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COMAR 10.09.24.01-.16 1622 State of Maryland Medical Assistance Manual Revised July 2012
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COMAR 10.09.24.01-.16 1622 State of Maryland Medical Assistance Manual Revised July 2012
(i) A signed application received from the applicant;
(ii) A form signed by a health professional, certifying that the enrollee needs treatment and, for a redetermination, specifying the anticipated length of treatment;
(iii) Confirmation from the Maryland Breast and Cervical Cancer Screening Program that the applicant received screening services in accordance with §A of this regulation;
(iv) Confirmation from the Maryland Breast and Cervical Cancer Screening Program or the Breast and Cervical Cancer Diagnosis and Treatment Program that the applicant had a biopsy which resulted in a diagnosis of breast cancer, cervical cancer, or a precancerous condition; and
(v) Additional information obtained by the Department to verify the applicant's eligibility in accordance with Regulation .03-1C of this chapter;
(b) Redetermine an enrollee's eligibility at least every 12 months, before the end of the certification period, based on the following:
(i) An application completed by the enrollee, verifying continuing eligibility under Regulations .03-1 and .03-2 of this chapter; and
(ii) A certification form completed by a health professional, verifying that the enrollee needs treatment and specifying the expected length of treatment; (c) Verify, before determining or redetermining eligibility, that the applicant or enrollee is not: (i) Currently covered by Medical Assistance and does not have an application under consideration in a coverage group which covers all State Plan services without requiring spend down or payment of a premium; or
(ii) Eligible for a mandatory Medical Assistance categorically needy coverage group; (d) Determine or redetermine eligibility within 45 days after receipt of a signed application; (e) Refer the applicant or recipient to the local department of social services or local health department for an eligibility determination or redetermination if the individual may be eligible for a mandatory Medical Assistance categorically needy coverage group; and
(f) Notify the applicant or enrollee of the eligibility decision and the rights for appeal and fair hearing, in accordance with Regulation .13 of this chapter; and
(4) Based on the application date, the Department shall establish a period under consideration, which shall be: