Current through Register Vol. 51, No. 19, September 20, 2024
A.
A Maryland resident diagnosed with end-stage renal disease may apply for
certification with the Program.
B.
An applicant, or the applicant's representative, shall complete a written
application on the form designated by the Program.
C. Application Supporting Documents.
(1) The Program may require the following as
part of the application form or in addition to the application form:
(a) Copies of the previous year's federal
income tax return of the applicant and each individual in the applicant's
family;
(b) Current statements of
liquid assets owned by the applicant and each individual in the applicant's
family;
(c) The amount of the
current Social Security benefits and all retirement or pension benefits, or
both, of the applicant and each individual in the applicant's family;
(d) Documentation of the applicant's identity
as well as citizenship or nationality, to the Department's satisfaction, based
on federal requirements;
(e)
Verification of the applicant's status as a resident of Maryland;
(f) Verification of the applicant's Medicare
status;
(g) Verification concerning
the applicant's enrollment in any health insurance benefit plan;
(h) Physician's certification that the
applicant has ESRD;
(i) Physician's
certification that the applicant has begun a regular course of maintenance
renal dialysis in a certified facility or received a renal transplant, or
both;
(j) A signed statement
authorizing the Program to verify, from any source including banks, insurance
companies, and public or private agencies providing monetary benefits,
information submitted to the Program by the applicant; and
(k) Other information the Program determines
is needed to establish whetherthe applicant is eligible to be a
recipient.
(2) Refusal
to sign an authorization that may be required under §C(1)(j) of this
regulation is considered failure to provide sufficient information, and the
applicant will be determined ineligible without prejudice in accordance with
§F of this regulation.
(3) In
reference to §C(1)(a) of this regulation, the Program may accept the
previous year's tax return through April 15 of the year in which an application
for certification is filed. After April 15, the Program requires the new tax
return or proof of extension granted for filing a return.
D. Signature Requirements.
(1) For the purpose of establishing
eligibility, the applicant or the applicant's representative, as appropriate,
shall complete and sign the application form.
(2) A physician shall sign the certification
that the applicant has ESRD and has begun a regular course of maintenance renal
dialysis, or has received a renal transplant, or both.
E. The applicant or the applicant's
representative shall forward the completed application form and supporting
documents to the address designated on the form.
F. An applicant shall provide all required
information within 90 days from the date the information is originally
requested by the Program or the applicant shall be determined ineligible
without prejudice and may reapply.
G. The applicant, or the applicant's
representative, may voluntarily withdraw an application at any time without
prejudice.
H. If the Program
determines that an applicant is not eligible for Program enrollment, the
Program shall notify the applicant or the applicant's representative, as
appropriate, in writing within 45 days of receipt of a completed application
and include the following in the notice:
(1)
The basis for the determination of ineligibility;
(2) An explanation of the right to request a
hearing; and
(3) A statement that
the applicant is permitted to submit a new application for Program enrollment
at any time.
I. If the
Program determines that an applicant is eligible for Program enrollment, the
Program shall:
(1) Establish a certification
period in accordance with Regulation .03C of this chapter;
(2) Notify the applicant or the applicant's
representative, as appropriate, in writing within 45 days of receipt of a
completed application;
(3) Issue a
Kidney Disease Program recipient identification card and instructions for using
the card; and
(4) Notify the
applicant or the applicant's representative, as appropriate, about any Program
participation fee due in accordance with Regulation .04 of this
chapter.
