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10.18.07.00.htm 10.18.07.00. Title 10 DEPARTMENT OF HEALTH AND MENTAL HYGIENE Subtitle 18 HUMAN IMMUNODEFICIENCY VIRUS (HIV) INFECTION AND ACQUIRED IMMUNODEFICIENCY SYNDROME (AIDS) Chapter 07 Maryland AIDS Drug Assistance Program: Health Insurance (MADAP-PLUS) Authority: Health-General Article, §2-104(b) and (i) and 2-105(a) and (b) Annotated Code of Maryland
10.18.07.01.htm 10.18.07.01. 01 Definitions.. A. In this chapter, the following terms have the meanings indicated.. B. Terms Defined.. 1) “Acquired Immunodeficiency Syndrome (AIDS) means the medical condition caused by the Human Immunodeficiency Virus.2) “Applicant” means an individual who has submitted an application to the Maryland AIDS Drug Assistance Program—Plus and whose eligibility status for the Maryland AIDS Drug Assistance Program—Plus has not yet determined.3) “Core medical services
10.18.07.02.htm 10.18.07.02. 02 Eligibility.. To be eligible for MADAP-Plus coverage, an individual shall be:. A. Enrolled in MADAP; and. B. Receiving or eligible to receive health insurance and prescription drug coverage..
10.18.07.03.htm 10.18.07.03. 03 Application and Enrollment.. A. An applicant shall apply in the manner set forth in COMAR 10.18.05.03A.. B. A recipient and the Department shall meet the enrollment responsibilities set forth in COMAR 10.18.05.03B.C. The recipient’s enrollment period for MADAP-Plus shall be the same as the MADAP enrollment period in 10.18.05.03B.
10.18.07.04.htm 10.18.07.04. 04 Covered Services.. A. The Department shall pay for health and prescription plan premiums with a prescription drug formulary comparable to the MADAP formulary.B. Within the limits established by the Department and in accordance with policy guidance issued by the Health Resources and Services Administration, the Department:1) Shall pay for copays, coinsurance, and deductibles for formulary drugs; and. 2) May pay for visits associated with core medical services..
10.18.07.05.htm 10.18.07.05. 05 Changes in Eligibility and Disenrollment.. A. A recipient shall inform the Department of a change in eligibility as set forth in COMAR 10.18.05.04A.B. If a change reported in §A of this regulation results in a recipient no longer qualifying for MADAP-Plus, the Department shall:1) Determine the recipient ineligible for MADAP-Plus; and. 2) Disenroll the recipient.. C. If a MADAP-Plus recipient is disenrolled from MADAP, the recipient is automatically disenrolled from MADAP-Plus.
10.18.07.06.htm 10.18.07.06. 06 Reconsideration and Appeal.. A. An applicant or recipient who has been notified by the Department of disenrollment or ineligibility for MADAP-Plus benefits may request reconsideration of the decision by submitting additional supporting documentation or information to the Department within 30 business days of notification.B. If an applicant or recipient submits a timely request for reconsideration, the Department shall:. 1) Review all additional supporting documentation,
10.18.07.07.htm 10.18.07.07. 07 Payment Procedures.. A. A recipient, recipient’s representative, health care provider, insurer, employer, or health plan administrator, as applicable:1) May request payment costs allowed under this chapter on behalf of the recipient according to procedures established by the Department;2) Shall submit a payment request that is:. a) An invoice for the recipient’s health or prescription drug plan insurance premium, copays, coinsurance, and deductibles for core medical services i
10.18.07.08.htm 10.18.07.08. 08 Recovery of Payments.. If MADAP-Plus payments have been incorrectly paid or another payer has been identified, the Department shall seek recovery of the amount of those payments.
10.18.07.09.htm 10.18.07.09. 09 Fraud.. The Department shall pursue cases of suspected misrepresentation or fraud pursuant to Criminal Law Article, §8-503, Annotated Code of Maryland, or any other applicable statutory provision.
10.18.07.10.htm 10.18.07.10. 10 Confidentiality.. Unless otherwise authorized by law, the Department:. A. Shall keep all applicant and recipient personal information confidential;. B. May not disclose personal information kept on an applicant or recipient without the written consent of the:1) Applicant;. 2) Recipient;. 3) Applicant’s parent or legal guardian; or. 4) Recipient’s parent or legal guardian;. C. Shall comply with the laws and regulations concerning the privacy and security of protected healt
10.18.07.11.htm 10.18.07.11. 11 Availability of Funding and Program Termination.. A. If sufficient monies are not available to fund MADAP-Plus, the Department shall take the action necessary to eliminate a deficit which may include MADAP-Plus termination.B. If MADAP-Plus is terminated, the Department shall provide coverage for each current recipient until the earlier of:1) The end of the recipient’s enrollment period; or. 2) Six months from the date MADAP-Plus is terminated..
10.18.07.9999.htm 10.18.07.9999. Administrative History Effective date: February 3, 2003 (30:2 Md. R. 76). Regulation .01B amended effective December 27, 2010 (37:26 Md. R. 1788) March 16, 2015 (42:5 Md. R. 486)Regulation .03 amended effective December 27, 2010 (37:26 Md. R. 1788) March 16, 2015 (42:5 Md. R. 486)Regulation .04 amended as an emergency provision effective January 1, 2014 (41:4 Md. R. 298) amended permanently effective May 26, 2014 (41:10 Md. R. 561)Regulation .04D amended as an emergency provision
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