines. Deficiencies in concentration, persistence and pace are best observed in work and work-like settings. 4. Documentation. The presence of a mental disorder should be documented primarily on the basis of reports from individual providers, such as psychiatrists, and facilities such as hospitals and clinics. Adequate descriptions of functional limitations must be obtained from these or other sources which may include programs and facilities where the individual has been observed over a considerable period of time.

Information from both medical and nonmedical sources may be used to obtain detailed descriptions of the individual's activities of daily living; social functioning; concentration, persistence and pace; or ability to tolerate increased mental demands (stress). This information can be provided by programs such as community mental health centers, day care centers, sheltered workshops, etc. It can also be provided by others, including family members, who have knowledge of the individual's functioning. In some cases descriptions of activities of daily living or social functioning given by individuals or treating sources may be insufficiently detailed and/or may be in conflict with the clinical picture otherwise observed or described in the examination or reports. Evidence may include treatment notes, hospital discharge summaries, and work evaluation or rehabilitation progress notes if these are available. It is necessary to resolve any inconsistencies or gaps that may exist in order to obtain a proper understanding of the individual's functional restrictions.

Some individuals may have attempted to work or may actually have worked during the period of time pertinent to the determination of disability. This may have been an independent attempt at work, or it may have been in conjunction with a community mental health or other sheltered program which may have been of either short or long duration. Information concerning the individual's behavior during any attempt to work and the circumstances surrounding termination of the work effort are particularly useful in determining the individual's ability or inability to function in a work setting.

5. Chronic Mental Impairments. Particular problems are often involved in evaluating mental impairments in individuals who have long histories of repeated hospitalizations or prolonged outpatient care with supportive therapy and medication. Individuals with chronic psychotic disorders commonly have their lives structured in such a way to minimize stress and reduce their signs and symptoms. Such individuals may be much more impaired for work than their signs and symptoms would indicate. The results of a single examination may not adequately describe these individuals' sustained ability to function. It is therefore, vital to include all pertinent and available information relative to the individual's condition, especially at times of increased stress.

6. Effect of Medication. Attention must be given to the effect of medication on the individual's signs, symptoms and ability to function. While psychotropic medications may control certain primary manifestations of a mental disorder, e.g., hallucinations, such treatment may or may not affect the functional limitations imposed by the mental disorder. In such cases where overt symptomatology is attenuated by the psychotropic medications, particular attention should be included on the functional restrictions which may persist. These functional restrictions are important for the measure of impairment severity.

Neuroleptics, the medicines used in the treatment of some mental illnesses, may cause drowsiness, blunted effect, or other side effects involving other body systems. Such side effects must be considered in evaluating overall impairment severity. Where adverse effects of medications contribute to the impairment severity and the impairment does not meet the listings but is nonetheless severe, such adverse effects must be considered in the assessment of the disability.

7. Effect of Treatment. It must be remembered that with adequate treatment some individuals suffering with chronic mental disorders not only have their symptoms and signs ameliorated but also return to a level of function close to that of their premorbid status.

1. disorientation to time and place;

2. substantial memory loss impairment;

3. perceptual or thinking disturbances (e.g., hallucinations, delusions);

4. change in personality;

5. disturbance in mood;

6 emotional liability (e.g., explosive temper outbursts, sudden crying, etc.) and impairment in impulse control; or

7. loss of measured intellectual ability of at least 15 I.Q. points from premorbid levels or overall impairment index clearly within the moderately to severely impaired range on neuropsychological testing, e.g., the Luria-Nebraska, Halstead-Reitan, etc.; and

1. marked restriction of activities of daily living;

2. marked difficulties in maintaining social functioning;

3. deficiencies of concentration, persistence or pace resulting in frequent failure to complete tasks in a timely manner (in work settings or elsewhere); or

4. repeated episodes of deterioration or decompensation in work or work-like settings which cause the individual to withdraw from that situation or to experience exacerbation of signs and symptoms (which may include deterioration of adaptive behaviors).

1. delusions or hallucinations;

2. catatonic or other grossly disorganized behavior;

3. incoherence, loosening of associations, illogical thinking, or poverty of content of speech if associated with one of the following:

4. emotional withdrawal and/or isolation; and

1. marked restriction of activities of daily living; or

2. marked difficulties in maintaining social functioning; or

3. deficiencies of concentration, persistence or pace resulting in frequent failure to complete tasks in a timely manner (in work settings or elsewhere); or

4. repeated episodes of deterioration or decompensation in work or work-like settings which cause the individual to withdraw from that situation or to experience exacerbation of signs and symptoms (which may include deterioration of adaptive behaviors); or

1. repeated episodes of deterioration or decompensation in situations which cause the individual to withdraw from the situation or to experience exacerbation of signs or symptoms (which may include deterioration of adaptive behaviors); or

2. documented current history of two or more years inability to function outside of a highly supportive living situation.

