The purpose of this chapter is to increase employment opportunities by making Medical Assistance coverage available to employed individuals with disabilities who meet: The disability criteria under Title II or XVI of the Social Security Act; and The nonfinancial and financial eligibility requirements established in this chapter. Applicability of COMAR 10.09.24.02 Definitions. Except as provided in §A(2) of this regulation, terms used in this chapter that are not defined in §C of this regulation have the meanings stated for the same terms in COMAR 10.09.24.02. If a term's definition in COMAR 10.09.24.02 references a “local department of social services” in the context of a determination of eligibility, the words “local department of social services” in the COMAR 10.09.24.02 definition shall be replaced, for purposes of the term's meaning in this chapter, with “the Department” . In this chapter, the following terms have the meanings indicated. Terms Defined. “Applicant” means an individual: Who is not a recipient; Who has submitted to the Department an application for the Employed Individuals with Disabilities coverage group; and Whose application has not received final action. “Application” means the filing with the Department of a written and signed application form for the Employed Individuals with Disabilities (EID) coverage group to establish eligibility for Medical Assistance benefits. “Application date” means the date a written and signed application form for determination or redetermination of eligibility for the EID coverage group is received by the Department. “Assistance unit” means an applicant or recipient and, when living together, the applicant's or recipient's spouse, whose eligibility for Medical Assistance benefits is determined in conjunction with each other. “Certification period” means a period of time of up to 12 months, beginning on the first day of the month in which the Department receives the application, for which the EID applicant’s or recipient’s eligibility to receive Medical Assistance benefits is certified. “Chronic hospital” has the meaning stated in COMAR 10.09.06.01B. “Continuing eligibility” means a recipient's EID eligibility for a subsequent certification period after the current certification period, based on the Department's redetermination of eligibility with respect to an individual who is enrolled in the EID coverage group on the application date. “Days” has the meaning stated in Article I, §36, Annotated Code of Maryland. “Department” means the Maryland Department of Health, as defined in COMAR 10.09.36.01, or its authorized agents acting on behalf of the Department. “Determination” means a decision by the Department regarding an applicant's or recipient's eligibility for the EID coverage group. “Disability” means an individual's medically determinable impairment that is the basis of a determination that the individual is disabled, according to the standards set forth in §1614(a)(3) of the Social Security Act, except substantial gainful activity is not considered in determining disability. “Disabled” means having a disability. “Disregard” means a fixed monetary amount or documented expense that is deducted from countable gross income to determine countable net income. “Employed” means being engaged in employment: That is verifiable; That yields earnings during the period under consideration; and The earnings from which are subjected to reporting, withholding, and payment as required by law, including but not limited to individual income tax, payroll tax, estimated income tax, and withholding or payments required by the Federal Insurance Contribution Act. “Employed Individuals with Disabilities (EID)” means the Medical Assistance coverage group for employed individuals with disabilities, which is: Operated under the regulations of this chapter; Funded jointly by the State and the federal governments; and Administered by the Department. “Employer-sponsored insurance (ESI)” means group health insurance coverage provided wholly or partly at the expense of an applicant's, recipient's, or spouse's employer. “Employment” means working for payment either for an employer or on a self-employed basis. “Excludable” means the types of income and resources that are specified in this chapter as not countable in the determination of eligibility for the EID coverage group. “Family unit size” means the number of individuals included in an assistance unit, which is used to determine the applicable income or resource standard. “Grace period” means a period of time not longer than 6 months during which an unemployed EID recipient pays premiums and remains eligible to receive EID benefits despite failing to meet the requirement that EID recipients be employed. “Hardship” means financial adversity or misfortune significant enough that it reasonably can be expected to compromise an applicant's or recipient's ability to obtain and provide basic food, shelter, and clothing for the applicant or recipient, another member of the assistance unit, or any dependents of the applicant or recipient. “Health insurance” has the same meaning as “health insurance coverage”, as stated in COMAR 10.09.43.02B. “Initial eligibility” means the EID eligibility of an individual who is not enrolled in the EID coverage group on the application date. “Long-term care facility services” means services delivered to patients admitted to a nursing facility, chronic hospital, or a rehabilitation hospital. “Medical criteria for disability” means the criteria applied by the Social Security Administration (SSA) to determine