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COMAR 10.09.24.05

528

State of Maryland Medical Assistance Manual Revised July 2012

as all other requirements in a federal MA or MCHP category, except citizenship and SSN. Therefore, if the alien is applying as ABD and is not aged (65 or older),) a disability determination by SRT is necessary in addition to the emergency medical review. Then local department should promptly submit the paperwork to UCA for review of the emergency medical condition.

The local department should include a copy of the SRT decision with the request sent to UCA for a medical review. (3) Medical Eligibility Review Process All services, except labor and delivery, must be reviewed and approved by a medical professional within the Delmarva Foundation before payment is made. Medical Assistance does not compensate for service that are not directly related to the injury or illness that caused the emergency. The approval authorizes payment for only those services necessary for treatment and stabilization of the emergency medical condition, not the full range of services covered under the Medical Assistance State Plan The medical report for determining medical emergency must be sent to: Delmarva Foundation Attn: MDMA Acute 6940 Columbia Gateway Dr., Suite 420 Columbia, Md. 21046-2788 Fax 1-888-513-1995

The DES 401 should accompany each report. If the applicant requires an SRT disability determination, the SRT decision must also be included. The UCA will evaluate the medical report to determine if the services received were for the treatment of an emergency medical condition. The local department will be notified of whether the services received meet that requirement. NOTE: The medical eligibility review process does not apply to labor and delivery services. The LDSS or LHD will determine whether the woman meets the medical eligibility requirements based on the documentation of labor and delivery services discussed above. (f)Certification of Eligibility of X02 If all eligibility requirements are met, certify on a one time only basis the alien who has the incurred expense for the approved emergency service (including labor and delivery). If eligibility is being determined by a hospital outstation worker, the LDSS supervisor must review the case and approve eligibility before the worker finalizes the X02 eligibility.