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COMAR 10.09.24.05

527

State of Maryland Medical Assistance Manual Revised July 2012

(1)Medical Eligibility Requirements for Coverage Group X02 For an alien to be eligible in X02, the service received must be consistent with the “Explanation of Emergency Medical Services”. The UCA determines whether the service meets the X02 coverage requirements by reviewing a medical report of the treatment received. The medical report must be in sufficient detail for the UCA to determine both the diagnosis and whether the treatment was of an emergency nature. The documentation of the emergency nature of the medical services must include: Diagnosis (or diagnoses), Description of treatment, Dates of treatment and MMIS Screen 1 or the CARES or MMIS inquiry screen showing the results of a search for whether the applicant has a previous history on CARES or MMIS.

Following is a list of acceptable medical documentation: When the patient have been discharged 1. Discharge summary with admission and discharge dates. When the patient has not been discharged: 1. Course of medical treatment, including admission date and tentative discharge date.

The following materials are unacceptable for medical documentation: Bills Nurses notes State Review Team (SRT) materials, including DHR 402B Case record materials, including immigration documents.

(e) Documentation of Services (1)Documentation of Labor and Delivery Services The medical eligibility review process by DHMH does not apply to labor and delivery services. The applicant/representative must provide the LDSS or LHD with a copy of the Discharge Summary or other written documentation from the hospital (but not nurses notes or a bill) that includes the mother’s name, the child’s name, the admission and discharge dates, the date of delivery, and confirmation of live birth. This documentation is not required to be signed by the physician or another hospital representative. (2) Documentation of Disability Coverage as X02 is only available to persons who would be eligible in a federal coverage category (MA, FAC, ABD or MCHP) but not for the qualified aliens status. The applicant is only eligible if the emergency medical condition requirement is met as well