PROPOSAL
Maryland Register
Issue Date: April 29, 2016
Volume 43 • Issue 9 • Pages 543—544
Title 10
DEPARTMENT OF HEALTH AND MENTAL HYGIENE
Subtitle 09 MEDICAL CARE PROGRAMS
10.09.24 Medical Assistance Eligibility
Authority: Health-General Article, §§2-104(b), Annotated Code of Maryland
Notice of Proposed Action
[16-109-P]
The Secretary of Health and Mental Hygiene proposes to amend Regulation .05-4 under COMAR 10.09.24 Medical Assistance Eligibility.
Statement of Purpose
The purpose of this action is to provide clearer language for existing regulations regarding Medicaid eligibility disability decisions so that State regulations are consistent with existing federal regulations.
Comparison to Federal Standards
There is a corresponding federal standard to this proposed action, but the proposed action is not more restrictive or stringent.
Estimate of Economic Impact
The proposed action has no economic impact.
Economic Impact on Small Businesses
The proposed action has minimal or no economic impact on small businesses.
Impact on Individuals with Disabilities
The proposed action has no impact on individuals with disabilities.
Opportunity for Public Comment
Comments may be sent to Michele Phinney, Director, Office of Regulation and Policy Coordination, Department of Health and Mental Hygiene, 201 West Preston Street, Room 512, Baltimore, MD 21201, or call 410-767-6499 (TTY 800-735-2258), or email to dhmh.regs@maryland.gov, or fax to 410-767-6483. Comments will be accepted through May 30, 2016. A public hearing has not been scheduled.
.05-4 [MAGI Exempt and other] Nonfinancial Criteria for MAGI Exempt Coverage Groups.
A. (text unchanged)
B. Disability.
(1) (text unchanged)
(2) Procedure for Determination of Disability.
(a)―(b) (text unchanged)
(c) A Family Investment Administration review team shall review the medical report and other evidence obtained under [§C(2)(b)] §B(2)(b) of this regulation and determine whether the individual’s condition meets the definition of disability. The review team shall be composed of a medical or psychological consultant, and another individual who is qualified to interpret and evaluate medical reports and other evidence relating to the individual’s physical or mental impairments and, as necessary, to determine the capacities of the individual to perform substantial gainful activity as specified in 20 CFR Part 416, Subpart J.
(3) Disability Determination Made by the Social Security Administration.
[(3)] (a) (text unchanged)
[(4)] (b) A determination by the Social Security Administration is binding on the Family Investment Administration until it is changed by the Social Security Administration. If the Social Security Administration determination is changed, the new determination is [also] binding on the Family Investment Administration.
[(5)] (c) The [local department of social services] Department or its designee shall refer to the Social Security Administration for reconsideration or reopening of the determination all applicants who allege new information or evidence affecting previous Social Security Administration determinations of ineligibility based on disability, except as specified in §B(4)(d)(i) of this regulation.
[(6)] (4) Disability Determination made by the [FIA] Family Investment Administration. The Family Investment Administration shall make a determination of disability if any of the following circumstances exists:
(a)―(b) (text unchanged)
(c) The individual has applied for both Medical Assistance and SSI benefits, and the Social Security Administration has not made [a Supplemental Security Income] an SSI determination within 90 days from the date of the individual’s application for Medical Assistance;
(d) The individual has applied for Medical Assistance and [alleges]:
(i) [A] Alleges a disabling condition different from, or in addition to, that considered by the Social Security Administration in making its determinations;
(ii) [Not] Alleges more than 12 months after the most recent determination by the Social Security Administration denying disability[,] that the individual’s condition has changed or deteriorated since that determination[,] and alleges a new period of disability[, which] that meets the durational requirements for disability, and has not applied to the Social Security Administration for a determination with respect to those allegations; [or]
(iii) [Less] Alleges less than 12 months after the most recent determination by the Social Security Administration denying disability[,] that the individual’s condition has changed or deteriorated[,] and alleges a new period of disability [which] that meets the durational requirements for disability, and has applied to the Social Security Administration for reconsideration or reopening of its disability decision but the Social Security Administration has refused to consider the new allegations; or
[(e) The individual has applied for Medical Assistance, and:
(i)] (iv) Alleges less than 12 months after the most recent determination by the Social Security Administration denying disability that the individual’s condition has changed or deteriorated[;],
[(ii) Alleges] alleges a new period of disability [which] that meets the durational requirements for disability[;], and
[(iii) No] no longer meets the nondisability requirements for [Supplemental Security Income] SSI, but may meet the State’s nondisability requirements for Medical Assistance eligibility.
VAN T. MITCHELL
Secretary of Health and Mental Hygiene
