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COMAR 10.09.24.04

338 State of Maryland Medical Assistance Manual Revised July 2012

400.19 Good Faith C, Concept

The concept of “good faith” ha a very specific meaning with regard to MA policy pertaining to the application process. This concept is applied when determining what verification standards are to be applied in a specific case. It is one step in a sequential decision making process.

Most factors of eligibility must be verified by hard copy documentation, electronic, verification or verbal communications between CM and an authoritative source. CM is trained to determine when it is appropriate to use these means of verifications for different factors of eligibility. For MA LTC cases, most factors or eligibility must be verified by written documentation from authoritative sources (e.g. bank statements) or electronically (e.g. Social Security Benefits). CM must request appropriate verifications from the applicant or the applicants authorized representative in writing, and in a time frame that will enable the CM to complete the eligibility determination within the required 30 days.

At times, verifications cannot be submitted within the required time frame. In that circumstance, an applicant or representative may request an extension of time limits. If an extension is requested and granted by the case manager at the end of that period, (generally 45 days from the date of application) the information still cannot be provided by the A/R, a CM may decide to process the application based on a declaration made by the applicant/representative about the eligibility factor in question. A declaration means that the A/R makes a written statement confirming the information to the best of their knowledge, even though written or electronic documentation cannot be obtained. This declaration may be substituted for written or electronic verification for a limited period of time, i.e. until the next redetermination is due. The declaration does not mean that the factor of eligibility is not being considered or is in any way waived. An application could either be denied or granted based on a declaration (e.g. excess resources.

The five (5) conditions below must be met in order for a case manager to decide to determine eligibility based on the declaration rather that a verification. The first of these is “good faith”. The A/R made a “good faith effort” to obtain the required verification in a timely manner. In this context” good faith” means that the A/R has taken the reasonable steps to try to obtain the documentation, but has been unable to do so. If the case manager determines that this element of good faith has been met, the next four (4) factors must be considered:

The reason for failure to obtain information is beyond the control of the A/R He/she believes to be accurate The CM has no other contradictory information or other reasons to doubt the statements The A/ R agrees to provide the written verification as soon as received but no later than the reason for failure to obtain information is beyond the control of the A/R The A/R made a “good faith effort” to obtain the required verification in a timely manner The required verification cannot be obtained within 45 days for reasons beyond the control of the A/R, and there is no other way to verify the specific factor of eligibility The A/R has provided information that he/she believes to be accurate; There is no other existing information that leads the MA CM to believe that the statement of the A/R is inaccurate or incomplete: and The A/R agrees to produce the required verifications no later than the next scheduled