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State of Maryland Medical Assistance Manual Revised April 2014

h. Redetermination Procedures for Children Under the Age of 21 Being Discharged from Institutions for Mental Disease (IMDs), Regional Institutes for Children and Adolescents (RICAs), or Residential Treatment Centers (RTCs) (Policy Alert 10-09)

Federal and State regulations provide for the prompt redetermination of (MA eligibility when there is a change in an individual’s circumstances, i.e., disability, living arrangements, income, resources, etc, which could result in the loss of eligibility. Federal and State guidelines also stipulate that MA eligibility must continue until it has been determined that an individual no longer meets the criteria for continued eligibility. This Policy Alert sets forth procedures, effective immediately, which are to be followed to facilitate the transition when a recipient under 21 years of age is discharged to the community from an IMD, RICA, or RTC. Upon the discharge of recipients under 21 years of age from IMDs, RICAs, and RTCs, the facilities have been instructed to give the parents or guardians the children’s Medical Care Program Identification cards so that they may access Medical Assistance services. The facilities have also been instructed to provide the parents or guardians with a supply of any needed prescriptions for the children to last through the end of the month. Rather than closing the Medical Assistance (MA) case upon the child’s discharge, the CM must allow MA eligibility to continue for at least 90 days, so there will be time for an unscheduled redetermination using MA community rules. Procedures to be followed by the CMs for Canceling Long-Term Care Eligibility and Establishing Community Case Medical Assistance eligibility may not be terminated based on a child’s discharge from the facility. The child’s MA eligibility must continue until it has been determined eligibility no longer exists. The CM at the local department of social services (LDSS) must make this determination through the redetermination process. To facilitate this process and the child’s transition from long-term care Medical Assistance to the community, use the following procedures: Procedures for Financial Agents and MA Waiver CMs • The Financial Agent or MA Waiver CM, as the worker of record, must change the redetermination end date to allow the case to go into the CARES automatic redetermination cycle so that the MA CM at the LDSS can redetermine eligibility. • Financial eligibility tests are not required until the redetermination is initiated. • Income and assets will be considered beginning the month following the redetermination. • The Financial Agent or MA Waiver CM should use the following procedures when a copy of the DES 1000 form is received from as IMD/RICA/RTC, indicating that a recipient under 21 years of age has been discharged:

1. In the Historical month enter the discharge date onto the “INST” Screen. This will generate a transaction to effect closure of the long-term care span on MMIS Screen 4 as of the discharge date, and will also allow the child to continue to receive necessary specialty mental health services and other MA services on a fee-for-service basis. DO NOT change the information on the “DEM1” or “DEM2” Screens. However, the “ADDR” Screen should be changed to reflect the discharge address indicated on the DES 1000.