reglab/statecodes huggingface dataset:
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.23 - Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) Services › Section 10.09.23.05 - Limitations

Current through Register Vol. 51, No. 14, July 12, 2024
A. Any Program
				  limits on services or treatments identified in this regulation are not
				  applicable for individuals younger than 21 years old if it is shown that the
				  treatments or services are medically necessary to correct or ameliorate
				  identified or suspected health problems.
B. The dental covered services specified in
				  COMAR 10.09.05.04, which follow the
				  periodicity schedule issued by the American Academy of Pediatric Dentists, are
				  limited to two dental examinations per participant per 12-month
				  period.
C. Vision services
				  specified in COMAR
				  10.09.14.04A,
				  including eye examinations and eyeglasses or contact lenses, are limited to not
				  more than once a year.
D.
				  Environmental lead investigations:
(1) Are
				  limited to the child's primary dwelling;
(2) Are limited to one on-site inspection per
				  dwelling; and
(3) Do not include
				  testing of any substances sent to a laboratory for analysis.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.23 - Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) Services › Section 10.09.23.06 - Preauthorization

Current through Register Vol. 51, No. 14, July 12, 2024
Preauthorization is required for:
A. Certain audiology and hearing aid
				  services, as specified in COMAR
				  10.09.51.06A;
B. Certain dental services, as specified in
				  COMAR 10.09.05.06A;
C. Certain vision services, as specified in
				  COMAR 10.09.14.06A;
D. Private duty nursing services, as
				  specified in COMAR
				  10.09.53.06A;
E. Residential treatment services, as
				  specified in COMAR
				  10.09.29.06;
F. Therapeutic behavioral services, as
				  specified in COMAR
				  10.09.34.05; and
G. Intermediate Care Facilities, as specified
				  in COMAR 10.47.02.09 or COMAR
				  10.63.03.13, whichever is
				  applicable.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.23 - Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) Services › Section 10.09.23.08 - Recovery and Reimbursement

Current through Register Vol. 51, No. 14, July 12, 2024
A. Regardless
				  of whether the participant has other third-party insurance coverage, EPSDT
				  screening providers shall bill the Program directly for the following
				  components of an EPSDT screen:
(1)
				  Comprehensive unclothed physical examinations;
(2) Immunizations when the vaccine is not
				  covered by the Vaccines for Children Program;
(3) Vaccine administration; and
(4) Objective screenings for:
(a) Developmental assessment;
(b) Hearing; and
(c) Vision.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.23 - Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) Services › Section 10.09.23.09 - Cause for Suspension or Removal and Imposition of Sanctions

Current through Register Vol. 51, No. 14, July 12, 2024
A. Cause for
				  suspension or removal and impositions of sanctions are as set forth in COMAR
				  10.09.36.08A.
B. If during a quality assessment,
				  the Department staff determines that the provider does not meet the standards
				  established by the Department, the Department may decertify the provider as an
				  EPSDT screening provider.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.23 - Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) Services › Section 10.09.23.10 - Appeal Procedures

Current through Register Vol. 51, No. 14, July 12, 2024
Appeal procedures are as set forth in COMAR
					 10.09.36.09A.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.23 - Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) Services › Section 10.09.23.11 - Interpretive Regulations

Current through Register Vol. 51, No. 14, July 12, 2024
State regulations are interpreted as set forth in COMAR
					 10.09.36.10A.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.23 - Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) Services › Section 10.09.23.12 - Repealed

Current through Register Vol. 51, No. 14, July 12, 2024
Authority: Health-General Article, §§2-104(b),
						15-103, and 15-105, Annotated Code of
						Maryland
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.24 - Medical Assistance Eligibility › Section 10.09.24.01 - Purpose and Scope

Current through Register Vol. 51, No. 14, July 12, 2024
These regulations govern the determination of eligibility
					 for the Maryland Medical Assistance Program. Eligibility may be established for
					 aged, blind, or disabled persons, persons younger than 21 years old and
					 caretaker relatives.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.24 - Medical Assistance Eligibility › Section 10.09.24.02-1 - MAGI Definitions

