Ch. 513

1993 LAWS OF MARYLAND

(II) STATE MEDICAL ASSISTANCE.
15-403.                                                 

(A) TO BE ELIGIBLE FOR THE PROGRAM, AN INDIVIDUAL MUST:

(1)       (I) BE COVERED BY A LONG-TERM CARE POLICY THAT IS
APPROVED FOR THE PROGRAM BY THE COMMISSIONER UNDER § 15-404 OF THIS
SUBTITLE; AND

(II) HAVE EXHAUSTED ALL BENEFITS AVAILABLE UNDER THE
POLICY THAT ARE AVAILABLE FOR SERVICES TO TREAT OR MANAGE THE INSURED'S
CONDITION; AND

(2)       SATISFY ANY OTHER REQUIREMENT FOR ELIGIBILITY ESTABLISHED
BY THE DEPARTMENT.

(B) PROGRAM ELIGIBILITY MAY NOT BE DENIED UNDER THIS SECTION FOR
POLICY BENEFITS THAT ARE NOT AVAILABLE OR APPROPRIATE FOR TREATING THE
INSURED'S CONDITION.

15-404.

(A) THE COMMISSIONER, IN CONSULTATION WITH THE DEPARTMENT, SHALL
APPROVE STANDARDS FOR A LONG TERM CARE POLICY THAT QUALIFIES FOR THE
PROGRAM.                                       

(B) (A) TO QUALIFY UNDER THE PROGRAM, A LONG-TERM CARE POLICY
SHALL:

(1) SATISFY THE REQUIREMENTS OF ARTICLE 48A, SUBTITLE 48 OF THE
CODE;                                               

(2) COVER 5 UP TO 3 YEARS OF NURSING HOME CARE AND 6 YEARS OR
UP TO 3 YEARS OF HOME CARE OR COMMUNITY BASED SERVICES;

(3) PROVIDE FOR CASE MANAGEMENT SERVICES WHICH SHALL
INCLUDE PREAUTHORIZED ASSESSMENT AND REFERRAL PROGRAMS,. UTILIZATION
CONTROLS, AND THE USE OF APPROVED HEALTH CARE PROVIDERS;

(4) PROVIDE FOR A MINIMUM DAILY INDEMNITY AMOUNT OF UP TO

$100;

(5) (2) ALERT THE PURCHASER TO THE AVAILABILITY OF CONSUMER
INFORMATION AND PUBLIC EDUCATION PROVIDED BY THE COMMISSIONER UNDER
§ 15-406 OF THIS SUBTITLE;

(6) PROVIDE INFLATION PROTECTION;

(7) (3) PROVIDE FOR THE KEEPING OF RECORDS AND AN
EXPLANATION OF BENEFIT REPORTS ON INSURANCE PAYMENTS WHICH COUNT
TOWARD MEDICAID RESOURCE EXCLUSION; AND

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