disability under Title XVI of the Social Security Act, except for the disability criteria that consider an individual's earnings as evidence of an ability to perform substantial gainful activity. “Medically necessary” means that the service or benefit is: Directly related to diagnostic, preventive, curative, palliative, rehabilitative, or ameliorative treatment of an illness, injury, disability, or health condition; Consistent with current accepted standards of good medical practice; The most cost-efficient service that can be provided without sacrificing effectiveness or access to care; and Not primarily for the convenience of the consumer, family, or provider. “Notice of eligibility” means the written notice issued by the Department informing an applicant or recipient of: The Department's finding of eligibility or ineligibility; and The legal rights and obligations of the applicant or recipient associated with the Department's determination. “Nursing facility” has the meaning stated in COMAR 10.09.10.01B. “Period under consideration” means a period of 6 months, beginning on the first day of the month of the application date, for which an assistance unit's income is assessed for a determination of eligibility under this chapter. “Premium” means the monthly amount an applicant or recipient is required to pay, absent a successful claim of hardship pursuant to Regulation .07C of this chapter, as a condition of eligibility for the EID coverage group and Medical Assistance benefits. “Provider” has the same meaning as “health care provider”, as stated in Health-General Article, §19-132, Annotated Code of Maryland. “Recipient” means an individual who has been determined eligible for the EID coverage group. “Redetermination” means a determination by the Department, at least every 12 months, regarding the continuing eligibility of a recipient, in accordance with the requirements of this chapter. “Rehabilitation hospital” has the same meaning as “special rehabilitation hospital”, as stated in COMAR 10.07.01.02C. “Social Security Disability Insurance (SSDI)” means a federally administered program that provides benefits to individuals with disabilities who have paid sufficient Social Security taxes to be eligible for disability insurance payments under Title II of the Social Security Act, 42 U.S.C §423 et seq. “Substantial gainful activity” has the meaning stated in 20 CFR §416.910, which the Social Security Administration applies in determining disability under Title XVI of the Social Security Act. The Department shall determine whether an applicant or recipient meets the nonfinancial eligibility requirements for Medical Assistance benefits under this regulation. An applicant or participant meets the nonfinancial eligibility requirements for Medical Assistance benefits under this regulation if the applicant or participant: Is 16 years old or older, but younger than 65 years old; Is employed, except when an unemployment grace period described under Regulation .07 of this chapter applies, and verifies employment and compliance with all applicable requirements relating to FICA, income tax reporting, withholding, and payment requirements, including, if self-employed, payment of estimated taxes, by submitting documentation such as: Pay stubs; A letter from the employer verifying the applicant's or recipient's employment; Bank statements showing deposits of earnings; Income tax returns; Evidence of payment of estimated taxes; or Business ledgers; Except for the consideration of substantial gainful activity, meets the definition of disability in §1614(a)(3) of the Social Security Act, as determined by: The Department pursuant to a disability determination process for applicants who have not had a disability determination completed by the Social Security Administration within the time period prescribed in §C(2) of this regulation; or The Social Security Administration, if the applicant or recipient: Receives SSDI benefits; or Has lost eligibility for SSDI or SSI for any reason other than medical improvement; As specified in COMAR 10.09.24: Meets the eligibility requirements for Medical Assistance as to: Citizenship; and Residency; and Is not: An institutionalized person; An inmate of a public institution; or An inpatient in an institution for mental disease; and Is not a current recipient of: Comprehensive Medical Assistance benefits pursuant to COMAR 10.09.24; or Benefits under the Maryland Children's Health Program pursuant to COMAR 10.09.11 or 10.09.43. Periodic Redetermination of Disability. The Department shall periodically review a recipient's impairments to determine continuing disability status, consistent with §C(2) of this regulation. Frequency of Continuing Disability Reviews. The Department may schedule the periodic disability reviews required by §C(1) of this regulation at a frequency that is consistent with the time frames set forth in federal law and regulations as specified in 20 CFR §416.989, as amended, and 20 CFR §416.990, as amended, which are incorporated by reference. Assistance Unit. An applicant's or recipient's assistance unit shall include the: Applicant or recipient; and Applicant's or recipient's spouse when living in the same household, whether or not the spouse is eligible for the same benefits under this chapter. Consideration of Income. Except as provided in §B(2) or C of this regulation, the Department shall determine, in accordance with the policies and procedures for aged, blind, or disabled coverage groups specified at COMAR 10.09.24, the countable net income of an EID applicant or participant for