Current through Register Vol. 51, No. 14, July 12, 2024
A. In this
				  chapter, the following terms have the meanings indicated.
B. Terms Defined.
(1) Affordable Care Act means the Patient
				  Protection and Affordable Care Act of 2010 (Pub.L. 111-148), as amended by
				  the Health Care and Education Reconciliation Act of 2010 (Pub.L. 111-152),
				  as amended by the Three Percent Withholding Repeal and Job Creation Act
				  (Pub.L.
				  112-56).
(2) Authorized Representative has the meaning
				  stated in COMAR 10.01.04.12.
(3)
				  Designee means any entity designated to act on behalf of the Department such
				  as:
(a) Baltimore City or a county social
				  services department under the supervision of the Department of Human
				  Services;
(b) Baltimore City Health
				  Department and its subgrantees, or a county health department; and
(c) The Maryland Health Benefit
				  Exchange.
(4) Insurance
				  Affordability Program means a program that is one of the following:
(i) The Maryland State Medicaid
				  program;
(ii) The Maryland
				  Children's Health Insurance Program (CHIP), including the program known as
				  Maryland Children's Health Program (MCHP) Premium;
(iii) An optional State basic health program
				  established under § 1331 of the Affordable Care Act;
(iv) A program that makes available to
				  qualified individuals coverage in a qualified health plan through the Maryland
				  Health Benefit Exchange with advance payments of the premium tax credit
				  established under §36B of the Internal Revenue Code; and
(v) A program that makes available coverage
				  in a qualified health plan through the Maryland Health Benefit Exchange with
				  cost-sharing reductions established under § 1402 of the Affordable Care
				  Act.
(5) MAGI means
				  modified adjusted gross income, as calculated for purposes of determining
				  eligibility for insurance affordability programs under the Affordable Care
				  Act.
(6) MAGI exempt coverage group
				  means a coverage group as described under Regulation .03 of this chapter whose
				  eligibility is not determined by MAGI or by the Maryland Health Benefit
				  Exchange.
(7) Maryland Health
				  Benefit Exchange means the unit of State government that determines initial and
				  continuing eligibility for the MAGI based insurance affordability programs,
				  including, by delegation, certain eligibility in the program.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.24 - Medical Assistance Eligibility › Section 10.09.24.03 - Coverage Groups

Current through Register Vol. 51, No. 14, July 12, 2024
A. The following
				  individuals, including recipients of Temporary Cash Assistance, may be
				  determined eligible for the MAGI coverage groups:
(1) Parents and other caretaker relatives
				  whose household income is equal to or less than 123 percent of the federal
				  poverty level;
(2) Pregnant and
				  postpartum women of any age whose household income is equal to or less than 250
				  percent of the federal poverty level;
(3) Adults 19 years old or older and younger
				  than 65 years old who are not entitled to or enrolled in Medicare Part A or
				  Part B, whose household income is equal to or less than 133 percent of the
				  federal poverty level, including adults living with dependent children who have
				  provided minimum essential health care coverage for those children;
(4) Children younger than 21 years old and
				  whose household income is equal to or less than 133 percent of the federal
				  poverty level; and
(5) Former
				  Foster Care individuals who:
(a) Are younger
				  than 26 years old;
(b) Are not
				  eligible and enrolled for coverage under a mandatory Medicaid group other than
				  childless adult; and
(c) Were in a
				  Maryland out-of-home placement, including categorical Medicaid:
(i) On attaining age 18 and leaving
				  out-of-home placement, or
(ii) On
				  attaining age 19-21 during extended out-of-home placement under COMAR
				  07.02.11.04B.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.24 - Medical Assistance Eligibility › Section 10.09.24.03-1 - Coverage Group for Women with Breast or Cervical Cancer - Purpose, Definitions, and Eligibility Criteria

Current through Register Vol. 51, No. 14, July 12, 2024
A.
				  Purpose.
(1) The purpose of Regulations .03-1
				  and .03-2 of this chapter is to exercise the State's option under Title XIX of
				  the Social Security Act to create a new Medical Assistance optional
				  categorically needy coverage group for women who need treatment for breast
				  cancer, cervical cancer, or precancerous conditions, in accordance with the
				  Breast and Cervical Cancer Prevention and Treatment Act of 2000 (Public Law
				  106-354).
(2) Coverage under this regulation is subject
				  to the availability of State and federal funds.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.24 - Medical Assistance Eligibility › Section 10.09.24.03-2 - Coverage Group for Women with Breast or Cervical Cancer - Eligibility, Determination, and Covered Services Process

Current through Register Vol. 51, No. 14, July 12, 2024
A. Screening. A woman is considered to have
				  received screening services if the:
(1)
				  NBCCEDP funded all or part of the woman's screening services; or
(2) NBCCEDP did not fund all or part of the
				  woman's screening services, but the screening services were rendered by a
				  provider or entity funded at least in part by the NBCCEDP and the:
(a) Screening services were within the scope
				  of a grant, subgrant, or contract under the State's NBCCEDP; or
(b) NBCCEDP grantee elected to include such
				  screening services by that provider as screening services pursuant to the
				  NBCCEDP.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.24 - Medical Assistance Eligibility › Section 10.09.24.03-3 - Medicare Savings Program Coverage

