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 any premium payment required by Regulation .07 of this chapter, and issue a written notice that satisfies the requirements of Regulation .08B of this chapter; or

(b) Determine that it cannot complete its eligibility determination without additional information or verifications, and issue a written notice that informs the applicant or recipient of:

(i) The information and verifications required to determine or redetermine eligibility; and

(ii) The due dates for the Department's eligibility determination and for the applicant's or recipient's provision of the additional information and verifications requested by the Department.

(2) No Disability Determination by Social Security Administration. Unless the time standard is extended pursuant to §D of this regulation with respect to an applicant who has had no determination of disability or continuing disability completed by the Social Security Administration within the time frame prescribed by Regulation .03C(2) of this chapter, the Department shall complete the requirements specified in §A(1)(a) or (b) of this regulation not later than 90 days from the application date.

(3) Time Standard for Redeterminations. Before the beginning of a new certification period, the Department shall:

(a) Issue a redetermination form to a recipient at least 60 days before the end of the current certification period; and

(b) Perform a redetermination of a recipient's eligibility, subject to any premium payment required by Regulation .07 of this chapter, for the EID coverage group.

B. Time Standards for Applicants and Recipients.

(1) Unless the time standard is extended pursuant to §D of this regulation, the applicant or recipient shall, within the time standards specified in §B(2)—(4) of this regulation, provide to the Department:

(a) The completed and signed application required by Regulation .05A(3) of this chapter; and

(b) The information and verifications, if any, requested by the Department pursuant to §A(1)(b) of this regulation.

(2) If the Department's request for information or verification is part of the application packet, an applicant or recipient shall provide the signed and completed application and supporting information and materials specified in Regulation .05A(3) of this chapter to the Department early enough for the Department to meet the 30-day time standard specified in §A of this regulation for completion, subject to any premium payment required by Regulation .07 of this chapter, of an eligibility determination or redetermination.

(3) If the Department's request is made after the application date, an applicant or recipient shall provide the requested information and verifications to the Department within 10 days of the date of the Department's notice pursuant to §A(1)(b) of this regulation.

(4) For redeterminations, the recipient shall provide to the Department, by the last day of the current certification period, all materials and information required by §B(1)—(3) of this regulation.

C. Time for Payment of Premium.

(1) Unless a claim of hardship is raised pursuant to Regulation .07C of this chapter, an applicant or recipient shall submit, within the time allowed by §B of this regulation, the premium required by Regulation .07A of this chapter.

(2) If a claim of hardship raised pursuant to Regulation .07C of this chapter is denied by the Department, the applicant or recipient to whom Regulation .07C(3) of this chapter applies shall pay the premium required by Regulation .07A of this chapter within 10 days of the date of the Departmentís notice pursuant to Regulation .07C(2) of this chapter.

D. Extension of Time Standards.

(1) The Department shall extend the time standards specified in §B of this regulation if:

(a) The applicant or recipient is actively attempting to establish eligibility but has been unable to provide the required information or verifications due to circumstances beyond the applicant's or recipient's control; or

(b) There is an administrative delay or emergency beyond the control of the Department.

(2) If the circumstances described in §D(1) of this regulation are present:

(a) The Department shall document in the applicant's or recipient's record the reason for the delay; and

(b) The extension of time shall continue as long as the requirements of §D(1) of this regulation are met.

E. Effect of Noncompliance with Time Standards. The Department shall deny the application for the EID coverage group and issue a notice of ineligibility or termination pursuant to Regulation .08C of this chapter if:

(1) The applicant or recipient fails to meet the timeliness requirements of §B of this regulation without the circumstances set forth in §D(1) of this regulation being present; or

(2) The time standard for the applicant's or recipient's submission of information and verifications set forth in §B of this regulation initially was extended pursuant to §D(1) of this regulation, but the requirements of §D(1) of this regulation are no longer met.

F. The standards of timeliness for acting on applications may not be used:

(1) To deny eligibility except as provided in §E of this regulation; or

(2) As a waiting period for EID enrollment of eligible individuals.

G. Withdrawal and Reactivation of Application.

(1) An individual who has filed an application for the EID coverage group with the Department may voluntarily withdraw the application at any time.

(2) An individual who has withdrawn an application for the EID coverage group may not reactivate the application except as provided in COMAR 10.09.24.

(3) If an applicant or recipient withdraws a pending application, the application form shall remain the property of the Department.