purposes of determining the applicable premium amount under Regulation .07 of this chapter. To determine the countable net income of an EID assistance unit, the Department shall subtract from the assistance unit's total gross income: The general income exclusions and disregards and the specific income exclusions and disregards for aged, blind, or disabled coverage groups specified at COMAR 10.09.24; and An amount equal to the applicant's, recipient's, or spouse's documented out-of-pocket cost of premium payments to secure current employer-sponsored insurance coverage that includes coverage of the applicant or recipient. As a condition of eligibility for Medical Assistance benefits under this chapter, unless good cause for not doing so is shown, applicants and recipients, shall take all necessary steps to obtain any annuities, pensions, retirement, and disability benefits to which they are entitled, including, but not limited to: Veterans' compensation and pensions; Old Age and Survivors' Disability Insurance (OASDI) benefits; Railroad retirement benefits; Unemployment compensation; or Social Security Disability Income (SSDI). Income Standards. Effective January 1, 2024, no income standard applies to applicants or participant under this chapter. Consideration of Resources. Except as provided in this section, whether an applicant meets the resource standards for eligibility for the EID coverage group shall be determined according to the policies and procedures for aged, blind, or disabled coverage groups specified in COMAR 10.09.24. To determine the total countable resources of an applicant, the Department shall apply the general resource exclusions and specific resource exclusions for aged, blind, or disabled coverage groups specified in COMAR 10.09.24 to the total gross resources of the applicant. From the total countable resources of the applicant determined pursuant to §C(1) and (2) of this regulation, the Department shall subtract the aggregate current cash value of the applicant’s or participant’s ownership interest in any of the following types of accounts: 401(k) retirement account; 403(b) retirement account; Pension plan; Keogh plan; Individual retirement account (IRA); Independence Account; or Other retirement accounts as defined by the IRS. For an applicant or participant to be eligible for Medical Assistance benefits under this chapter, the countable resources attributed to the applicant’s or participant’s assistance unit pursuant to §§C and D of this regulation may not exceed $10,000 for an individual. Independence Accounts. Account Provisions. Contributions to any of the participant’s registered Independence Accounts are subject to the rules described in this section and to any policies of the respective financial institution governing the account. All contributions to the participant’s Independence Account or accounts, including interest, dividends, or other gains from the principal, shall be treated as an exempt asset for the purpose of calculating eligibility for Medical Assistance and the EID program. The purpose of an Independence Account is to allow the participant to purchase any items or services that may aid in the participant’s pursuit of personal or financial independence. The EID participant shall be the sole owner of any account registered as an Independence Account. The Department shall assess the participant’s Independence Account as a part of the verification process at redetermination for Medical Assistance. The review process shall include verifying all contributions to the participant’s Independence Account with the financial institution holding the participant’s account. The total amount a participant deposits in all independence accounts during an annual certification period may not exceed the participant’s gross earned income for that annual certification period. Independence Account Registration. A person shall complete an account registration form to register an applicable account as an Independence Account with the Department. A person shall re-register the Independence Account with the Department if the financial institution or other information for the Independence Account changes. The applicant or participant shall report any changes in personal or financial status that may affect the applicant’s or participant’s eligibility for Medical Assistance as described in COMAR 10.09.24. For all registered Independence Accounts, the date of account creation may be no earlier than the date an EID participant is determined eligible for Medical Assistance under this section. For all registered Independence Accounts, the funds in the Independence Account shall be held separate from the participant’s non-exempt assets. Application. To any individual requesting information, the Department shall provide oral or written information about: EID eligibility requirements; The coverage, scope, and related services of the Medical Assistance Program; and Applicants' and recipients' rights and obligations under the Medical Assistance Program. The Department shall issue an EID application form to any individual upon request. An applicant or recipient may apply for a determination or a redetermination of eligibility for the EID coverage group by submitting to the Department: The application form designated by the Department and signed in accordance with the signature requirements of COMAR 10.09.24; The social security numbers of each member of the assistance unit, in accordance with §A(5) of this regulation; and Signed consent forms as specified in §A(4) of this regulation. Consent Forms. An applicant