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COMAR 10.09.24.15

1511

State of Maryland Medical Assistance Manual Revised July 2012  Complete the Lien Worksheet and forward the original and copies of the deed(s) and tax assessment(s) for the home property to MACA, Division of Recoveries. File copy of the Lien Worksheet and the Notice of Medical Review Decision-Home Property in the case record.  Certify the eligible applicant or continue certification for the eligible recipient. COMPLETE OTHER CASE ACTIVITY.

Objection to Lien

A person who objects to the imposition of a lien is ineligible for MA. Ineligibility is based on the person‟s objection to the imposition of the lien, which impedes the Program‟s ability to implement its lien requirements. The basis for this action is COMAR 10.09.24.15A-3(l). The specific reason to be stated on the ineligibility or termination notice is: “You did not wish to subject your home property to the lien requirements of the Program.” Deny eligibility to an applicant. In the case of a recipient, immediate action (termination) in accordance with timely and adequate notice requirements, Regulation .13, is required to avoid erroneous payments Complete the Lien Worksheet and file it and the Notice Medical Review Decision Home Property in the case record. COMPLETE OTHER CASE ACTIVITY.

1500.10 Explanation of the Medical Review Process

To determine if the program will impose a lien on home property, a Medical Review is required. This process is called the “Medical Review” and is conducted for the Program by the Utilization Control Agent (UCA). Through this process, UCA determines if there is a reasonable expectation that the person can be discharged from the institution and resume living in his/her home property. If reasonable expectation is not determined to exist, a lien will be imposed on the home property irrespective of the person‟s expressed intent to return.

The LDSS completes Part I of the Physician Report and gives it to the representative to have the attending physician complete Part II. The physician will return the report to the representative, who in turn will forward it to the LDSS.

The LDSS will forward the Physician Report to UCA. UCA, using the medical information provided on the Level of Care Determination (on file with UCA) and the Physician Report, will complete a Medical Review to determine if there is any reasonable expectation that the person will be discharged from the LTCF and resume living in the home property. UCA will notify the person of the decision and his/her right to an appeal hearing via DHMH Form 4246 (LTC), Notice of Medical Review Decision- Home Property. The LDSS will receive a copy of this notice.

1500.11 Appeal of the Medical Review Decision