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COMAR 10.09.24.12

1219 State of Maryland Medical Assistance Manual Revised July 2012 Must include the excess amount remaining on the day spend-down was met, if the recipient was certified under spend-down

Step 2 . A completed DHMH 257 must be attached to the 501. Make sure the completed 257: Has “Community M.A” written across the top Has an Admission Date, Begin Pay Date, Date of Discharge, and Level-of-Care authorization by Delmarva. PLEASE NOTE: It is not necessary to receive Delmarva approval for Medicare co-payment requests. For QMB- Only co-payment request the Long-Term-Care span may remain open for as long as the recipient‟s admission is covered under Medicare, i.e., 21st-100th day.

Both forms DES 501 and DHMH 257 must be received before the request can be processed. If the LDSS fails to submit both documents the document submitted will be returned, unprocessed, to the LDSS.

Step 3 . Enter the requested dates onto Screen #4 to open the Long-Term-Care span. If the system rejects the span:

Determine why the span was rejected

Return unprocessed documents to the LDSS with a notation

Step 4 . After the Long-Term-Care span has been opened, notify the providers by fax or mail within 14 days that the transaction has been completed. Use the notification form developed for providers.

NOTE: The LTC/SP Unit may receive phone calls from providers if claims for stays of less than 30 days have been rejected and the recipients were fee-for-service on the dates of admission. If provider concerns cannot be addressed by the LTC/SP Unit refer to the providers to DHR‟s Problem Resolution Unit at 410-767-8699.