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State of Maryland Medical Assistance Manual Revised April 2014

For services already furnished and billed to an A/R, the CM must request documentation of any payments applied to the charges billed. If an A/R is a Medicare recipient or has another insurer, the bill will not be considered until it is verified what portion is paid or denied by Medicare or other insurance. The CM should only forward to DHMH a Request for Non-Covered Services that is supported by bills, receipts, or contracts that contain the required information listed above. The CM should return unacceptable bills, receipts, or contracts to the A/R and request the specific documentation required. DHMH will review the request and send the CM a memo with the allowable amount noted along with the A/R’s Non-Covered Service Report. Please note the following: • These deductible expenses cannot be covered by Medicaid, Medicare, any other health insurance, or 3rd party payment (e.g., long-term care insurance, disability insurance). • This allowance may not be given to reimburse a relative or someone else who has already paid the bill. • A deduction is not made for medical or remedial services received before the 3-month period prior to current application. • Since the deduction is only made for medical or remedial services, any extraneous charges such as for the barber/beauty parlor, TV rental, or personal items are not allowed. • The deduction may not include services covered by Medicaid that were received when the recipient was Medicaid-eligible, but for which the Program denied payment because the services were not medically necessary, were not authorized, were not provided by an enrolled and qualified provider, or were billed after the 12-month billing limitation. • If there is a contract for regular payments for an item or service, the monthly obligation may be allowed for the period specified in the contract. • If the amount of the medical expense in addition to other allowable deductions exceeds the recipient’s total countable income for the month, the excess portion of the deduction for the medical expenses may be carried forward to the ongoing month or months and, if necessary, may be carried forward into a subsequent 6-month period under consideration. • The CM should set a “745” alert in CARES to recalculate the recipient’s available income as of the month that the deduction is scheduled to end. There are no deductions from total income except those listed above. If total deductions for a month are greater than or equal to the recipient’s total countable monthly income, the person’s available income is $0. With the exception of medical care or remedial services, as specified above, deductions in excess of total countable income are not carried forward to subsequent months. If total deductions are less than the total income for the month, the amount remaining after these deductions is the available income. 1000.2 Cost of Care