Code of Maryland Regulations
Title 10 - MARYLAND DEPARTMENT OF HEALTH
Part 3
Subtitle 11 - MATERNAL AND CHILD HEALTH
Chapter 10.11.03 - Children's Medical Services Program
Section 10.11.03.04 - Rights and Responsibilities
Universal Citation: MD Code Reg 10.11.03.04
Current through Register Vol. 51, No. 19, September 20, 2024
A. Applicant.
(1) The applicant shall furnish
factual information regarding the applicant's eligibility, and shall keep the
CMS Program informed of any change in demographic, financial, medical, or
insurance coverage status.
(2) An
eligible applicant shall use only Medical Assistance approved
providers.
(3) An applicant shall
complete a Medical Assistance application when the applicant is considered
potentially eligible.
B. CMS Program.
(1) An applicant who meets
eligibility criteria as set forth in this chapter shall have access to approved
services within the budgetary limitations of the CMS Program.
(2) The CMS Program may purchase health
insurance benefits for an eligible child when all of the following conditions
are met:
(a) The cost of this expense is less
than the cost of directly purchasing the child's medical care;
(b) The policyholder is unable to pay for the
health insurance policy due to:
(i) An
increase in insurance cost;
(ii) A
change in employment;
(iii) Loss of
income;
(iv) An increase in
health-related expenses; or
(v) The
policyholder's eligibility to purchase health insurance benefits in accordance
with the Consolidated Omnibus Budget Reconciliations Act of 1985, P.L.
99-272;
(c) The health
insurance policy is issued directly from:
(i)
An authorized insurer;
(ii) A
nonprofit health services plan;
(iii) A health maintenance
organization;
(iv) A self-insured
health benefit plan; or
(v) The
employer of the family member whose health insurance provides coverage for the
eligible child; and
(d)
Payment is for premiums that can be costed out as related to the applicant
only.
(3) The CMS
Program may pay copays, deductibles, and coinsurance costs when the CMS Program
is purchasing the health insurance benefits.
(4) The CMS Program shall comply with the requirements
of:
(a) Title VI of the Civil Rights Act of
1964 as amended;
(b) The Age
Discrimination Act of 1975 as amended;
(c)
§ 504 of the Rehabilitation Act of
1973 as amended; and
(d) The
Americans with Disabilities Act of 1989.
(5) The CMS Program shall determine financial
assistance based on the income and allowable deductions.
(6) The CMS Program shall provide full
financial assistance for authorized services when the income is equal to or
less than that which is allowable in accordance with the financial eligibility
levels described in Regulation .06A(4) of this chapter.
(7) The CMS Program shall provide full CMS
Program eligible service to the extent that medical assistance for this service
is not covered under Title XIX.
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