Md. Code Regs. 10.11.03.09

Current through Register Vol. 51, No. 25, December 13, 2024

Section 10.11.03.09 - Disposition of Application

A. General.

(1) The CMS Program professional staff shall:

(a) Review individual applications;

(b) Determine CMS Program eligibility and services to be approved for payment by the CMS Program within 30 calendar days of receipt of the complete application;

(c) Verify the information provided by an applicant which may include an interview:

(i) With the applicant if the applicant is 18 years old or older, or with the applicant's parent or guardian; and

(ii) Which is held at a mutually convenient place and time for all parties.

(2) If additional information is needed to determine eligibility or service needed, the Program shall:

(a) Return the application within 15 business days of receipt; and

(b) Advise an applicant in writing of needed documentation.

(3) Within 30 calendar days of receipt of the completed application by the CMS Program the CMS Program shall send a written decision regarding Program eligibility to the applicant.

(4) For renewal applications, the CMS Program shall notify an applicant in writing at least 30 calendar days before the date on which the applicant shall reapply.

B. Eligible Applicant.

(1) An eligible applicant shall receive a letter from the CMS Program which includes, at a minimum, the following information:

(a) The effective dates of CMS Program eligibility;

(b) The name of the provider ; and

(c) The service to be covered by the CMS Program.

C. Ineligible Applicant.

(1) An applicant is ineligible when the applicant does not:

(a) Provide requested information sufficient to determine eligibility;

(b) Complete, sign, and date the application; or

(c) Complete an application for Medical Assistance when the applicant is potentially eligible for services covered by Medical Assistance.

(2) An applicant determined ineligible shall receive a letter from the CMS Program informing the applicant of the reasons for the determination.

(3) An applicant determined to be ineligible shall be advised of the right to appeal the determination in accordance with the procedures set forth in §D of this regulation.

D. Appeal Rights.

(1) Providers filing appeals of administrative decisions made in connection with these regulations shall do so in accordance with Health-General Article, §2-207, and State Government Article, Title 10, Subtitle 2, Annotated Code of Maryland.

(2) An applicant or eligible individual, or other authorized representative has a right to a meeting or informal conference with CMS staff responsible for a decision reflected in any notice of determination issued in this chapter.

Md. Code Regs. 10.11.03.09

Regulations .09 repealed effective November 28, 1988 (15:24 Md. R. 2769)
Regulations .09 adopted effective November 28, 1988 (15:24 Md. R. 2769)
Regulations .09 amended and recodified from Regulation .12 effective 42:7 Md. R. 568, eff.4/13/2015