<?xml version='1.0' encoding='utf-8'?>
<regulation prefix="Regulation" num=".03" citation="COMAR 07.03.07.03" title_num="07" subtitle_num="03" chapter_num="07" heading="Eligibility Criteria.">
  <paragraph num="A.">
    <text>An individual is eligible when, in any month, the individual:</text>
    <paragraph num="(1)">
      <text>Is a resident of the State;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Is receiving a federal benefit for age, blindness, or disability;</text>
    </paragraph>
    <paragraph num="(3)">
      <text>If not receiving a federal retirement or disability benefit, has filed an application for Supplemental Security Income (SSI) and Social Security Disability Insurance (SSDI), in accordance with §B of this regulation;</text>
    </paragraph>
    <paragraph num="(4)">
      <text>Is in an assisted living program, in a CARE home, or in a MDH rehabilitative residence while continuing to cooperate with all technical and financial requirements of eligibility; and</text>
    </paragraph>
    <paragraph num="(5)">
      <text>Continues to cooperate with all technical and financial requirements of eligibility.</text>
    </paragraph>
  </paragraph>
  <paragraph num="B.">
    <text>Social Security Administration Disability Benefits Applications and Appeals.</text>
    <paragraph num="(1)">
      <text>Applicants who are not receiving a federal retirement or disability benefit shall fully cooperate with the Social Security Administration (SSA) application and appeals processes.</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Failure to cooperate shall render the applicant or recipient ineligible and result in application denial or case closure.</text>
    </paragraph>
  </paragraph>
  <paragraph num="C.">
    <text>If SSA makes a final unfavorable decision, the customer is no longer eligible for assisted living benefits from the PAA program, unless:</text>
    <paragraph num="(1)">
      <text>Good cause exists for continued PAA eligibility, which the DHS Appointing Authority or its designee shall determine following a review; or</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Disability Services Operations (DSO) decides that the person meets the definition of disabled following a consultative exam or coordination with the State Disability Determination Services Agency.</text>
    </paragraph>
  </paragraph>
  <paragraph num="D.">
    <text>Determination of Medical Justification for Placement into an Assisted Living Facility.</text>
    <paragraph num="(1)">
      <text>The Department of Human Services shall establish a process through DSO to determine when medical justification for placement into a protected living environment is sufficient to support an individual’s eligibility for the PAA-Assisted Living program.</text>
    </paragraph>
    <paragraph num="(2)">
      <text>This provision does not apply to individuals participating in PAA-CARE homes and PAA-MDH rehabilitative residences.</text>
    </paragraph>
  </paragraph>
  <paragraph num="E.">
    <text>Temporary Absence from Maryland.</text>
    <paragraph num="(1)">
      <text>An individual remains a resident of the State despite temporary absence from the State if the individual intends to return when the purposes of the absence have been accomplished.</text>
    </paragraph>
    <paragraph num="(2)">
      <text>The local department shall verify, after 30 consecutive days of absence and monthly after that, whether the absence is temporary or permanent.</text>
    </paragraph>
  </paragraph>
  <paragraph num="F.">
    <text>Cooperation with the Eligibility Process.</text>
    <paragraph num="(1)">
      <text>An individual shall:</text>
      <paragraph num="(a)">
        <text>Provide all necessary information needed for initial or continued program eligibility and ensure that the information is true, correct, and complete; and</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Cooperate with the Agency in all aspects of program administration.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(2)">
      <text>The individual and the individual’s authorized representative are subject to the requirements in COMAR 07.03.14 if they provide false information.</text>
    </paragraph>
  </paragraph>
  <paragraph num="G.">
    <text>After meeting all other program requirements, an individual is eligible for Public Assistance to Adults:</text>
    <paragraph num="(1)">
      <text>While the application for other benefits is pending; and</text>
    </paragraph>
    <paragraph num="(2)">
      <text>After the application for other benefits is denied if the individual meets the conditions described in §A(3) of this regulation.</text>
    </paragraph>
  </paragraph>
  <paragraph num="H.">
    <text>Interim Payment Reimbursement Authorization.</text>
    <paragraph num="(1)">
      <text>Assisted living program and CARE home applicants and recipients shall sign an Interim Payment Reimbursement Authorization which:</text>
      <paragraph num="(a)">
        <text>Permits the Social Security Administration to mail the initial SSI payment to the local department providing the Public Assistance to Adults; and</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Allows the local department to reimburse itself for the assistance granted the recipient.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(2)">
      <text>If the initial SSI payment mailed to the local department is less than or equal to the amount of Public Assistance to Adults received for the months the individual was entitled to SSI, the local department may retain the full amount of the SSI payment.</text>
    </paragraph>
    <paragraph num="(3)">
      <text>If the amount of SSI received by the local department is greater than the amount of assistance paid, the local department shall pay the excess amount to the individual within 10 days of the receipt of the SSI payment and the Supplemental Security Income Notice of Interim Assistance Reimbursement Eligibility and Accountability Report.</text>
    </paragraph>
  </paragraph>
</regulation>