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COMAR 10.09.24.03

373 State of Maryland Medical Assistance Manual Revised July 2012 Note: The information below provide local offices uniform policies and procedures to be followed when determining LTC eligibility in the T-Track for a child or a TCA adult.

Eligibility Policy-Coverage Groups in the T-Track for Children or TCA Adults in Long- Term Care Following is a description of the basic eligibility for policy for the T-track. For all individuals being determined for T-track eligibility:

Eligibility is determined by LTC MA CM at the LDSS‟s. However, a Financial Agent or a MA CM at the Division of Eligibility Waiver Services (DEWS) determines MA LTC eligibility for seriously mentally ill or emotionally disturbed children who are admitted to an Institution for Mental Disease (IMD), Regional Institute for Children and Adolescents (RICA), or Residential Treatment Center (RTC). The applicant/recipient (A/R) is considered a household of one person, since the child is an out-of-home placement. Children who are active in coverage groups S02 for SSI recipients, or who are revealed by clearances using SVES/SDX/SQLQ to be receiving SSI, should have their LTC eligibility determined in coverage group L01 if they have no income besides SSI, the same as adult SSI recipients admitted to LTCFs. The DHR/FIA CARES 9708 is used as the MA application form for a children A/R. If the A/R is considered an adult, the DHR/FIA CARS 9709 is used. As with the L-track, The T-track requires a DHMH 257 before MA LTC eligibility may be determined. The State‟s Utilization Control Agent must certify that the child needs the level of care provided by the LTCG. A child is considered institutationalized as of the 1st day of the first full calendar month in the LTCF. However, an adult is considered institutionalized as of the 30th consecutive day in hospital or by transfer to a different LTCF. i.e. A child who is 10 years old and active coverage group P08 enters a LTCF on 7/15. The child is an acute hospital 8/2-8/8, then returns to the LTCF and is there as of the end of August. Eligibility is determined for T05. P08 eligibility ends as of 7/31. T05 eligibility and the LTC span begin as of 8/1. When a MA or MCHP recipient is admitted to the LTCF, the community-based eligibility continues and the services in the LTCF are paid until the recipient is considered to be institutionalized. Then, a MA LTC eligibility determination is necessary in order of MA to cover the LTC services. If the recipient is enrolled in the HealthChoice when admitted to the LTCF, the MCO or the Mental Hygiene Administration for recipient admitted to a (Residential Treatment Center or other psychiatric facility) covers the authorized care in the LTCF while the recipient is considered a community MA or MCHP recipient.