or recipient, or, if necessary and consistent with the signature requirements specified in COMAR 10.09.24, a representative or other individual acting on behalf of the applicant or recipient, shall sign consent forms as needed to authorize the Department's verification of information needed to establish eligibility through sources such as employers, banks, and public or private agencies. Social Security Number. As required in COMAR 10.09.24 for each assistance unit member requesting benefits under this chapter, an applicant or recipient shall: Provide the Department with the individual's Social Security number; or Verify that the individual has applied to the Social Security Administration for a Social Security card. An applicant's or recipient's failure to meet the requirements of §A(5)(a) of this regulation shall result in a determination of ineligibility under this chapter. An applicant or recipient shall provide to the Department information and verifications needed for the determination of all elements of nonfinancial, income, and resource eligibility, including but not limited to information relating to health insurance coverage or potential third-party payments. Additional Information Requirements. An applicant or recipient shall, at the Department's request: Be available for and participate in an interview; and Answer questions and provide information relevant to: The applicant's eligibility for the EID coverage group; or The recipient's continuing eligibility for the EID coverage group. An individual temporarily absent from the State who intends to return to the State: May apply to the Department by mail for the EID coverage group; and To establish eligibility for the EID coverage group, shall: Demonstrate continued residency in the State; and Meet all technical and financial requirements of eligibility under this chapter. An applicant or recipient shall cooperate and assist with the Department's eligibility determination or redetermination process under this chapter, including but not limited to the requirements of §A of this regulation. The Department shall: Maintain a case record for the applicant or recipient, including documentation of all required elements of eligibility; Conduct a wage-screening inquiry to determine wages, benefits, and claimant history for each assistance unit member; Verify all factors of eligibility under this chapter for each assistance unit member applying for the EID coverage group; and Restrict disclosures of information concerning applicants and recipients to purposes directly connected with the administration of the EID coverage group of the Medical Assistance program. Time Standards for the Department. Disability Determined by Social Security Administration. With respect to an application submitted by an individual determined to be disabled as provided in Regulation .03B(3)(b) of this chapter, unless the time standard is extended pursuant to §D of this regulation, the Department shall, not later than 30 days from the application date: Complete its determination or redetermination of eligibility, subject to any premium payment required by Regulation .07 of this chapter, and issue a written notice that satisfies the requirements of Regulation .08B of this chapter; or Determine that it cannot complete its eligibility determination without additional information or verifications, and issue a written notice that informs the applicant or recipient of: The information and verifications required to determine or redetermine eligibility; and The due dates for the Department's eligibility determination and for the applicant's or recipient's provision of the additional information and verifications requested by the Department. No Disability Determination by Social Security Administration. Unless the time standard is extended pursuant to §D of this regulation with respect to an applicant who has had no determination of disability or continuing disability completed by the Social Security Administration within the time frame prescribed by Regulation .03C(2) of this chapter, the Department shall complete the requirements specified in §A(1)(a) or (b) of this regulation not later than 90 days from the application date. Time Standard for Redeterminations. Before the beginning of a new certification period, the Department shall: Issue a redetermination form to a recipient at least 60 days before the end of the current certification period; and Perform a redetermination of a recipient's eligibility, subject to any premium payment required by Regulation .07 of this chapter, for the EID coverage group. Time Standards for Applicants and Recipients. Unless the time standard is extended pursuant to §D of this regulation, the applicant or recipient shall, within the time standards specified in §B(2)—(4) of this regulation, provide to the Department: The completed and signed application required by Regulation .05A(3) of this chapter; and The information and verifications, if any, requested by the Department pursuant to §A(1)(b) of this regulation. If the Department's request for information or verification is part of the application packet, an applicant or recipient shall provide the signed and completed application and supporting information and materials specified in Regulation .05A(3) of this chapter to the Department early enough for the Department to meet the 30-day time standard specified in §A of this regulation for completion, subject to any premium payment required by Regulation .07 of this chapter, of an eligibility determination or redetermination. If the Department's request is made