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COMAR 10.09.24.03

376 State of Maryland Medical Assistance Manual Revised July 2012 CAREs denial/closure notice should be suppressed by the MA CM, unless it is determined that the A/R is not eligible for any other LTC coverage group.

AU Screen in T01

A T01 assistance unit (AU) consists of a child or adult who at admission to a LTCF is actively receiving TCA benefits and so is MA community-eligible in F01. MA will pay the facility‟s cost of care while the child or adult remains eligible for TCA. When the CM adds a program to the existing F01 AU, CARES will not display T01 coverage group on the “INCH” screen. Therefore, the CM must call it up. In order to process correctly a T01 Au: o The Living Arrangement for this recipient must be coded as “TL” (Temporary LTC Admissions) on the customer‟s “DEM1” screen for both the F01 and T01 Aus. o All members of the recipient‟s F01 AU must be coded on the “STAT” screen as a Nonmember (NM) for the recipient‟s T01 Au. o The recipient must be changed on the “STAT” screen to a NM of the F01 Au, which should trigger unscheduled redeterminations for the F01 AU.

As long as the family remains eligible for TCA (and so is MA eligible as F01), the LTC recipient should remain eligible in T01, unless the recipient ages out of TCA. Then, the recipient‟s LTC eligibility should be redetermined for the most appropriate coverage group.

AU Screened in T02

This MA coverage group is for an unmarried child under age 21 residing in a LTCF, whose countable resources do not exceed the medically needy standard for a household of one person ($2,500) and whose countable net income is insufficient to pay the LTC cost of care.

If the child‟s resources are within standard and the income is within standard (less than the LTC cost-of-care), the case is eligible for T02 and certified for 12 months, as long as the child‟s age is under 21.

If the child is ineligible for T02 because the child‟s resources are within standard but the income is in excess of the standard (LTC cost-of-care), the case trickles to T99 (spend- down) in a preserved “M” status. As with other MA coverage groups, CARES also evaluates the income. For only the T-track, CARES actually changes the MA coverage group from T02 to T99, indicates that the Au is in spend-down, and gives the Au status Reason Code of “401” to deny for over-scale resources. Therefore, the CM should add