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COMAR 10.09.24.04

325 State of Maryland Medical Assistance Manual Revised July 2012

1. A retroactive eligibility determination for an interrupted period within the retroactive period of an retroactive eligibility determination combined with a current eligibility determination equals two applications and /or eligibility determinations. 2. A retroactive eligibility determination for the first and third month of the retroactive period equals two applications and or/or eligibility determinations. (First and third months are interrupted periods). If accompanied by a current eligibility determination a third application and/or eligibility determination is required. 3. A retroactive eligibility determination for a continuous, uninterrupted period of one to three months equals one application and/or eligibility determination. If accompanied by a current eligibility determination, a second application and/or eligibility determination is required.

As a general rule, the number of applications and/or eligibility determination may be determined by the number of separate applications that are required. Separate calculation and decision sheets and separate form AMF-Is needed for each determination. Each determination is counted as an application.

400.7 Special Verification Requirements for Persons in or Planning to Enter an Long Term Care Facility

When an application is filed for a person who is already in or planning to enter an LTC facility for a general hospital, all necessary information and verifications should be requested. If all required information/verification is not submitted that fact needs to be included in the notice of ineligibility along with any other reason for ineligibility. For example, an applicant presents a book showing excess resources and the application shows that the person has other countable resources which would increase the amount of the excess, but the applicant fails to provide verifications of the exact value of the other resources. In this circumstance, the notice of ineligibility should include the fact that the applicant is ineligible based on the excess resources associated with the bank account. The notice should also include a statement that the applicant has additional resources (specify type) the values of which are unverified but which may increase the amount of the excess. This same principle applies regardless of the specific reason for ineligibility. This should be done only after the applicant has been given sufficient opportunity to provide all required information but fails to do so. Because of the significant impact of excess resources and eligibility, it is important that eligibility determinations be made within the 30-day time frame, or earlier if possible so that applicants can take appropriate action to reduce the resources consistent with Program policy, and limit the period of ineligibility.

(a) Period Under Consideration

For an institutionalized person, the period under consideration must be adjusted when the person applies pending admission to a LTC facility or in the month of admission to a LTC facility. For details refer to procedures for institutionalized persons in chapter 1000.

(1) Summary of Requirements

1. A completed and signed application form is required when a person requests current or retroactive