after the application date, an applicant or recipient shall provide the requested information and verifications to the Department within 10 days of the date of the Department's notice pursuant to §A(1)(b) of this regulation. For redeterminations, the recipient shall provide to the Department, by the last day of the current certification period, all materials and information required by §B(1)—(3) of this regulation. Time for Payment of Premium. Unless a claim of hardship is raised pursuant to Regulation .07C of this chapter, an applicant or recipient shall submit, within the time allowed by §B of this regulation, the premium required by Regulation .07A of this chapter. If a claim of hardship raised pursuant to Regulation .07C of this chapter is denied by the Department, the applicant or recipient to whom Regulation .07C(3) of this chapter applies shall pay the premium required by Regulation .07A of this chapter within 10 days of the date of the Department’s notice pursuant to Regulation .07C(2) of this chapter. Extension of Time Standards. The Department shall extend the time standards specified in §B of this regulation if: The applicant or recipient is actively attempting to establish eligibility but has been unable to provide the required information or verifications due to circumstances beyond the applicant's or recipient's control; or There is an administrative delay or emergency beyond the control of the Department. If the circumstances described in §D(1) of this regulation are present: The Department shall document in the applicant's or recipient's record the reason for the delay; and The extension of time shall continue as long as the requirements of §D(1) of this regulation are met. Effect of Noncompliance with Time Standards. The Department shall deny the application for the EID coverage group and issue a notice of ineligibility or termination pursuant to Regulation .08C of this chapter if: The applicant or recipient fails to meet the timeliness requirements of §B of this regulation without the circumstances set forth in §D(1) of this regulation being present; or The time standard for the applicant's or recipient's submission of information and verifications set forth in §B of this regulation initially was extended pursuant to §D(1) of this regulation, but the requirements of §D(1) of this regulation are no longer met. The standards of timeliness for acting on applications may not be used: To deny eligibility except as provided in §E of this regulation; or As a waiting period for EID enrollment of eligible individuals. Withdrawal and Reactivation of Application. An individual who has filed an application for the EID coverage group with the Department may voluntarily withdraw the application at any time. An individual who has withdrawn an application for the EID coverage group may not reactivate the application except as provided in COMAR 10.09.24. If an applicant or recipient withdraws a pending application, the application form shall remain the property of the Department. Submission of Premium. Unless an exception under §A(2) of this regulation applies or a timely claim of hardship is raised pursuant to §C of this regulation, an applicant or recipient shall, as a condition of eligibility for the EID coverage group, pay the premium specified in §A(3) of this regulation. Limitation of Premium Requirement. An applicant or recipient with income at or below the federal poverty level is not required to pay a premium as a condition of eligibility in the EID coverage group. With respect to an applicant determined eligible subject to the requirements of §A(3) of this regulation, the Department shall waive the premium payment before the notice of eligibility for a period not to exceed 6 months if such notice of eligibility is delayed by factors beyond the applicant's control. An applicant or participant whose assistance unit has income: Above the federal poverty level, but at or below 200 percent of the federal poverty level, shall pay a monthly premium of $25; Above 200 percent, but at or below 250 percent of the federal poverty level, shall pay a monthly premium of $40; Above 250 percent, but at or below 300 percent of the federal poverty level, shall pay a monthly premium of $55; Above 300 percent, but at or below 450 percent of the federal poverty level, shall pay a monthly premium of 4 percent of the monthly net countable income determined under Regulation .04B of this chapter; Above 450 percent, but at or below 600 percent of the federal poverty level, shall pay a monthly premium of 5 percent of the monthly net countable income determined under Regulation .04B of this chapter; or Above 600 percent of the federal poverty level, shall pay a monthly premium of 7.5 percent of the monthly net countable income determined under Regulation .04B of this chapter. Request for Payment. With respect to an applicant or recipient determined eligible subject to the requirements of §A(3) of this regulation, the Department shall issue a request for payment of the applicable premium, indicating that the applicant or recipient shall pay the amount specified within 30 days of the date the Department mailed the request for payment. An applicant or recipient to whom §A(3) of this regulation applies shall, within 30 days of the Departments request for payment pursuant to Regulation §A(4) of this regulation: Pay the full premium due as specified in the request for payment issued pursuant to §A(4) of this regulation; or Submit a claim of hardship as authorized by §C of this regulation. Upon request by the recipient, the Department