<?xml version='1.0' encoding='utf-8'?>
<regulation prefix="Regulation" num=".09" citation="COMAR 10.11.03.09" title_num="10" subtitle_num="11" chapter_num="03" heading="Disposition of Application.">
  <paragraph num="A.">
    <text>General.</text>
    <paragraph num="(1)">
      <text>The CMS Program professional staff shall:</text>
      <paragraph num="(a)">
        <text>Review individual applications;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>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;</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Verify the information provided by an applicant which may include an interview:</text>
        <paragraph num="(i)">
          <text>With the applicant if the applicant is 18 years old or older, or with the applicant’s parent or guardian; and</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>Which is held at a mutually convenient place and time for all parties.</text>
        </paragraph>
      </paragraph>
    </paragraph>
    <paragraph num="(2)">
      <text>If additional information is needed to determine eligibility or service needed, the Program shall:</text>
      <paragraph num="(a)">
        <text>Return the application within 15 business days of receipt; and</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Advise an applicant in writing of needed documentation.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(3)">
      <text>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.</text>
    </paragraph>
    <paragraph num="(4)">
      <text>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.</text>
    </paragraph>
  </paragraph>
  <paragraph num="B.">
    <text>Eligible Applicant.</text>
    <paragraph num="(1)">
      <text>An eligible applicant shall receive a letter from the CMS Program which includes, at a minimum, the following information:</text>
      <paragraph num="(a)">
        <text>The effective dates of CMS Program eligibility;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>The name of the provider; and</text>
      </paragraph>
      <paragraph num="(c)">
        <text>The service to be covered by the CMS Program.</text>
      </paragraph>
    </paragraph>
  </paragraph>
  <paragraph num="C.">
    <text>Ineligible Applicant.</text>
    <paragraph num="(1)">
      <text>An applicant is ineligible when the applicant does not:</text>
      <paragraph num="(a)">
        <text>Provide requested information sufficient to determine eligibility;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Complete, sign, and date the application; or</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Complete an application for Medical Assistance when the applicant is potentially eligible for services covered by Medical Assistance.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(2)">
      <text>An applicant determined ineligible shall receive a letter from the CMS Program informing the applicant of the reasons for the determination.</text>
    </paragraph>
    <paragraph num="(3)">
      <text>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.</text>
    </paragraph>
  </paragraph>
  <paragraph num="D.">
    <text>Appeal Rights.</text>
    <paragraph num="(1)">
      <text>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.</text>
    </paragraph>
    <paragraph num="(2)">
      <text>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.</text>
    </paragraph>
  </paragraph>
</regulation>