Chapter 01. Maryland AIDS Drug Assistance Program: Temporary Assistance Program
Regulation .01 Purpose.LinkCopy Citation
The purpose of the Maryland AIDS Drug Assistance Program’s Temporary Assistance Program is to provide short term assistance to individuals with Human Immunodeficiency Virus (HIV) who:
A.
Need HIV drugs and other products;
B.
Have an application for Medical Assistance or Low-Income Subsidy pending; and
C.
Are considered likely to have their application approved.
Regulation .02 Definitions.LinkCopy Citation
A.
In this chapter, the following terms have the meanings indicated.
B.
Terms Defined.
(1)
“Acquired immunodeficiency syndrome (AIDS)” means the medical condition caused by the Human Immunodeficiency Virus.
(2)
“Agent” means a case manager, licensed social worker, registered nurse, or any other related professional that assists an individual in submitting an application to the Temporary Assistance Program.
(3)
“Applicant” means an individual on whose behalf an application has been submitted to the Temporary Assistance Program and whose eligibility status for the Temporary Assistance Program has not yet been determined.
(4)
“Department” means the Maryland Department of Health.
(5)
“Drug” means an article intended for use in the diagnosis, cure, mitigation, treatment, or prevention of disease licensed by the U.S. Food and Drug Administration, and covered by the Maryland AIDS Drug Assistance Program as specified in COMAR 10.18.06.04.
(6)
“Enrollment period” means the period of time a recipient may receive Temporary Assistance Program benefits.
(7)
“Health care practitioner” means any individual licensed to prescribe U.S. Food and Drug Administration-approved drugs or other products in the state in which they practice.
(8)
“Human immunodeficiency virus (HIV)” means the virus that causes AIDS.
(9)
“Low-Income Subsidy (LIS)” means the federal program available under the Medicare Part D prescription drug program and Medicare advantage plans that assists persons who have limited income to pay for the cost of premiums, deductibles, and copayments.
(10)
“Maryland AIDS Drug Assistance Program (MADAP)” means the program administered by the Department that provides services specified in COMAR 10.18.06.04 for enrolled recipients.
(11)
“Medical Assistance” has the meaning specified in COMAR 10.09.24.02.
(12)
“Open formulary” means all U.S. Food and Drug Administration-approved prescription medications and related devices that are not on the list of excluded drugs and other products maintained by the Department per COMAR 10.18.06.04-1.
(13)
“Recipient” means an individual who is enrolled in the Temporary Assistance Program.
(14)
“Resident” means an individual:
(a)
Who is living in the State voluntarily with the intention of making it that individual’s home and not for a temporary purpose; and
(b)
For whom any temporary absence from the State is coupled with an intent to return so as not to interrupt the continuity of residence.
(15)
“Temporary Assistance Program (TAP)” means the program administered by the Department that provides short term MADAP services as specified in Regulation .05 of this chapter for low income eligible individuals.
Regulation .03 Eligibility.LinkCopy Citation
To be eligible for benefits, an individual shall meet the following criteria:
A.
Be a resident of Maryland;
B.
Be infected with HIV; and
C.
Have a pending application to Medical Assistance or LIS.
Regulation .04 Application and Enrollment.LinkCopy Citation
A.
Application.
(1)
The agent of the applicant shall submit a completed TAP application to the Department on the form designated by the Department that includes:
(a)
Responses to all applicable questions; and
(b)
A copy of the completed application or other verifiable documentation for Medical Assistance or LIS enrollment.
(2)
The agent of the applicant or the applicant may voluntarily withdraw the application at any time without prejudice.
(3)
The Department shall:
(a)
Review and process a TAP application by the end of the first business day following receipt;
(b)
Approve a TAP application if the:
(i)
TAP application is complete;
(ii)
Applicant is determined to be eligible; and
(iii)
Department is able to ascertain that the applicant will likely be found eligible for Medical Assistance or LIS;
(c)
Issue a client identification number if the TAP application is approved;
(d)
Disapprove a TAP application if the:
(i)
TAP application is incomplete; or
(ii)
Agent of the applicant fails to provide sufficient information or documentation to determine eligibility; and
(e)
Contact the agent of the applicant with the status of the TAP application.
B.
Enrollment.
(1)
A recipient shall be approved for coverage beginning the first day of the month in which the:
(a)
TAP application was received; or
(b)
Recipient will need access to medications through TAP.
(2)
Benefits shall end on the date that a determination of Medical Assistance or LIS coverage occurs.
Regulation .05 Covered Services.LinkCopy Citation
A.
The recipient shall obtain a prescription for each drug or other product ordered for the recipient.
B.
The Department shall pay for a prescription drug or other product not excluded from the open formulary if the prescription is ordered and signed by a health care practitioner for a recipient.
Regulation .06 Recovery of Payments.LinkCopy Citation
If benefits have been incorrectly paid or another payer has been identified, the Department shall seek recovery of the amount of those payments.
Regulation .07 Fraud.LinkCopy Citation
The Department shall pursue cases of suspected misrepresentation or fraud pursuant to Criminal Law Article, §8-503, Annotated Code of Maryland, or any other applicable statutory provision.
Regulation .08 Confidentiality.LinkCopy Citation
Except when communicating with the parties listed in §B of this regulation and unless otherwise authorized by law, the agent of an applicant, or the agent of a recipient, the Department:
A.
Shall keep all applicant and recipient personal information confidential;
B.
May not disclose personal information kept on an applicant or recipient without written consent of the:
(1)
Applicant;
(2)
Recipient;
(3)
Applicant’s parent or legal guardian; or
(4)
Recipient’s parent or legal guardian;
C.
Shall comply with the laws and regulations concerning the privacy and security of protected health information under:
(1)
Health-General Article, Title 4, Subtitle 3, Annotated Code of Maryland; and
(2)
The Health Insurance Portability and Accountability Act of 1996 (HIPAA), 42 U.S.C. §§1320d et seq., as amended, the HITECH Act, 42 U.S.C. §§17932, et seq., as amended, and 45 CFR Parts 160 and 164, as amended, and their implementing regulations; and
D.
Shall ensure that all interactive video technology-assisted communication comply with HIPAA patient privacy and security regulations.
Regulation .09 Availability of Funding and Program Termination.LinkCopy Citation
A.
If sufficient monies are not available to fund TAP, the Department shall take the action necessary to eliminate a deficit which may include program termination.
B.
If TAP is terminated, the Department shall provide benefits for each current recipient in accordance with Regulation .04B of this chapter.
Chapter annotations
Authority: Health-General Article, §§2-104(b), 2-104(j), 2-105(a), and 18-102(a), Annotated Code of Maryland
History: Effective date: March 28, 2016 (43:6 Md. R. 408)
History: Regulation .02B amended effective May 20, 2019 (46:10 Md. R. 488)
History: Regulation .04B amended effective May 20, 2019 (46:10 Md. R. 488)
History: Regulation .05B amended effective May 20, 2019 (46:10 Md. R. 488)