shall approve an unemployment grace period, not to exceed 6 months within a 12-month period, provided the recipient: Has unemployment due to medical reasons or involuntary job loss; Is otherwise eligible for EID; and Continues to pay the premium during the unemployment grace period. Nonpayment of Premium. If an applicant who is required to pay a premium under §A(3) of this regulation, and is the subject of a request for payment issued by the Department pursuant to §A(4) of this regulation, does not pay the premium or submit a hardship claim within 30 days of the Department's notice, the Department shall: Determine the applicant is not eligible for the EID coverage group; and Issue a denial notice as required by Regulation .08C(1) of this chapter. If recipient who is required to pay a premium under §A(3) of this regulation, and is the subject of a request for payment issued by the Department pursuant to §A(4) of this regulation, does not pay the premium or submit a hardship claim within 30 days of the Department's notice, the Department shall: Determine the recipient is not eligible for the EID coverage group; Issue a termination notice as required by Regulation .08C(2) of this chapter; and Refer the recipient to the Central Collection Unit. An applicant or recipient whose eligibility is denied or terminated due to failure to pay the premium as specified in §A(4) of this regulation may not be reenrolled in the EID coverage group until the applicant or recipient pays all monies due to the Department in full. Hardship. If the applicant or recipient suffers financial adversity or misfortune so severe that payment of the premium would compromise the applicant's or recipient's ability to obtain and provide basic food, shelter, and clothing for members of the assistance unit or other legal dependents of the applicant or recipient, the applicant or recipient may submit a claim of hardship, specifying the underlying circumstances, to the Department. The Department shall evaluate the claim of hardship and notify the applicant or recipient of its decision within 30 days of the Department's receipt of the written claim of hardship. If the Department determines that the applicant or recipient's claim of hardship is without merit, the applicant or recipient shall pay the applicable premium within 10 days after the date the Department's notice is issued pursuant to §C(2) of this regulation. Department's Determination. Based on the information presented, the Department shall determine whether an applicant or recipient is or is not eligible for the EID coverage group under this chapter. Finding of Eligibility or Continuing Eligibility. Notice of Initial Eligibility. If the Department determines that an applicant is eligible, subject to the requirements of Regulation .07A of this chapter, for the EID coverage group, the Department shall issue to the applicant written notice that includes: A statement of the finding of eligibility, as applicable, indicating the beginning and ending dates of coverage, in accordance with §E of this regulation; and Notice of the right to request a hearing pursuant to Regulation .13 of this chapter. Notice of Continuing Eligibility. If the Department determines that a recipient qualifies for continuing eligibility for the EID coverage group, the Department shall issue to the recipient a written notice that includes: A statement of the finding of continuing eligibility, indicating the beginning and ending dates of coverage, in accordance with §E of this regulation; and A notice of the right to request a hearing pursuant to Regulation .13 of this chapter. Denial or Termination. Applicant—Denial Notice. If the Department determines that an applicant is not eligible for the EID coverage group, the Department shall issue to the applicant a written denial notice that includes: A statement of the Department's finding for the EID coverage group; The reason for the finding; The regulation supporting the finding; and Notice of the right to request a hearing pursuant to Regulation .13 of this chapter. Recipient—Notice of Termination. If the Department finds that a recipient is no longer eligible for the EID coverage group, the Department shall issue to the recipient a written notice of termination that includes: A statement of the Department's finding that the recipient is no longer eligible for the EID coverage group; The reason for the finding; The regulation supporting the finding; and Notice of the right to request a hearing pursuant to Regulation .13 of this chapter. Grounds for Department's Denial or Termination. If the Department finds one or more of the reasons for denial or termination listed in §D(2) of this regulation with respect to an applicant or recipient, the Department shall determine that: An applicant is not eligible for the EID coverage group and issue a notice of denial as specified in §C(1) of this regulation; or A recipient is no longer eligible for the EID coverage group and issue a notice of termination as specified in §C(2) of this regulation. Grounds for denial or termination from the EID coverage group shall include that an applicant or recipient: Does not meet, or no longer meets, the EID eligibility criteria for: Nonfinancial eligibility, as specified in Regulation .03 of this chapter; or Financial eligibility, as specified in Regulation .04 of this chapter; Did not submit, within the time standard specified in Regulation .06B of this chapter: A complete application, signed by the applicant as required by Regulation .05A(3) of this chapter; and All information and verifications