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State of Maryland Medical Assistance Manual Revised April 2014

• For medically needy and other MA recipients who are not automatically eligible, their MA eligibility must be terminated with timely notice. MCO-enrolled recipients requiring specialty mental health services (e.g. IMD services) receive those services through the Administrative Service Organization (ASO) contracted by DHMH’s Mental Hygiene Administration to assist the local Core Service Agencies (CSAs) with specialty mental health systems management. The ASO handles service preauthorization and claims payment for all MA recipients requiring mental health services, whether or not they are enrolled in Health Choice. The ASO also administers mental health services for persons who do not qualify for MA but cannot afford to pay for their own care. The DES 1000, “Certification of Institutionalized and Health Choice Disenrollment” is a four-part snapset form. It is used by IMDs to notify the Health Choice Enrollment Section in DHMH and the MA CM (Financial Agent, LDSS MA CM, or DHMH Division of Eligibility Waiver Services) of a recipient’s admission to or discharge from an IMD. The authorizing agent for this form is the ASO, rather that DHMH’s Utilization Control Agent (UCA) for other long term care services. . Procedures When a MA CM or financial agent is notified through the DES 1000 of an IMD admission: • The admission date specified in Part III, IV, or V of the DES 1000 is compared with the admission date in Part 1; • The recipient’s age is determined; and • It is confirmed that the recipient is institutionalized in an IMD.

1. For a recipient admitted for a long-term care stay in an IMD who is a child (younger than 21) or an elderly adult (aged 65 or older) • A completed and signed MA long-term care (LTC) application is obtained from the recipient or representative. • The MA CM or financial agent initiates an unscheduled redetermination. Eligibility is determined in a LTC coverage group-“L” Track for SSI recipients or adults, or “T” track for children or TCA adults. • The date that the person is considered institutionalized is specified in Part III or V of the DES 1000. • The ASO’s authorizing signature on the DES 1000 is used as the level of care certification, rather that the DHMH 257. The MA CM or Financial Agent uses the following CARES procedures to complete the unscheduled redeterminations; a) For a recipient who is on the only member receiving benefits in his or her existing community MA assistance unit (AU). • Go in through “O” Interview • The “ADDR” screen should reflect that the individual is residing in a long-term care facility (IMD). • Include information on the authorized representative on the “AREP” screen.