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COMAR 10.09.24.12

1218 State of Maryland Medical Assistance Manual Revised July 2012

(a) CARES Procedures for Tardy Redeterminations:

1. The screener should run a clearance to find the most recent MA case closure for the individual and determine if it was processed within the past four months. 2. “J” screen the closed AU, using the first day of the month following the month in which eligibility was lost as the application date (i.e., if case closed on 1/31/2002, use effective 2/1/2002 as the effective date). 3. Complete the interview (“O”) Process on CARES. 4. In Processing (P) evaluate the technical and financial circumstances, (i.e. living arrangements, income and assets, etc.) for each pending month, since the month of case closure. Review and enter in the actual gross income and resources for each month to ensure that eligibility existed. 5. Certify for months in which eligibility existed. If it is determined that the individual‟s eligibility would have continued uninterrupted if he/she had completed the redetermination timely, certify the case with no lapse in coverage, beginning the first day of the month following the months in which eligibility was terminated. 6. If the individual was resource ineligible during any months since the month of case closure, allow CARES to determine eligibility, which will result in the AU denial due to over scale resources. Send proper CARES notification. The customer would then need to file a new application. Note: On the denial notice use PF13 to explain the exact resource that was used to determine ineligibility for the AU. Be specific to allow the customer the ability to re-apply as soon as possible when resources are within scale. 7. If the individual was income ineligible during any months since the month of case closure, the case manager should allow CARES to determine eligibility, which may result in the AU going into spend-down. Send Proper CARES notification.

REMINDER: UPDATE THE NARRATIVE TO REFLECT ALL ELIGIBILITY DECISIONS.

1200.5 Procedures for DES 501 Admission to Long-Term-Care( LTC)- Less Than 30 Days

Upon receipt of the DHMH 257 showing a stay of less than 30 days, the LDSS must make sure that the individual is eligible for Medical Assistance prior to completion of the DES 501 form, and its submission to this office. If the recipient is enrolled in an MCO on the date of admission, the request cannot be processed, as the MCO is responsible for the first 30 days of admission. Please take the following steps when processing the case.

Step1. Review the faxed or mailed DES 501 received from the LDSS for completeness the completed form: Must have a began date Must have a date of discharge Must be signed and dated by the LDSS worker Must have the Provider‟s I.D. Number