Current through Register Vol. 51, No. 14, July 12, 2024
A. Non-Financial and Resource Eligibility for
				  the Medicare Savings Programs. In order to be eligible for the Medicare savings
				  program under §§E"H of this regulation, an individual:
(1) May not be enrolled in Medical Assistance
				  or the Maryland Children's Health Program under this chapter or under COMAR
				  10.09.11;
(2) Shall be entitled to
				  hospital insurance benefits under Medicare Part A, or medical insurance
				  benefits under Medicare Part B, or both, with or without payment of
				  premiums;
(3) Shall meet the
				  non-financial eligibility requirements for Medical Assistance under this
				  chapter; and
(4) Shall be part of
				  an assistance unit whose countable resources do not exceed:
(a) For individuals eligible under
				  §§E"G of this regulation, 3 times the maximum amount allowed by the
				  Supplemental Security Income program, as adjusted from time to time by the
				  Social Security Administration, for the number of persons in the assistance
				  unit; or
(b) For individuals
				  eligible under §H of this regulation, 2 times the maximum amount allowed
				  by the Supplemental Security Income program for the number of persons in the
				  assistance unit.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.24 - Medical Assistance Eligibility › Section 10.09.24.03-4 - Medicare Buy-In Coverage for Medical Assistance Recipients

Current through Register Vol. 51, No. 14, July 12, 2024
A. If a recipient,
				  who is determined federally eligible and enrolled in Medical Assistance or the
				  Maryland Children's Health Program according to the requirements of this
				  chapter or COMAR 10.09.11, is entitled to hospital insurance benefits under
				  Medicare Part A, or medical insurance benefits under Medicare Part B, or both,
				  with or without payment of premiums, the Medical Assistance program shall
				  provide the same coverage of Medicare savings program expenses as specified for
				  a Qualified Medicare Beneficiary under Regulation .03-3E of this
				  chapter.
B. A qualified recipient
				  is automatically made eligible by the Department for the Medicare buy-in
				  benefits effective the first day of the:
(1)
				  Second month after the month in which the individual is determined eligible for
				  Medical Assistance or the first day of the third month of Medicare entitlement,
				  whichever date is later, if the individual is eligible in a long-term care or
				  spend down coverage group; or
(2)
				  Month that the individual is eligible for both Medical Assistance and Medicare,
				  if the individual is eligible under COMAR 10.09.24 or COMAR 10.09.11 for
				  Medical Assistance in any coverage groups other than long-term care or spend
				  down.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.24 - Medical Assistance Eligibility › Section 10.09.24.04 - Application - General Requirements

Current through Register Vol. 51, No. 14, July 12, 2024
A. The Department or its designee shall
				  determine initial (retroactive and current) and continuing
				  eligibility.
B. The Department or
				  its designee shall give oral, written, or electronic information about the
				  Medical Assistance Program such as:
(1)
				  Requirements for eligibility;
(2)
				  Available services;
(3) An
				  individual's rights and responsibilities;
(4) Information in plain English, supported
				  by translation services; and
(5)
				  Information accessible to disabled individuals requesting an application.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.24 - Medical Assistance Eligibility › Section 10.09.24.04-1 - Specific Application Requirements for MAGI Exempt Coverage Groups

Current through Register Vol. 51, No. 14, July 12, 2024
A. All of the
				  requirements of Regulation .04 of this chapter shall apply with the exceptions
				  stated in this chapter.
B.
				  Application Filing and Signature Requirements.
(1) An individual who wishes to apply for
				  Medical Assistance shall submit a signed application to the Department or its
				  designee in the jurisdiction where his residence is located.
(2) A deemed newborn is eligible for
				  receiving Medical Assistance if at the time of birth the child's mother was
				  covered in another state as a child under CHIP or under a 1115
				  waiver.
(3) An individual who has
				  filed an application may voluntarily withdraw that application; but the
				  withdrawal may not affect the requirements for the penalty period associated
				  with the transfer of a resource specified under Regulation .08I of this
				  chapter.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.24 - Medical Assistance Eligibility › Section 10.09.24.05 - Nonfinancial Eligibility Requirements - Citizenship

Current through Register Vol. 51, No. 14, July 12, 2024
A. Eligibility. To be eligible for federal
				  coverage of full Medical Assistance benefits, an individual shall be:
(1) A citizen of the United States,
				  including:
(a) An individual who was born in:
(i) One of the 50 states;
(ii) The District of Columbia;
(iii) Puerto Rico;
(iv) Guam;
(v) The Northern Mariana Islands;
				  or
(vi) The Virgin
				  Islands;
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.24 - Medical Assistance Eligibility › Section 10.09.24.05-1 - Documentation of Citizenship and Identity