1. depressive syndrome characterized by at least three of the following:

2. Manic syndrome characterized by at least two of the following:

3. Bipolar syndrome with a history of episodic periods manifested by the full symptomatic picture of both manic and depressive syndromes (and currently characterized by either or both syndromes); and

1. marked restriction of activities of daily living;

2. marked difficulties in maintaining social functioning;

3. deficiencies of concentration, persistence or pace resulting in frequent failure to complete tasks in a timely manner (in working settings or elsewhere); or

4. repeated episodes of deterioration or decompensation in work or work-like settings which cause the individual to withdraw from that situation or to experience exacerbation of signs and symptoms (which may include deterioration of adaptive behaviors).

1. marked restriction of activities of daily living;

2. marked difficulties in maintaining social functioning;

3. deficiencies of concentration, persistence or pace resulting in frequent failure to complete tasks in a timely manner (in work settings or elsewhere); or

4. repeated episodes of deterioration or decompensation in work or work-like settings which cause the individual to withdraw from that situation or to experience exacerbation of signs and symptoms (which may include deterioration or adaptive behaviors).

1. generalized persistent anxiety accompanied by two out of four of the following signs or symptoms:

2. a persistent irrational fear of a specific object, activity, or situation;

3. recurrent severe panic attacks manifested by a sudden unpredictable onset of intense apprehension, fear, terror and sense of impending doom occurring on the average of at least once a week;

4. recurrent obsessions or compulsions which are a source of marked distress; or

5. recurrent and intrusive recollections of a traumatic experience, which are a source of marked distress; and

1. marked restriction of activities of daily living;

2. marked difficulties in maintain social functioning;

3. deficiencies of concentration, persistence or pace resulting in frequent failure to complete tasks in a timely manner (in work settings or elsewhere); or

4. repeated episodes of deterioration or decompensation in work or work-like settings which cause the individual to withdraw from that situation or to experience exacerbation of signs and symptoms (which may include deterioration of adaptive behaviors); or

1. a history of multiple physical symptoms of several years duration, beginning before age 30, that have caused the individual to take medicine frequently, see a physician often and alter life patterns significantly;

2. persistent nonorganic disturbance of one of the following:

3. Unrealistic interpretation of physical signs or sensations associated with the preoccupation or belief that one has a serious disease or injury; and

1. marked restriction of activities of daily living;

2. marked difficulties in maintaining social functioning;

3. deficiencies of concentration, persistence or pace resulting in frequent failure to complete tasks in a timely manner (in work settings or elsewhere); or

4. repeated episodes of deterioration or decompensation on work or work-like settings which cause the individual to withdraw from that situation or to experience exacerbation of signs and symptoms (which may include deterioration of adaptive behavior).

1. seclusiveness or autistic thinking;

2. pathologically inappropriate suspiciousness or hostility;

3. oddities of thought, perception, speech and behavior;

4. persistent disturbances of mood or affect;

5. pathological dependence, passivity, or aggressivity; or

6. intense and unstable interpersonal relationships and impulsive and damaging behavior; and

1. marked restriction of activities of daily living;

2. marked difficulties in maintaining social functioning;

3. deficiencies of concentration, persistence or pace resulting in frequent failure to complete tasks in a timely manner (in work settings or elsewhere); or

4. repeated episodes of deterioration or decompensation in work or work-like settings which cause the individual to withdraw from that situation or to experience exacerbation of signs and symptoms (which may include deterioration of adaptive behavior).

1. Anal Squamous Cell Carcinoma;

2. Invasive Carcinoma of Cervix FIGO stage II or more;

3. Nocardiosis;

4. Non-Hodgkins Lymphoma; or

5. Strongyloidiasis, extra-intestinal.

1. Anemia (Hematocrit value less than 30%);

2. Granulocytopenia (absolute neutrophil count less than or equal to 1000/mm3);

3. Thrombocytopenia (platelet count less than or equal to 40,000/mm3);

4. Documented Fever (daily greater than or equal to 100.4°F or 38°C);

5. Undesired Weight loss greater than or equal to 10% of baseline;

6. Oral Recurrent Candidiasis;

7. Oral hairy leukoplakia;

8. Recurrent Herpes Zoster;

9. Persistent, Unresponsive Diarrhea;

10. Mucosal (including vulvovaginal candidiasis other than listed in 106 CMR 703.192(M)(1)(a) or new added vulvovaginal conditions);

11. Persistent dermatological conditions such as Eczema or psoriasis; or

12. Persistent or recurrent radiographically documented Sinusitis; and