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COMAR 10.09.24.11

1103 State of Maryland Medical Assistance Manual Revised July 2012 Certification begins on the first day of the month of application. Certification ends on the last day of the period under consideration. Certification of a deceased person may not continue beyond the date of death. Certification of an eligible new member of an assistance unit may not proceed the date he becomes a member of the household.

1100.4 Non-Certification of Persons Required to be Included in the Assistance Unit

The LDSS will exclude form the DHMH 8000 any family member who does not wish to apply for MA but is required to be included in the assistance unit under Regulation .06. The case record will be documented to reflect this fact.

The person may request issuance of the card at any time during the period under consideration and the Local Department, will grant the request by adding the person to the DHMH 8000 unless it has reason to believe the person is not eligible, in which case eligibility for the entire unit must be redetermined.

1100.5 Notice to Eligible Units

Each separate assistance unit within a family must be sent a notice of eligibility. The notice is to be addressed to the person who is listed on the 8000 form as head of household. In cases of children who do not live with a parent or Caretaker Other than Relative or Parent (CTROP), correspondence is to be mailed to the person who takes overall responsibility for the child. In most instances, this will also be the person who applied on behalf of the child.

NOTE: Certification Periods for Institutionalized Persons, See Chapter 10, “Determining Financial Eligibility for Institutionalized Persons”

1100.6 Administrative Error Letter

The form DHR/IMA 81, known as the Administrative Error Letter, has a very specific use. Regulation .06 under COMAR 10.09.36 specifies the time limitations for billing Medical Assistance. Providers are allowed at most 9 months from the date of service to bill the Department for services rendered.

When a provider is not able to bill within 9 months from the date of service due to an administrative error on the part of DHMH or the LDSS, it is necessary for the provider to submit the DHR/IMA 81, along with the claim, to the DHMH Division of Claims Processing in order for the 9 month rule to be overridden and for the provider to be paid. Any reason for delay other than agency administrative error, such as failure of the provider‟s office to bill in a timely manner or failure of the client to provide required information, does not warrant the use of the DHR/IMA 81.