requested by the Department pursuant to Regulation .05A(3)—(7) of this chapter, to determine the applicant’s or recipient’s eligibility for the EID coverage group; Did not cooperate with the Department’s eligibility determination process as required by Regulation .05A(9) of this chapter; Did not: Pay the premium required by Regulation .07A of this chapter; or Submit a claim of hardship that was approved by the Department pursuant to Regulation .07C of this chapter; Did not comply with the posteligibility requirements specified in Regulation .09B and C of this chapter; or Died. Certification Period. A recipient's certification period for initial eligibility shall begin on the first day of the month in which the Department receives the application. For a recipient approved by the Department for continuing eligibility, the next certification period shall begin on the first day of the month immediately following the month in which the previous certification period ends. Unless the recipient is terminated before the end of the certification period due to a change in circumstances or other reason for ineligibility, a recipient’s certification period ends, except as provided in §§D(2)(f) and E(4) of this regulation, on the last day of the current 12-month eligibility period. A recipient's certification period may be extended if the Department requires additional time to complete its redetermination of the recipient's eligibility. Department's Responsibility. If it makes a determination as described in Regulation .08A of this chapter, the Department shall: Inform the applicant or recipient of the applicant's or recipient's legal rights and obligations; and 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. Recipient Responsibility. A recipient or the recipient's representative shall: Notify the Department within 10 business days of changes that may affect the recipient's eligibility for EID; Limit use of the Medical Assistance card to the individual whose name appears on the card; 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; If services covered under the State Plan are provided for injuries resulting from an accident, provide to the Department: Notice as to the time, date, and location of the accident; The name and address of the attorney; The names and addresses of all parties and witnesses to the accident; and The police report number if an investigation is made; If written notice of cancellation is received, discontinue use of the Medical Assistance card on the first day of ineligibility; and Cooperate with the Medical Assistance Quality Control—Program Integrity. 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: Termination of benefits under this chapter; and Legal action. Additional Recipient Responsibilities Concerning Third Party Reimbursement. A recipient of Medical Assistance in the EID coverage group: 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; Shall assign benefits to the Department and cooperate in the Department's recovery procedures as required in COMAR 10.09.24; and 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. Except as provided in §§B and C of this regulation, a recipient in the EID coverage group is covered for medically necessary services required by the recipient, if the services are: Furnished by a provider who, with respect to the services rendered, is approved by the Department to participate in the Medical Assistance Program; Covered under the State Plan; Not covered under ESI or any other health insurance coverage besides Medical Assistance; and Not the subject of any third party liability. Copayments, Deductibles, and Coinsurance. Medical Assistance does not cover any copayments, deductibles, or coinsurance applicable to the ESI coverage of a recipient in the EID coverage group. An EID recipient is not entitled to: Enrollment in the Maryland Medicaid Managed Care Program (HealthChoice) in accordance with COMAR 10.09.62—10.09.75; Enrollment in Rare and Expensive Case Management (REM), in accordance with COMAR 10.09.69; Enrollment in the Program of All-Inclusive Care for the Elderly (PACE) under COMAR 10.09.44; or Long-term care facility services exceeding 30 consecutive days. The requirements for provider participation and reimbursement for services furnished to Medical Assistance recipients in the EID coverage group are governed by the same authorities that apply to services furnished to Medical Assistance recipients in other coverage groups, including: General Medical Assistance Provider Participation Criteria, as specified in COMAR 10.09.36; and Service-specific provisions included within regulations applicable to individual service categories. The provisions of COMAR 10.09.24.14 concerning fraud apply to this chapter. The Department shall make a claim against income or resources, or both, of a recipient for benefits correctly paid, or to be paid, under the circumstances specified in COMAR 10.09.24.15A-1. The Department may impose a lien on the property of a recipient under the circumstances specified in COMAR 10.09.24.15A-2(1). The Department shall seek recovery of Medical Assistance benefits correctly paid as provided in COMAR 10.09.24.15A-3. The Department shall accept reimbursement if voluntarily offered by a current or former recipient or by someone acting on behalf of the current or former recipient. Extended Benefits Pending a Hearing Decision. The Department shall refer for reimbursement consideration all cases in which: A recipient received extended benefits pending a hearing and decision by the hearing officer; and The hearing officer affirmed the