Current through Register Vol. 51, No. 14, July 12, 2024
A. An applicant or recipient shall be
				  required as a condition of eligibility to provide documentary evidence of
				  identity as well as citizenship or nationality, to the Department's
				  satisfaction, based on federal requirements, if the individual is:
(1) Declared to be a citizen or national of
				  the United States; and
(2) Being
				  determined for:
(a) Initial eligibility based
				  on an application filed on or after September 1, 2006; or
(b) Continuing eligibility based on a
				  redetermination with an end date on or after September 30, 2006.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.24 - Medical Assistance Eligibility › Section 10.09.24.05-2 - Nonfinancial Eligibility Requirements - Emergency Medical Services for Ineligible or Illegal Aliens

Current through Register Vol. 51, No. 14, July 12, 2024
A. An alien
				  shall be eligible for federal Medical Assistance coverage of emergency medical
				  services, as specified under §§B and C of this regulation, if the
				  alien is determined by the Department to:
(1)
				  Have received emergency medical services described under §§B and C of
				  this regulation that are necessary for treatment of an emergency medical
				  condition; and
(2) Meet all other
				  requirements of Medical Assistance eligibility as specified in this chapter,
				  including Maryland residency and financial eligibility, except the requirements
				  related to:
(a) Social Security number;
				  and
(b) Alien eligibility and
				  declaration of immigration status.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.24 - Medical Assistance Eligibility › Section 10.09.24.05-3 - Nonfinancial Eligibility Requirements - Residency

Current through Register Vol. 51, No. 14, July 12, 2024
A. To be eligible for the Maryland Medical
				  Assistance Program, an applicant or recipient shall be a Maryland
				  resident.
B. An individual is a
				  Maryland resident if the individual resides in Maryland with the intent of
				  remaining permanently or for an indefinite period, regardless of whether the
				  individual maintains the residence permanently or at a fixed address.
C. Residency in a state begins on
				  the day that an individual:
(1) Enters the
				  state with the intent to remain permanently or for an indefinite period;
				  or
(2) Decides to remain in the
				  state permanently or for an indefinite period after entering for another
				  purpose.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.24 - Medical Assistance Eligibility › Section 10.09.24.05-4 - Nonfinancial Criteria for MAGI Exempt Coverage Groups

Current through Register Vol. 51, No. 14, July 12, 2024
A. Blindness.
(1) To be eligible for Medical Assistance as
				  a blind individual, an applicant or a recipient shall be blind as defined at
				  Regulation .02 of this chapter.
(2)
				  Procedure for Determination of Blindness.
(a)
				  If an applicant's or recipient's eligibility for Medical Assistance is
				  determined on the basis of blindness, an ophthalmologist or a licensed
				  optometrist shall examine the individual, unless:
(i) Both of the individual's eyes are
				  missing; or
(ii) The Social
				  Security Administration has determined that the individual is currently
				  blind.
(b) The
				  ophthalmologist or licensed optometrist shall submit a report of the
				  examination to the local department of social services or other entity
				  designated by the Department.
(c)
				  An ophthalmologist, contracted by the Department or its designee, shall review
				  the report and determine, on behalf of the local department of social services
				  or other entity designated by the Department:
(i) Whether the individual meets the
				  definition of blindness; and
(ii)
				  The need and frequency of reexamination for periodic redetermination of
				  blindness.
(3) Reexaminations for periodic
				  redeterminations of blindness shall be conducted according to the procedures
				  described under §B(2) of this regulation.
(4) The local department of social services
				  or other entity designated by the Department shall accept the Social Security
				  Administration's determination of blindness for an individual receiving a
				  Social Security benefit based on blindness.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.24 - Medical Assistance Eligibility › Section 10.09.24.06 - Assistance Unit

Current through Register Vol. 51, No. 14, July 12, 2024
A. Purpose and
				  Scope.
(1) This regulation establishes who
				  shall be a member of an assistance unit, who may be excluded from an assistance
				  unit, who will have separate eligibility determinations, and whose income and
				  resources will be considered in determining financial eligibility for
				  applicants and recipients of Medical Assistance.
(2) This regulation applies to:
(a) Children and their caretaker
				  relatives;
(b) Persons younger than
				  21 years old; and
(c) Aged, blind,
				  or disabled persons.
(3)
				  This regulation sets forth the requirements for determining eligibility as
				  aged, blind, or disabled or as families and children.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.24 - Medical Assistance Eligibility › Section 10.09.24.06-1 - MAGI Household Unit

Current through Register Vol. 51, No. 14, July 12, 2024
A.
				  Purpose and Scope.
(1) This regulation
				  establishes who shall be a member of the MAGI household and who will be
				  excluded from the MAGI household.
(2) The regulation applies to applicants and
				  recipients of coverage groups described under Regulation .03A of this
				  chapter.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.24 - Medical Assistance Eligibility › Section 10.09.24.07 - Consideration of Income

