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COMAR 10.09.24.15

1515

State of Maryland Medical Assistance Manual Revised July 2012 NOTE: It is also used to obtain a physician‟s statement as to the person‟s ability to be discharged from an LTC facility within 6 months from the month of admission and, therefore, to determine the person‟s entitlement to a residential maintenance allowance. UCA review is not required for determining entitlement to this allowance.

(e)Lien Worksheet- DHMH 1159c (LTC) The LDSS completes this form only for institutionalized recipients who own home property to determine if the Program may impose a lien. The DHMH 1159B (LTC), Worksheet for Institutionalized Persons, makes this point clear. If the lien worksheet (Part II) indicates the lien provision is not applicable, file it in the MA case record. If the worksheet (Part IV) indicates the lien provision is applicable, forward a copy of the worksheet to MCCA, Division of Recoveries, for appropriate action relating to the imposition of a lien.

(f)Lien Memorandum-DHMH 4242 (LTC) This is a multi-purpose memorandum that is used to transmit and exchange information, documents, and forms associated with the lien and recovery process between the LDSS and MACA and its various divisions. Included in its uses are those of MACA, Division of Recoveries, informing the LDSS when the lien has been imposed, when property has been sold and of the proceeds from the sale, and the remaining resource, if any, after the recovery requirement has been satisfied.

(g)Home Exclusion- Statement of Intent -DHMH 4255 (LTC) This form is used by the LDSS to obtain a statement of an institutionalized person‟s intent to resume or not to resume living in his/her home property to determine if the home property is an excludable resource. (Refer to Regulation .24, Chapter .08, Policy Alert 08-3, and Evaluation of the Home Property of an Institutionalized Person).