PROPOSAL
Maryland Register
Issue Date: June 9, 2017
Volume 44 • Issue 12 • Pages 591—592
Title 10
DEPARTMENT OF HEALTH AND MENTAL HYGIENE
Subtitle 09 MEDICAL CARE PROGRAMS
10.09.24 Medical Assistance Eligibility
Authority: Estates and Trusts Article, §14.5-1002; Health-General Article, §§2-104(b), 2-105(b), 15-103, 15-105, 15-121, and 15-401—15-407; Annotated Code of Maryland
Notice of Proposed Action
[17-154-P]
The Secretary of Health and Mental Hygiene proposes to amend Regulations .02 and .10 under COMAR 10.09.24 Medical Assistance Eligibility.
Statement of Purpose
The purpose of this action is to permit institutionalized individuals who have court-appointed guardians to receive an incremental increase to their personal needs allowance, allowing them to pay guardianship fees, as required by Ch. 390, Acts of 2016. This method allows the Department to facilitate fee payments while remaining compliant with State and federal requirements for calculating an institutionalized beneficiary’s available income. Additionally, this proposal adds definitions for the terms “guardian of the person” and “guardian of the property”.
Comparison to Federal Standards
There is no corresponding federal standard to this proposed action.
Estimate of Economic Impact
I. Summary of Economic Impact. Guardianship services were utilized by 813 unduplicated individuals out of 49,480 nursing facility residents, or 1.64 percent, during the implementation period at a cost of $480,000.
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Revenue (R+/R-) |
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II. Types of Economic Impact. |
Expenditure
(E+/E-) |
Magnitude |
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A. On issuing agency: |
(E+) |
$480,000 |
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B. On other State agencies: |
NONE |
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C. On local governments: |
(R+) |
$380,000 |
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Benefit (+)
Cost (-) |
Magnitude |
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D. On regulated industries or trade groups: |
NONE |
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E. On other industries or trade groups: |
(+) |
$100,000 |
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F. Direct and indirect effects on public: |
NONE |
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III. Assumptions. (Identified by Impact Letter and Number from Section II.) |
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A. Assumes every institutionalized Medicaid recipient with a guardian has sufficient income to allow for both guardianship fee and historic lower-priority deductions. This overstates the impact to the extent guardianship fees displace historic deductions. |
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C. Assumes primary beneficiaries of fee payments will be local governments. |
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E. Assumes guardians without government affiliation will receive some portion of the fee payments from Medicaid recipients. |
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 an impact on individuals with disabilities as follows:
Individuals with disabilities will benefit to the extent they are represented in the population of institutionalized individuals without capacity who may have better access to services of guardians as a result of the proposed action.
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 July 10, 2017. A public hearing has not been scheduled.
.02 Definitions.
A. (text unchanged)
B. Terms Defined.
(1)—(21-1) (text unchanged)
(21-2) “Guardian of the person” means a guardian appointed by a court pursuant to Estates and Trusts Article, Title 13, Subtitle 7, Annotated Code of Maryland, to serve the interests of a minor or disabled person under that subtitle.
(21-3) “Guardian of the property” means a guardian appointed by a court pursuant to Estates and Trusts Article, Title 13, Subtitle 2, Annotated Code of Maryland, to serve the interests of a minor or disabled person under that subtitle.
(22)—(63) (text unchanged)
.10 Determining Financial Eligibility for Institutionalized Persons.
A.—B. (text unchanged)
C. Retroactive Eligibility.
(1)—(4) (text unchanged)
(5) Subject to the requirements of §C(6) of this regulation, effective October 1, 2016, the personal needs allowance set forth in §C(4) of this regulation shall be increased as follows:
(a) For a Medicaid recipient who has been assigned a guardian of the person, $50 per month;
(b) For a Medicaid recipient who has been assigned a guardian of the property, $50 per month;
(c) For a Medicaid recipient who has been assigned a single guardian serving all purposes, $50 per month; and
(d) For a Medicaid recipient who has been assigned one individual to serve as guardian of the person and one different individual to serve as guardian of the property, $100 per month.
(6) A guardian shall submit a monthly bill to the Medicaid recipient or authorized representative in order for a guardianship fee to be added to the recipient’s personal needs allowance set forth in §C(4) of this regulation.
[(5)] (7)—[(6)] (8) (text unchanged)
[(7)] (9) When the available income as determined under §C(4) of this regulation is greater than the person’s incurred cost-of-care to the facility and countable resources are equal to or less than the medically needy resource standard, retroactive eligibility may exist under [§C(8)] §C(10) of this regulation.
[(8)] (10) Retroactive Spend-Down Eligibility.
(a)—(c) (text unchanged)
(d) Retroactive spend-down eligibility is established on the day the incurred medical expenses considered under [§C(8)(b)] §C(10)(b) of this regulation equal or exceed the excess available income. Certification is established under Regulation .11D of this chapter.
(e) (text unchanged)
D. Current Eligibility.
(1)—(2) (text unchanged)
(3) Subject to the requirements of §D(4) of this regulation, effective October 1, 2016, the personal needs allowance is increased as follows:
(a) For a Medicaid recipient who has been assigned a guardian of the person, $50 per month;
(b) For a Medicaid recipient who has been assigned a guardian of the property, $50 per month;
(c) For a Medicaid recipient who has been assigned a single guardian serving all purposes, $50 per month;
(d) For a Medicaid recipient who has been assigned one individual to serve as guardian of the person and one different individual to serve as guardian of the property, $100 per month.
(4) A guardian shall submit a monthly bill to the Medicaid recipient or authorized representative in order for a guardianship fee to be added to the recipient’s personal needs allowance set forth in §D(2) of this regulation.
[(3)] (5)—[(4)] (6) (text unchanged)
[(5)] (7) If, after application of the disregards in §D(2) of this regulation, the person’s income exceeds the projected cost-of-care, eligibility may be established under [§D(6)] §D(8) of this regulation.
[(6)] (8) Spend-down Eligibility.
(a)—(d) (text unchanged)
(e) Medical expenses incurred during the time periods specified in [§D(6)(b) and (c)] §D(8)(b) and (c) of this regulation shall be deducted from the excess available income beginning with the earliest time period and in the following order:
(i)—(iii) (text unchanged)
(f) Spend-down eligibility is established for the remainder of the period under consideration on the day the incurred medical expenses, considered under [§D(6)(e)] §D(8)(e) of this regulation, including projected private cost-of-care obligations, equal or exceed the amount of excess available income. Certification is established under Regulation .11D of this chapter.
(g)—(k) (text unchanged)
DENNIS R. SCHRADER
Secretary of Health and Mental Hygiene