Current through Register Vol. 51, No. 14, July 12, 2024
A. This
				  regulation contains the rules for considering earned and unearned income of:
(1) Members of the MAGI household unit and
				  those individuals whose income is considered pursuant to Regulation .06-1 of
				  this chapter in determining financial eligibility of individuals for
				  retroactive and current eligibility for the period under consideration;
				  or
(2) Members of the MAGI exempt
				  assistance unit and those individuals whose income and resources are considered
				  pursuant to Regulation .06 of this chapter in determining financial eligibility
				  of an assistance unit for retroactive and current eligibility for the period
				  under consideration.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.24 - Medical Assistance Eligibility › Section 10.09.24.08-1 - Disposal of Assets for Less Than Fair Market Value

Current through Register Vol. 51, No. 14, July 12, 2024
A. Definitions. In this regulation, the
				  following terms have the meanings indicated:
(1) "Assets" means all income and resources
				  of an individual and of an individual's spouse, including any income or
				  resources which the individual or the individual's spouse is entitled to but
				  does not receive because of action by:
(a)
				  The individual;
(b) The
				  individual's spouse;
(c) A person,
				  including a court or administrative body:
(i)
				  With legal authority to act in place of or on behalf of the individual or the
				  individual's spouse, or
(ii) Acting
				  at the direction or upon the request of the individual or the individual's
				  spouse.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.24 - Medical Assistance Eligibility › Section 10.09.24.08-2 - Treatment of Trust Amounts

Current through Register Vol. 51, No. 14, July 12, 2024
A.
				  For the purpose of this regulation, "trust" has the meaning defined under
				  Regulation .08-1A of this chapter.
B. Treatment of Trusts Established after
				  August 10, 1993.
(1) In determining
				  eligibility for Medical Assistance for any period under consideration beginning
				  on or after October 1, 1993, in the case of trusts established after August 10,
				  1993, an individual shall be considered to have established a trust if assets
				  of the individual as defined under Regulation .08-1A of this chapter were used
				  to form all or part of the corpus of the trust and if any of the following
				  persons established the trust other than by will:
(a) The individual;
(b) The individual's spouse;
(c) A person, including a court or
				  administrative body:
(i) With legal authority
				  to act in place of or on behalf of the individual or the individual's spouse,
				  or
(ii) Acting at the direction or
				  upon the request of the individual or the individual's spouse.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.24 - Medical Assistance Eligibility › Section 10.09.24.08-3 - Resource Consideration of Entrance Fees for Continuing Care Retirement Communities

Current through Register Vol. 51, No. 14, July 12, 2024
A.
				  Treatment of Entrance Fees before January 1, 2006. For Medical Assistance
				  applications or requests for spousal resource assessments filed before January
				  1, 2006, the entrance fee shall be considered in accordance with the policies
				  for exclusion of home property in this chapter.
B. Treatment of Entrance Fees On or After
				  January 1, 2006.
(1) For Medical Assistance
				  applications or requests for spousal resource assessments filed on or after
				  January 1, 2006, an entrance fee shall be considered available to the owner as
				  a countable resource if the CCRC provides written verification, based on CCRC
				  practice or policy, which satisfies the Department that all of the following
				  criteria are met:
(a) The applicant or
				  recipient or a designated beneficiary is eligible for a full refund of any
				  amount remaining in the entrance fee, after subtracting any payments or
				  transfers made by the individual in accordance with §B(1)(c)-(e) of this
				  regulation, when the individual:
(i) Dies;
				  or
(ii) Terminates the continuing
				  care agreement and leaves the CCRC facility;
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.24 - Medical Assistance Eligibility › Section 10.09.24.08-4 - Resource Consideration of Long-Term Care Partnership Policies

Current through Register Vol. 51, No. 14, July 12, 2024
A. This regulation
				  establishes the rules for applicants and recipients who:
(1) Own a long-term care (LTC) partnership
				  policy; and
(2) Meet all factors
				  of Medicaid eligibility in accordance with MAGI Exempt coverage groups
				  described in this chapter.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.24 - Medical Assistance Eligibility › Section 10.09.24.09 - Determining Financial Eligibility for Noninstitutionalized Persons

Current through Register Vol. 51, No. 14, July 12, 2024
A. Basis.
(1) Financial eligibility is determined on
				  the basis of the countable net income and resources of members of the
				  assistance unit and those persons whose income and resource are considered
				  pursuant to Regulations .06, .07, and .08 of this chapter for the period under
				  consideration. For current eligibility under spend-down, a review to identify
				  changes in the unit's financial and nonfinancial eligibility status shall be
				  made before spend-down eligibility is established.
(2) The appropriate medically needy income
				  level shall be the amount specified in Schedule MA-1 for the number of persons
				  whose income is considered in determining financial eligibility.
(3) The appropriate medically needy resource
				  level shall be the amount specified in Schedule MA-2 for the number of persons
				  whose resources are considered in determining financial eligibility.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.24 - Medical Assistance Eligibility › Section 10.09.24.10 - Determining Financial Eligibility for Institutionalized Persons

