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COMAR 10.09.24.15

1512

State of Maryland Medical Assistance Manual Revised July 2012

A person has a right to appeal the Medical Review decision made by a UCA within 90 days of the date of the notice of the decision.

(a)Administrative Review

If an appeal is filed, the first step of the appeal process involves an administrative review of UCA‟s decision by MACA, Division of Long Term Care. MACA may affirm or reverse UCA‟s decision. MACA will notify the person, the person‟s representative, UCA, the Office of Hearings, the LDSS, and the Division of Recoveries of the result of the administrative review.

If the Administrative Review affirms UCA‟s decision, MACA will forward the case to the Office of Hearings for an appeal hearing. If the Administrative Review reverses UCA‟s decision, that there is a reasonable expectation the person can resume living in his/her home, the lien, if already imposed, will be lifted. If not yet imposed, it will not be imposed.

(b)Appeal Hearing

If the case is forwarded to the Office of Hearings by MACA, an appeal hearing will be held and a decision rendered concerning the Medical Review decision made by UCA and MACA. When the appeal decision is rendered, the Office of Hearings will notify the person, the person‟s representative, the LDSS, the Division of Recoveries, and UCA of the decision.

If the Hearing Officer reverses the Medical Review decision made by UCA and MACA, that there is a reasonable expectation that the person can resume living in his home, the lien, if already imposed, will be lifted. If not yet imposed, it will not be imposed.

(c) Summary

Although the administrative review or appeal hearing decision does not affect MA eligibility, they do affect applicability of the lien provision.

If the administrative review or the appeal hearing determined that a lien will not be imposed on the institutionalized person‟s home property and a lien was imposed, the LDSS must notify MACA, Division of Recoveries, via the DHMH Form 4242, Lien Memorandum, to lift the lien. The memorandum must include the date of hearing or administrative review.

1500.12 MACA, Division of Recoveries Activity