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10.09.91.00.htm 10.09.91.00. Title 10 DEPARTMENT OF HEALTH AND MENTAL HYGIENE Subtitle 09 MEDICAL CARE PROGRAMS Chapter 91 Hospital Presumptive Eligibility Authority: Health-General Article, §2-104(b) 2-105(b) and 15-103, Annotated Code of Maryland
10.09.91.01.htm 10.09.91.01. 01 Purpose and Scope.. This chapter establishes requirements for the determination of presumptive eligibility by qualified hospitals effective October 1, 2014.
10.09.91.02.htm 10.09.91.02. 02 Definitions.. A. In this chapter, the following terms have the meanings indicated.. B. Terms Defined.. 1) “Applicant” means an individual who has applied for presumptive eligibility at a participating hospital.2) “Application” means the presumptive eligibility application.. 3) “Authorized representative” has the same meaning as set forth in COMAR 10.01.04.01.. 4) “Department” means the Department of Health and Mental Hygiene which is the single State agency d
10.09.91.03.htm 10.09.91.03. 03 Requirements.. A. A hospital eligible to make presumptive eligibility decisions shall:. 1) Participate as a Maryland Medical Assistance Program provider in good standing; and. 2) Sign an agreement prepared by the Department.. B. The agreement required under §A of this regulation shall require that the hospital:. 1) Comply with Departmental policies and procedures supplied by the Department at the time of application and training;
10.09.91.04.htm 10.09.91.04. 04 Hospital or Hospital Staff Disqualifications.. A. A hospital qualified to make presumptive eligibility decisions shall:. 1) Make presumptive eligibility determinations in accordance with established Departmental policies and procedures; and2) Disqualify individual hospital employees who do not follow established Departmental regulations, policies and procedures.B. Upon a finding that a qualified hospital has failed to meet the requirements of §A of this regula
10.09.91.05.htm 10.09.91.05. 05 Criteria.. A. An individual, the individual’s guardian, or a representative of the individual with personal knowledge shall apply for presumptive eligibility through a participating hospital.B. An individual, the individual’s guardian, or a representative of the individual with personal knowledge who applies for presumptive eligibility shall attest to:1) The citizenship requirements in COMAR 10.09.24.05;. 2) The residency requirements in COMAR 10.09.24.05-3;.
10.09.91.06.htm 10.09.91.06. 06 Populations Eligible.. Presumptive eligibility may be established for the following eligibility groups:. A. Parents and other caretaker relatives whose household income is equal to or less than 133 percent of the federal poverty level;B. Pregnant women whose income is equal to or less than 250 percent of the federal poverty level;. C. Adults without dependent children who are older than 19 years old and younger than 65 years old, whose household income is equal to or less than 13
10.09.91.07.htm 10.09.91.07. 07 Limitations.. An individual may not apply for presumptive eligibility in Maryland if the individual:. A. Is currently enrolled in the Maryland Medical Assistance Program or Medicare;. B. Is an incarcerated inmate in a public institution as defined in COMAR 10.09.24.05-5B;. C. Had a prior presumptive eligibility period during the last 12 months with the exception of pregnant women;D. Does not meet the residency requirements stated in COMAR 10.09.24.05-3; or.
10.09.91.08.htm 10.09.91.08. 08 Certification Period.. A. Presumptive eligibility begins on the day the hospital determines that the individual is presumptively eligible.B. Presumptive eligibility ends on the earlier of:. 1) The day in which the individual is determined eligible for Medical Assistance; or. 2) The last day of the month following the month in which the hospital determined presumptive eligibility, if:a) An individual is found ineligible for Medical Assistance; or.
10.09.91.09.htm 10.09.91.09. 09 Presumptive Eligibility Appeal Rights.. An individual or an organization does not have appeal rights for presumptive eligibility determinations.
10.09.91.9999.tx.htm 10.09.91.9999. Administrative History Effective date: December 22, 2014 (41:25 Md. R. 1485).
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