Current through Register Vol. 51, No. 14, July 12, 2024
A. Scope.
(1) This section applies to persons who are
				  institutionalized throughout a calendar month.
(2) Institutional status is presumed to begin
				  on the first day of the first full calendar month in which the person is
				  institutionalized and ends on the last day of the last full calendar month
				  before discharge.
(3) Institutional
				  status is not interrupted by a transfer from one long-term care facility to
				  another or by a transfer from a long-term-care facility to a
				  hospital.
(4) Presumed
				  institutional status changes on the first day of the month of discharge to the
				  community.
(5) Eligibility for
				  noninstitutionalized persons shall be determined separately under Regulation
				  .09 of this chapter.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.24 - Medical Assistance Eligibility › Section 10.09.24.10-1 - Treatment of Income and Resources of Certain Institutionalized Spouses

Current through Register Vol. 51, No. 14, July 12, 2024
A. Basis.
(1) Except as this regulation specifically
				  provides, the provisions of this regulation may not affect:
(a) The determination of what constitutes
				  income or resources;
(b) The
				  methodology and standards for determining and evaluating income and
				  resources;
(c) The criteria and
				  standards for determining financial and nonfinancial eligibility for Medical
				  Assistance; or
(d) Any other
				  provision of this chapter.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.24 - Medical Assistance Eligibility › Section 10.09.24.10-2 - Substantial Home Equity and Exclusion of Long-Term Care Coverage

Current through Register Vol. 51, No. 14, July 12, 2024
A. Subject to
				  §E of this regulation, an institutionalized individual is not covered by
				  Medical Assistance for long-term care services in a nursing facility, medical
				  institution with a level of care equivalent to a nursing facility, or home and
				  community-based services waiver if:
(1) The
				  individual's equity interest in the individual's home property, reduced by any
				  bona fide, legally binding, documented encumbrances secured by the home,
				  exceeds the amount specified in §D of this regulation; and
(2) The individual does not have, lawfully
				  residing in the home, the individual's spouse or the individual's son or
				  daughter who is:
(a) Younger than 21 years
				  old; or
(b) Blind or disabled as
				  determined under Regulation .05-4 of this chapter.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.24 - Medical Assistance Eligibility › Section 10.09.24.11 - Certification Periods

Current through Register Vol. 51, No. 14, July 12, 2024
A. This
				  regulation specifies the time periods for certifying eligible members of an
				  assistance unit. Certification periods for retroactive and current coverage
				  will be based on consideration periods established in accordance with the
				  provisions of Regulations .09 and .10 of this chapter.
B. Certification of Eligible
				  Noninstitutionalized Persons.
(1) The
				  following eligible noninstitutionalized persons shall be certified for a
				  one-time-only period of 6 months or less and scheduled redetermination for
				  continued eligibility may not be made:
(a)
				  Those who are certified for a retroactive period only, including retroactive
				  spend-down;
(b) Those who are
				  certified under the spend-down provision; and
(c) Those whose anticipated circumstances
				  preclude eligibility beyond the current period.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.24 - Medical Assistance Eligibility › Section 10.09.24.12 - Post-Eligibility Requirements

Current through Register Vol. 51, No. 14, July 12, 2024
A. Notice
				  of Eligibility Determination. The local department of social services shall
				  inform an applicant of his legal rights and obligations and give the applicant
				  written notification of the following:
(1)
				  For eligible persons:
(a) A finding of
				  eligibility, the beginning and ending dates for coverage; and
(b) The right to request a hearing.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.24 - Medical Assistance Eligibility › Section 10.09.24.13 - Hearings

Current through Register Vol. 51, No. 14, July 12, 2024
The procedures for the Program granting a hearing to an
					 applicant or a recipient and the status of benefits pending a hearing are set
					 forth in COMAR 10.01.04.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.24 - Medical Assistance Eligibility › Section 10.09.24.14-1 - Recipient Abuse

Current through Register Vol. 51, No. 14, July 12, 2024
A. Forms of
				  Abuse. Recipient abuse exists when:
(1) A
				  recipient utilizes an inappropriate type of provider for care;
(2) A recipient utilizes an appropriate type
				  of provider at an inappropriate frequency for care;
(3) A recipient utilizes an appropriate
				  provider in an inappropriate manner; or
(4) A recipient utilizes a Medical Assistance
				  card in an inappropriate manner.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.24 - Medical Assistance Eligibility › Section 10.09.24.15 - Liens, Adjustments, and Recoveries

