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State of Maryland Medical Assistance Manual Revised April 2014
MARYLAND MEDICAL ASSISTANCE PROGRAM NOTICE OF MEDICAL REVIEW DECISION – HOME PROPERTY
Date:
Re:
Name
Case Number
Dear
:
This is to inform you that a medical review was held on to decide if there is reasonable expectation that the above named person will be able to resume living in his/her home property. The review was based on medical information provided by his/her attending physician and the Long Term Care Facility. The decision is checked below:
The above named person can reasonably be expected to be discharged from the Long Term Care Facility to resume living in his/her home property.
The above name person cannot reasonably be expected to be discharged from the Long Term Care Facility to resume living in his/her home property. The Division of Medical Assistance Recoveries will contact you concerning the placing of a lien on this person’s real property.
The person’s medical condition will be reviewed every six months or when a change is indicated, and you will be notified if the above decision is changed. The Medical Assistance Program’s authority to make this decision is based on COMAR 10.09.24.15A-2(2). If you do not agree with the medical review decision, you have the right to request a hearing. The procedures for requesting a hearing are on the back of this letter.
Sincerely,
Utilization Control Agent
Telephone Number
cc: Recipient Division of Medical Assistance-Recoveries
Local Department of Social Services
DHMH 4246 (LTC) Revised 12/08 White-Authorized Representative Yellow-Division of Recoveries Pink-Case Record Blue-Applicant/Recipient