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10.09.41.00.htm 10.09.41.00. Title 10 MARYLAND DEPARTMENT OF HEALTH Subtitle 09 MEDICAL CARE PROGRAMS Chapter 41 Employed Individuals with Disabilities Authority: Health-General Article, §15-138, Annotated Code of Maryland
10.09.41.01.htm 10.09.41.01. 01 Purpose.. The purpose of this chapter is to increase employment opportunities by making Medical Assistance coverage available to employed individuals with disabilities who meet:A. The disability criteria under Title II or XVI of the Social Security Act; and. B. The nonfinancial and financial eligibility requirements established in this chapter..
10.09.41.02.htm 10.09.41.02. 02 Definitions.. A. Applicability of COMAR 10.09.24.02 Definitions.. 1) Except as provided in §A(2) of this regulation, terms used in this chapter that are not defined in §C of this regulation have the meanings stated for the same terms in COMAR 10.09.24.02.2) If a term's definition in COMAR 10.09.24.02 references a "local department of social services" in the context of a determination of eligibility, the words "local department of social services" in the COMAR 10.09.24.02 defi
10.09.41.03.htm 10.09.41.03. 03 Nonfinancial Eligibility.. A. The Department shall determine whether an applicant or recipient meets the nonfinancial eligibility requirements for Medical Assistance benefits under this regulation.B. An applicant or recipient meets the nonfinancial eligibility requirements for Medical Assistance benefits under this regulation if the applicant or recipient:1) Is 18 years old or older, but younger than 65 years old;. 2) Is employed, except when an unemployment grace
10.09.41.04.htm 10.09.41.04. 04 Financial Eligibility.. A. Assistance Unit. An applicant's or recipient's assistance unit shall include the:. 1) Applicant or recipient; and. 2) Applicant's or recipient's spouse when living in the same household, whether or not the spouse is eligible for the same benefits under this chapter.B. Consideration of Income.. 1) Except as provided in §B(2) or C of this regulation, the Department shall determine, in accordance with the policies and procedures for aged, blind
10.09.41.05.htm 10.09.41.05. 05 Application Requirements ― Determination and Redetermination of Eligibility.. A. Application.. 1) To any individual requesting information, the Department shall provide oral or written information about:a) EID eligibility requirements;. b) The coverage, scope, and related services of the Medical Assistance Program; and. c) Applicants' and recipients' rights and obligations under the Medical Assistance Program..
10.09.41.06.htm 10.09.41.06. 06 Time Standards.. A. Time Standards for the Department.. 1) Disability Determined by Social Security Administration. With respect to an application submitted by an individual determined to be disabled as provided in Regulation .03B(3)b) of this chapter, unless the time standard is extended pursuant to §D of this regulation, the Department shall, not later than 30 days from the application date:a) Complete its determination or redetermination of eligibility, subject to
10.09.41.07.htm 10.09.41.07. 07 Premium.. A. Submission of Premium.. 1) Unless an exception under §A(2) of this regulation applies or a timely claim of hardship is raised pursuant to §C of this regulation, an applicant or recipient shall, as a condition of eligibility for the EID coverage group, pay the premium specified in §A(3) of this regulation.2) Limitation of Premium Requirement.. a) An applicant or recipient with income at or below the federal poverty level is not required to pay a premium as a conditio
10.09.41.08.htm 10.09.41.08. 08 Determination, Notice, and Certification Period.. A. Department's Determination. Based on the information presented, the Department shall determine whether an applicant or recipient is or is not eligible for the EID coverage group under this chapter.B. Finding of Eligibility or Continuing Eligibility.. 1) Notice of Initial Eligibility. If the Department determines that an applicant is eligible, subject to the requirements of Regulation .07A of this chapter, for the EID cover
10.09.41.09.htm 10.09.41.09. 09 Posteligibility Requirements.. A. Department's Responsibility. If it makes a determination as described in Regulation .08A of this chapter, the Department shall:1) Inform the applicant or recipient of the applicant's or recipient's legal rights and obligations; and2) Provide to the applicant or recipient written notice of the findings, rights, and obligations as specified in COMAR 10.09.24.12A(2) and (4) and Regulation .08B or C of this chapter.B. Recipient Responsibility..
10.09.41.10.htm 10.09.41.10. 10 Covered Services.. A. Except as provided in §B and C of this regulation, a recipient in the EID coverage group is covered for medically necessary services required by the recipient, if the services are:1) Furnished by a provider who, with respect to the services rendered, is approved by the Department to participate in the Medical Assistance Program;2) Covered under the State Plan;. 3) Not covered under ESI or any other health insurance coverage besides Medical Assistance; and.
10.09.41.11.htm 10.09.41.11. 11 Conditions of Participation and Reimbursement.. The requirements for provider participation and reimbursement for services furnished to Medical Assistance recipients in the EID coverage group are governed by the same authorities that apply to services furnished to Medical Assistance recipients in other coverage groups, including:A. General Medical Assistance Provider Participation Criteria, as specified in COMAR 10.09.36; and. B. Service-specific provisions included within reg
10.09.41.12.htm 10.09.41.12. 12 Fraud, Liens, Recovery, and Reimbursement.. A. The provisions of COMAR 10.09.24.14 concerning fraud apply to this chapter.. B. The Department shall make a claim against income or resources, or both, of a recipient for benefits correctly paid, or to be paid, under the circumstances specified in COMAR 10.09.24.15A-1.C. The Department may impose a lien on the property of a recipient under the circumstances specified in COMAR 10.09.24.15A-2(1)D. The Department shall s
10.09.41.13.htm 10.09.41.13. 13 Hearings.. A. An EID applicant or recipient shall have the hearing rights specified in COMAR 10.01.04, subject to the qualification set forth in §B of this regulation.B. To apply the terms of COMAR 10.01.04 to the hearing rights of an EID applicant or recipient, substitute “the Department” for references therein to the “local department of social services”
10.09.41.9999.htm 10.09.41.9999. Administrative History Effective date:. Regulations .01―13 adopted as an emergency provision effective April 1, 2006 (33:9 Md. R. 795) adopted permanently effective July 3, 2006 (33:13 Md. R. 1063)Regulation .01A amended as an emergency provision effective October 1, 2008 (35:22 Md. R. 1955) amended permanently effective February 9, 2009 (36:3 Md. R. 208)Regulation .02C amended as an emergency provision effective October 1, 2008 (35:22 Md. R. 1955) amended permanently effective
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