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 10.11.03.09 - Disposition of Application
Universal Citation: MD Code Reg 10.11.03.09
Current through Register Vol. 51, No. 19, September 20, 2024
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.
Disclaimer: These regulations may not be the most recent version. Maryland may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
This site is protected by reCAPTCHA and the Google
Privacy Policy and
Terms of Service apply.
