Md. Code Regs. 10.09.41.09

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

Section 10.09.41.09 - Posteligibility Requirements

A. Department's Responsibility. If it makes a determination as described in Regulation .08A of this chapter, the Department shall:

(1) Inform the applicant or recipient of the applicant's or recipient's legal rights and obligations; and

(2) Provide to the applicant or recipient written notice of the findings, rights, and obligations as specified in COMAR 10.09.24.12A(2) and (4) and Regulation .08B or C of this chapter.

B. Recipient Responsibility.

(1) A recipient or the recipient's representative shall:

(a) Notify the Department within 10 business days of changes that may affect the recipient's eligibility for EID;

(b) Limit use of the Medical Assistance card to the individual whose name appears on the card;

(c) Cooperate with the Department by completing forms to report all pertinent information that would assist the Department in seeking reimbursement for expenditures made on the recipient's behalf;

(d) If services covered under the State Plan are provided for injuries resulting from an accident, provide to the Department:

(i) Notice as to the time, date, and location of the accident;

(ii) The name and address of the attorney;

(iii) The names and addresses of all parties and witnesses to the accident; and

(iv) The police report number if an investigation is made;

(e) If written notice of cancellation is received, discontinue use of the Medical Assistance card on the first day of ineligibility; and

(f) Cooperate with the Medical Assistance Quality Control-Program Integrity.

(2) A recipient's failure to comply with the provisions of §B(1) of this regulation may result in the adverse consequences specified in COMAR 10.09.24, including:

(a) Termination of benefits under this chapter; and

(b) Legal action.

C. Additional Recipient Responsibilities Concerning Third Party Reimbursement. A recipient of Medical Assistance in the EID coverage group:

(1) Is considered, as specified in COMAR 10.09.24, to have created an authorization for the release of data, records, and information necessary for the Department's pursuit of third-party reimbursement;

(2) Shall assign benefits to the Department and cooperate in the Department's recovery procedures as required in COMAR 10.09.24; and

(3) Shall assist and cooperate with the Department's efforts to collect available health insurance benefits and other third party payments as specified in this regulation and Regulation .12 of this chapter.

Md. Code Regs. 10.09.41.09

Regulations .09 adopted as an emergency provision effective April 1, 2006 (33:9 Md. R. 795); adopted permanently effective July 3, 2006 (33:13 Md. R. 1063)
Regulation .09 amended effective 42:3 Md. R. 316, eff.2/16/2015