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State of Maryland Medical Assistance Manual Revised April 2014

3. As soon as the A/R is determined eligible, the CM requests and/or collects the bills from the applicant/authorized representative and then:

a) Verifies that the items or services: • Occurs during one of the two time periods in section B above; • As of the first day of the month of application the bill must have been unpaid and remained obligation of the applicant/recipient (A/R) to pay, as verified by a detailed bill, or statement from the provider. Bills for medical or remedial services received prior to the three-month period may not be deducted from the recipient’s available income for the cost of care; • The dates of service are not more than three months prior to application; • Are recognized under Maryland law as a medical or remedial service; and • Were medically necessary (e.g. would be reimbursed by Maryland Medicaid if the individual and/or service were covered).

b) Requests the necessary verifications. The provider’s bill, invoice or statement must: • Be an itemized bill, statement , contract or invoice, for items or services furnished during the three months prior to the application month or for an ineligible month between the application month and the first month of current eligibility; • Specify the date(s) of service; • Describe the services received in detail, including procedure codes when applicable; • Specify the provider’s charge for each service received (e.g. give separate charges for nursing facility services and for non-medical services such as beauty parlor/barber services, cable, telephone or security alarms and monitors); • Specify any payments received or third party liability for the services (e.g. payments from the A/R or others on the A/R’s behalf prior to the month of application, and any third party payments from health insurance, Medicare, LTC insurance, etc.); and • Give the provider’s name, address, and telephone number.

4. To determine the allowable deduction, the CM must complete all fields on the OES 001 and send a copy of the CARES STAT Screen for all denied months, and a copy of the detailed current bill, invoice or contract to:

DHMH Attn: Non-Covered Services 201 West Preston Street, Room SS-10 Baltimore, MD 21201

5. When the CM receives DHMH’s approval to deduct a specified total amount for the non-covered services, the CM manually calculates the A/R’s available income for the cost of care, to assure that it is calculated correctly. Use the DHMH 1159 (LTC) Worksheet for Institutionalized Persons- Cost of Care/Available Income. Enter the allowable deduction for non-covered services as “Other” under deductions on the worksheet.

Rev. 10/2013

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