Md. Code Regs. 10.09.43.04

Current through Register Vol. 51, No. 22, November 1, 2024

Section 10.09.43.04 - Application

A. Who Determines Eligibility.

(1) The LHD and the LDSS shall determine eligibility for MCHP.

(2) The Department shall determine eligibility for MCHP Premium.

B. Who Provides Program Information to Individuals.

(1) The LHD or the LDSS shall give oral or written information about the eligibility requirements for MCHP Premium to any individual requesting this information.

(2) The Department shall give oral and written information about the eligibility requirements, coverage, scope, and related services of MCHP Premium, and an individual's rights and obligations under MCHP Premium, to any individual requesting this information.

C. The LHD, the LDSS, or the Department shall provide the application form without delay to an individual requesting one.

D. Applicant Temporarily Absent from the State.

(1) If an applicant is temporarily absent from the State, the applicant's representative may:

(a) Apply for assistance by mail to the LHD in the jurisdiction in which the resident applicant's home is located; and

(b) Act on behalf of the applicant to satisfy application requirements to establish eligibility for the MCHP Premium, as specified in §D(2) of this regulation.

(2) To establish eligibility for MCHP Premium for an applicant temporarily absent from the State, the applicant or the applicant's representative shall:

(a) Affirm that:

(i) The applicant intends to return to the State; or

(ii) The applicant's parent or guardian intends to return the applicant to the State;

(b) Demonstrate the applicant's continued residency in the State; and

(c) Meet other technical and financial requirements.

E. Application Filing and Signature Requirements.

(1) The representative shall:

(a) Submit a written and signed MCHP application form to the LHD or the LDSS in the jurisdiction in which the applicant's residence is located; and

(b) Indicate on the MCHP application form a willingness to contribute part of the cost of a health plan to provide medical care for the applicant, if the applicant is not eligible for MCHP.

(2) The representative is responsible for completing the application, but may be assisted in the completion by an individual of the representative's choice.

(3) The application date is the date the MCHP application is received by the Department for consideration for eligibility for MCHP Premium.

(4) The parent or parents living with the child shall complete and sign the MCHP application form. If the child does not live with a parent, an authorized representative who is 21 years old or older shall complete and sign the application form.

F. A representative who has filed an application, which has been received by the Department, may voluntarily withdraw that application at any time.

G. Period Under Consideration. The period under consideration shall be a 12-month period beginning with the month of application.

H. Processing Applications-Time Limitations.

(1) When an application is filed, the Department shall make a determination of eligibility to participate in MCHP Premium promptly, but not later than 60 calendar days from the application date.

(2) The time period specified in §H(1) of this regulation covers the period from the application date to the date the Department mails notice of its decision to the representative.

(3) Time standards do not apply if, due to extenuating circumstances, the Department cannot reasonably make the determination within 60 calendar days from the date of application.

(4) The Department shall provide notice of delay for extenuating circumstances within 60 calendar days of the delay, stating the reason for the delay and the anticipated date of decision.

I. Information Required.

(1) The Department shall inform the representative of any additional information that the Department considers necessary for eligibility determination.

(2) The representative shall provide the additional information within a reasonable time limit as established by the Department.

(3) If the representative fails to provide required information within the 60 calendar days, the applicant shall be determined ineligible.

J. Third-Party Liability.

(1) A representative shall notify the Department within 10 working days if medical treatment has been provided as a result of a motor vehicle accident or other occurrence in which a third party may be liable for the recipient's medical expenses.

(2) A representative shall cooperate with the Department in completing a form designated by the Department to report all pertinent information and in collecting available health insurance benefits and other third-party payments.

(3) In accident situations, a representative shall notify the Department of the:

(a) Time, date, and location of the accident;

(b) Name and address of the attorney;

(c) Names and addresses of all parties and witnesses to the accident; and

(d) Police report number if an investigation is made.

K. Consent Forms. A representative shall sign consent forms, as determined necessary by the Department, authorizing the Department, or the Department's designee, to verify information needed to establish eligibility and compliance with conditions of participation.

Md. Code Regs. 10.09.43.04

Regulations .04 adopted as an emergency provision effective July 1, 2001 (28:12 Md. R. 1102); adopted permanently effective September 3, 2001 (28:17 Md. R. 1556)
Regulation .04E amended effective November 10, 2003 (30:22 Md. R. 1580)