Current through Register Vol. 51, No. 14, July 12, 2024
A. Definitions. In this regulation, the
				  following terms have the meanings indicated:
(1) "Dependent" means a:
(a) Child of the decedent, or the decedent's
				  descendants;
(b) Sibling, including
				  half or step, of the decedent; or
(c) Parent of the decedent, or the decedent's
				  ancestors.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.24 - Medical Assistance Eligibility › Section 10.09.24.16 - Interpretive Regulation

Current through Register Vol. 51, No. 14, July 12, 2024
Except if the language of a specific regulation indicates
					 an intent by the Department to provide reimbursement for covered services to
					 Program recipients without regard to the availability of federal financial
					 participation, State regulations shall be interpreted in conformity with
					 applicable federal statutes and regulations.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.24 - Medical Assistance Eligibility › Section 10.09.24.17 - Information from and Liability of Health Insurance Carriers

Current through Register Vol. 51, No. 14, July 12, 2024
A. A carrier shall:
(1) Provide, at the request of the
				  Department, information about individuals who are eligible for benefits under
				  the Program or are Program recipients so that the Department may determine:
(a) Whether an individual, the spouse of an
				  individual, or the dependent of an individual is receiving health care coverage
				  from a carrier; and
(b) The nature
				  of that coverage;
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.25 - Transportation Services Under the Individuals with Disabilities Education Act (IDEA) › Section 10.09.25.02 - Licensure and Certification

Current through Register Vol. 51, No. 14, July 12, 2024
A.
				  Providers shall meet the requirements of COMAR 13A.06.07.
B. Providers shall meet all the requirements
				  of the jurisdiction in which they operate.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.25 - Transportation Services Under the Individuals with Disabilities Education Act (IDEA) › Section 10.09.25.03 - Conditions for Participation

Current through Register Vol. 51, No. 14, July 12, 2024
Providers shall meet all requirements for participation in
					 the Program stated in COMAR
					 10.09.36.03A and
					 COMAR 13A.06.07.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.25 - Transportation Services Under the Individuals with Disabilities Education Act (IDEA) › Section 10.09.25.04 - Covered Services

Current through Register Vol. 51, No. 14, July 12, 2024
A. The
				  Program covers the services listed in §B of this regulation when the
				  services are provided to a child:
(1) Eligible
				  for services under IDEA;
(2) Who is
				  an eligible Medicaid recipient;
(3)
				  Who was transported to or from a Medicaid-covered service under IDEA;
(4) Whose transportation and Medicaid-covered
				  service or services are included on the child's IEP or IFSP.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.25 - Transportation Services Under the Individuals with Disabilities Education Act (IDEA) › Section 10.09.25.05 - Limitations

Current through Register Vol. 51, No. 14, July 12, 2024
A. To participate
				  in the Program as a provider of transportation services under IDEA, a provider
				  shall be a local education agency, a local lead agency, a State-operated
				  education agency, or State-supported education agency.
B. Providers shall only bill the Program for
				  transportation services on dates when other Medicaid covered services are
				  provided.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.25 - Transportation Services Under the Individuals with Disabilities Education Act (IDEA) › Section 10.09.25.06 - Payment Procedures

Current through Register Vol. 51, No. 14, July 12, 2024
A. Request
				  for Payment.
(1) An enrolled provider shall
				  submit a request for payment of services rendered and completed under this
				  chapter according to procedures established by the Department. The Department
				  reserves the right to return to the provider, before payment, all payment
				  requests not properly prepared or submitted.
(2) The provider shall submit a request for
				  payment in the manner specified by the Department. The completed form shall
				  indicate the:
(a) Date or dates of
				  service;
(b) Participant's name and
				  Medical Assistance number;
(c)
				  Provider's name, location, and provider number; and
(d) Nature, unit or units, and procedure code
				  or codes of covered services provided.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.25 - Transportation Services Under the Individuals with Disabilities Education Act (IDEA) › Section 10.09.25.07 - Recovery and Reimbursement

Current through Register Vol. 51, No. 14, July 12, 2024
Recovery and reimbursement is as set forth in COMAR
					 10.09.36.07A.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.25 - Transportation Services Under the Individuals with Disabilities Education Act (IDEA) › Section 10.09.25.08 - Cause for Suspension or Removal and Imposition of Sanctions

Current through Register Vol. 51, No. 14, July 12, 2024
Cause for suspension or removal and imposition of sanctions
					 is as set forth in COMAR
					 10.09.36.08A.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.25 - Transportation Services Under the Individuals with Disabilities Education Act (IDEA) › Section 10.09.25.09 - Appeal Procedures

