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10.09.63.00.htm 10.09.63.00. Title 10 DEPARTMENT OF HEALTH AND MENTAL HYGIENE Subtitle 09 MEDICAL CARE PROGRAMS Chapter 63 Maryland Medicaid Managed Care Program: Eligibility and Enrollment Authority: Health-General Article, Annotated Code of Maryland Regulations Sections 01.15-103(b)3) (4) and (6) 02―04.15-103(b)16) 05.15-103(b)23) 06.
10.09.63.01.htm 10.09.63.01. 01 Eligibility.. A. Criteria. Except as provided in §B of this regulation, a Program recipient shall be enrolled in the Maryland Medicaid Managed Care Program, described in this chapter, if the recipient is eligible for receipt of Medical Assistance benefits by qualifying:1) As categorically needy or medically needy under COMAR 10.09.24, unless the recipient is:. a) 65 years old or older;. b) Newly eligible and 64 1/2 years old or older;. c) Eligible to receive Medicare benefits,.
10.09.63.02.htm 10.09.63.02. 02 Enrollment.. A. The Department shall provide to waiver-eligible individuals:. 1) Materials regarding each MCO providing services in the eligible individual’s county of residence including, but not limited to:a) The names and addresses of all participating providers, upon enrollee's request;. b) A schedule of the benefits offered, including any benefits offered beyond the basic required package described in COMAR 10.09.67; andc) If applicable, a list of services that the MCO
10.09.63.03.htm 10.09.63.03. 03 Health Service Needs Information.. A. The Department or its agent shall attempt to complete the health service needs information at the time of enrollment.B. The Department shall transmit any information obtained from health service needs information to the recipient's MCO within 5 business days.C. Upon its receipt and review of the health service needs information, an MCO shall take appropriate action to ensure that a new enrollee, who needs special or immediate heal
10.09.63.04.htm 10.09.63.04. 04 Assignment to Primary Care Provider (PCP). A. Within 10 days of the notification of enrollment of a new enrollee or within 10 days of any event that requires a change in an existing enrollee's PCP, an MCO shall notify the enrollee of the enrollee's PCP assignment.B. A Program recipient with no previous affiliation with any of the providers on the MCO's primary care provider panel who:1) Indicates a preference for a participating PCP during the enrollment pro
10.09.63.05.htm 10.09.63.05. 05 Reassignment.. A. Once every 12 months, a Program recipient may elect to:. 1) Maintain enrollment with the recipient's current MCO;. 2) Enroll in another MCO in the recipient's local access area; or. 3) Enroll in an MCO outside the recipient’s local access area, upon the approval of the Department and the MCO.B. The Department shall notify the enrollee no less than 60 days before the start of each new enrollment period.C. The Department shall reassign into the same MCO
10.09.63.06.htm 10.09.63.06. 06 Disenrollment.. A. Enrollee-Initiated Disenrollment for Cause.. 1) An enrollee may disenroll from an MCO and enroll into another MCO if:. a) The enrollee moves to a county that is not served by the enrollee's present MCO;. b) The family members are enrolled in different MCOs and the adult enrollee requests that other family members be enrolled in one of the MCOs in which another family member is currently enrolled;c) The enrollee requests enrollment into the MCO t
10.09.63.9999.htm 10.09.63.9999. Administrative History Effective date:. Regulations .01―06 adopted as an emergency provision effective November 8, 1996 (23:25 Md. R. 1730)adopted permanently effective March 10, 1997 (24:5 Md. R. 408)Regulation .01 amended as an emergency provision effective July 1, 1998 (25:16 Md. R. 1261) amended permanently effective January 1, 1999 (25:26 Md. R. 1925)Regulation .01A amended effective April 19, 2010 (37:8 Md. R. 615) March 14, 2016 (43:5 Md. R. 385) August 29, 2016 (43:17 Md
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