decision of the Department that was the subject of the appeal. The Department: Shall institute procedures to recover the cost of any expenditures made on behalf of a recipient in cases identified in §F(1) of this regulation; and May not apply §F(2)(a) of this regulation to an individual who requested a hearing and extended benefits based on a bona fide belief that the adverse action was erroneous. The Department shall refer for investigation and other appropriate action all cases in which a recipient has received coverage erroneously as a result of the action or inaction of the recipient, representative, or individual acting responsibly for the recipient. The Department shall investigate and take appropriate action in all cases in which eligibility has been incorrectly established as a result of the action or inaction of a recipient, representative, or individual acting responsibly for the recipient. Providers. If a recipient has ESI or other coverage, or if any other individual is obligated, either legally or contractually, to pay for, or to reimburse the recipient for, services covered by this chapter, a provider of covered services shall seek payment from that source before submitting a claim to the Medical Assistance Program. If an insurance carrier rejects the provider's claim or pays less than the amount allowed by the Medical Assistance Program, the provider may submit a claim to the Medical Assistance Program, which shall be accompanied by a copy of the insurance carrier's notice or remittance advice. If payment is made by both the Medical Assistance Program and the insurance or other source for the same service, the provider shall refund to the Department, within 60 days of receipt, the amount paid by the Medical Assistance Program or the insurance or other source, whichever is less. A provider shall reimburse the Department for any overpayment. Recipients. A recipient shall assist and cooperate with the Department's efforts to collect available health insurance benefits and other third party payments by: Completing a form designated by the Department to report all pertinent information to assist the Department in seeking reimbursement for services provided; Notifying the Department within 10 days if medical treatment has been provided as a result of any accident or other occurrence in which a third party may be liable for health care services provided to the recipient; and Providing to the Department, as set forth in §J(2) of this regulation, the information required under such circumstances pursuant to COMAR 10.09.24.12 and Regulation .09B(1)(d) of this chapter. An EID applicant or recipient shall have the hearing rights specified in COMAR 10.01.04, subject to the qualification set forth in §B of this regulation. To apply the terms of COMAR 10.01.04 to the hearing rights of an EID applicant or recipient, substitute “the Department” for references therein to the “local department of social services”. Health-General Article, §15-138, Annotated Code of Maryland Effective date: Regulations .01—.13 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 .01A amended as an emergency provision effective October 1, 2008 (35:22 Md. R. 1955); amended permanently effective February 9, 2009 (36:3 Md. R. 208) Regulation .02C amended as an emergency provision effective October 1, 2008 (35:22 Md. R. 1955); amended permanently effective February 9, 2009 (36:3 Md. R. 208) Regulation .02C amended effective May 27, 2013 (40:10 Md. R. 917); February 16, 2015 (42:3 Md. R. 316) Regulation .03 amended as an emergency provision effective October 1, 2008 (35:22 Md. R. 1955); amended permanently effective February 9, 2009 (36:3 Md. R. 208) Regulation .03B amended effective May 27, 2013 (40:10 Md. R. 917); December 25, 2023 (50:25 Md. R. 1087) Regulation .04 amended as an emergency provision effective October 1, 2008 (35:22 Md. R. 1955); amended permanently effective February 9, 2009 (36:3 Md. R. 208) Regulation .04 amended effective May 27, 2013 (40:10 Md. R. 917); December 25, 2023 (50:25 Md. R. 1087) Regulation .04D amended effective May 27, 2013 (40:10 Md. R. 917) Regulation .05 amended as an emergency provision effective October 1, 2008 (35:22 Md. R. 1955); amended permanently effective February 9, 2009 (36:3 Md. R. 208) Regulation .06 amended as an emergency provision effective October 1, 2008 (35:22 Md. R. 1955); amended permanently effective February 9, 2009 (36:3 Md. R. 208) Regulation .06C amended effective February 16, 2015 (42:3 Md. R. 316) Regulation .07 amended as an emergency provision effective October 1, 2008 (35:22 Md. R. 1955); amended permanently effective February 9, 2009 (36:3 Md. R. 208) Regulation .07 amended effective February 16, 2015 (42:3 Md. R. 316) Regulation .07A amended effective May 27, 2013 (40:10 Md. R. 917); December 25, 2023 (50:25 Md. R. 1087) Regulation .08 amended as an emergency provision effective October 1, 2008 (35:22 Md. R. 1955); amended permanently effective February 9, 2009 (36:3 Md. R. 208) Regulation .08 amended effective February 16, 2015 (42:3 Md. R. 316) Regulation .09A amended effective February 16, 2015 (42:3 Md. R. 316) Regulation .10C amended as an emergency provision effective October 1, 2008 (35:22 Md. R. 1955); amended permanently effective February 9, 2009 (36:3 Md. R. 208) Regulation .12J amended as an emergency provision effective October 1, 2008 (35:22 Md. R. 1955); amended permanently effective February 9, 2009 (36:3 Md. R. 208) Regulation .12J amended effective February 16, 2015 (42:3 Md. R. 316) Regulation .13 amended effective February 16, 2015 (42:3 Md. R. 316)