Current through Register Vol. 51, No. 14, July 12, 2024
Appeal procedures are those set forth in COMAR
					 10.09.36.09A.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.25 - Transportation Services Under the Individuals with Disabilities Education Act (IDEA) › Section 10.09.25.10 - Interpretive Regulation

Current through Register Vol. 51, No. 14, July 12, 2024
Interpretive regulations are those set forth in COMAR
					 10.09.36.10A.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.26 - Community Based Services for Developmentally Disabled Individuals Pursuant to a 1915(c) Waiver › Section 10.09.26.01 - Definitions

Current through Register Vol. 51, No. 14, July 12, 2024
A. In this chapter,
				  the following terms have the meanings indicated.
B. Terms Defined.
(1) "Alternative living unit" means a
				  residence that:
(a) Provides residential
				  services for individuals who, because of developmental disabilities, require
				  specialized living arrangements;
(b) Admits not more than 3 individuals;
				  and
(c) Provides 10 or more hours
				  of supervision per unit per week.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.26 - Community Based Services for Developmentally Disabled Individuals Pursuant to a 1915(c) Waiver › Section 10.09.26.02 - Licensing Requirements

Current through Register Vol. 51, No. 14, July 12, 2024
A.
				  Providers of residential habilitation services shall be licensed pursuant to
				  COMAR 10.22.03 or 10.22.14.
B.
				  Providers of day habilitation or supported employment services shall be
				  licensed pursuant to COMAR 10.22.12 or 10.22.13.
C. Providers of services coordination
				  services shall be licensed by the Department pursuant to COMAR
				  10.22.09.
D. Providers of
				  residential option services shall be licensed pursuant to COMAR
				  10.22.11.04A.
E. Providers of intensive behavior
				  management shall be:
(1) Licensed by the
				  Department to provide services for developmentally disabled individuals;
				  or
(2) Approved by the DDA as
				  qualified to render services in accordance with COMAR 10.22.10.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.26 - Community Based Services for Developmentally Disabled Individuals Pursuant to a 1915(c) Waiver › Section 10.09.26.03 - Conditions for Participation

Current through Register Vol. 51, No. 14, July 12, 2024
A.
				  General requirements for participation in the Medical Assistance Program are
				  that the providers:
(1) Meet all conditions
				  for participation specified in COMAR 10.09.36, except as otherwise specified in
				  this regulation;
(2) Meet the
				  licensure requirements as provided in Regulation .02 of this chapter;
(3) Have a provider agreement in effect with
				  the Developmental Disabilities Administration and the Medical Assistance
				  Program;
(4) Verify the licenses of
				  all service agencies with whom they contract and have a copy of the same
				  available for inspection;
(5)
				  Verify the licenses and credentials of all professionals whom they employ or
				  with whom they contract and have a copy of same available for
				  inspection;
(6) Maintain a written
				  clinical record for each waiver participant which includes:
(a) A copy of the waiver participant's signed
				  statement indicating the alternatives of care locations offered to him or her,
				  and his or her choice;
(b) Date of:
(i) Discharge from a State residential center
				  or a nursing or chronic care facility into the services covered under this
				  chapter; or
(ii) Diversion from a
				  State residential center or chronic care facility into the services covered
				  under this chapter; and
(7) Have waiver participants reevaluated
				  annually by the interdisciplinary team.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.26 - Community Based Services for Developmentally Disabled Individuals Pursuant to a 1915(c) Waiver › Section 10.09.26.04 - Covered Services for Services Coordination

Current through Register Vol. 51, No. 14, July 12, 2024
The Department shall reimburse for services coordination
					 which shall include the following:
A.
				  Convening the interdisciplinary team and conducting the team meeting for the
				  development and revision of the ISP;
B. Assisting the waiver participant in
				  identifying, negotiating, and obtaining needed services that are agreed upon
				  and specified in the ISP;
C.
				  Arranging, coordinating, and monitoring the delivery of services specified in
				  the ISP;
D. Reassessing or
				  arranging for the periodic reassessment of the waiver participant's needs and
				  services;
E. Participating in the
				  development of the waiver participant's initial IHP;
F. Participating in reviews of the waiver
				  participant's IHP; and
G. Assisting
				  the waiver participant in maximizing the use of the following sources of
				  services and equipment in an effort to achieve the least costly, yet
				  appropriate, delivery of services to the waiver participant:
(1) Services provided at no cost by
				  governmental or charitable agencies, such as the Department of Social Services
				  or the Department of Vocational Rehabilitation,
(2) Services covered by the Program or other
				  third-party payors,
(3) Generic
				  services covered by other programs,
(4) Services that can be paid for with the
				  waiver participant's funds.