Maryland Medical Assistance Program and Developmental Disabilities Administration - Home- and Community-Based Services Eligibility Determinations (Maryland Protecting People With Disabilities Act)

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*sb0742*

SENATE BILL 742
J1 (6lr2252)
ENROLLED BILL
— Finance/Health —
Introduced by Senators Guzzone and Zucker

Read and Examined by Proofreaders:

_______________________________________________
Proofreader.
_______________________________________________
Proofreader.

Sealed with the Great Seal and presented to the Governor, for his approval this

_______ day of _______________ at _________________ _______ o’clock, ________M.

______________________________________________
President.

CHAPTER ______

AN ACT concerning 1

Maryland Medical Assistance Program and Developmental Disabilities 2
Administration – Home– and Community–Based Services Eligibility 3
Determinations 4
(Maryland Protecting People With Disabilities Act) 5

FOR the purpose of altering the time within which an individual receiving services from 6
the Developmental Disabilities Administration must appeal a loss of eligibility for 7
services; establishing requirements related to eligibility determinations and 8
redeterminations under the Maryland Medical Assistance Program; requiring the 9
Maryland Department of Health to provide certain accessible information to 10
Program recipients and any o ther individuals on request; prohibiting the 11
Department from procedurally disenrolling individuals from the Program or 12
home– and community–based services solely on a certain basis except under certain 13
circumstances; requiring the Department, subject to fe deral approval, to reserve 14
certain home– and community–based services waiver slots for Program recipients 15
2 SENATE BILL 742

who lost eligibility under certain circumstances; and generally relating to 1
determinations of eligibility for home– and community–based services. 2

BY repealing and reenacting, with amendments, 3
Article – Health – General 4
Section 7–309(b) 5
Annotated Code of Maryland 6
(2023 Replacement Volume and 2025 Supplement) 7

BY repealing and reenacting, without amendments, 8
Article – Health – General 9
Section 15–101(a), (h), and (i) 10
Annotated Code of Maryland 11
(2023 Replacement Volume and 2025 Supplement) 12

BY adding to 13
Article – Health – General 14
Section 15–103.9 15
Annotated Code of Maryland 16
(2023 Replacement Volume and 2025 Supplement) 17

Preamble 18

WHEREAS, The landmark decision of the U.S. Supreme Court in Olmstead v. L.C. 19
ex rel. Zimring, 527 U.S. 581 (1999) affirmed that unjustified segregation of individuals 20
with disabilities constitutes discrimination in violation of Title II of the federal Americans 21
with Disabilities Act; and 22

WHEREAS, The Olmstead decision established that people with disabilities have 23
the right to receive services in the most integrated setting appropriate to their needs and 24
that states must provide community –based services when such services are appropriate, 25
desired by the individual, and can be reasonably accommodated; and 26

WHEREAS, Individuals with intellectual and developmental disabilities are vital 27
members of Maryland’s communities, contributing meaningfully in workplaces, classrooms, 28
places of worship, neighborhoods, and civic life across the State; and 29

WHEREAS, The State of Maryland has demonstrated a longstanding commitment 30
to community inclusion by closing nearly all large public institutions for people with 31
intellectual an d developmental disabilities and investing in supports that allow 32
Marylanders with disabilities to live, work, and thrive in the communities of their choosing, 33
with people they choose; and 34

WHEREAS, Despite this progress, barriers remain when administrati ve 35
inefficiencies and delays in Medicaid eligibility determinations or redeterminations cause 36
individuals to lose critical home – and community –based services or remain 37
institutionalized after they are medically ready for discharge; and 38
SENATE BILL 742 3

WHEREAS, Ensuring timely Medicaid eligibility determinations, preventing 1
procedural terminations, and protecting continuity of home – and community –based 2
services coverage are necessary to fulfill the promise of Olmstead and uphold Maryland’s 3
commitment to dignity, inclusion, and equality for all people with disabilities; and 4

WHEREAS, Maryland law requires the Developmental Disabilities Administration 5
and the Department of Disabilities to compile statewide and regional data from written 6
plans of habilitation, including barr iers to community placement, and to incorporate the 7
data annually into the State’s Olmstead Plan together with recommendations for 8
addressing those barriers; now, therefore, 9

SECTION 1. BE IT ENACTED BY THE GENERAL ASSEMBLY OF MARYLAND, 10
That the Laws of Maryland read as follows: 11

Article – Health – General 12

7–309. 13

(b) (1) An individual receiving Administration services who receives notice 14
from the Department that the individual has lost eligibility to receive Maryland Medical 15
Assistance Program services [shall have 90 days after the date on which the notification 16
letter was mailed to] MAY appeal the determination. 17

(2) If an individual appeals a loss of eligibility within the time period 18
required under [paragraph (1) of this subsection ] § 42 C.F.R. 431.231, Administration 19
services for the individual shall continue uninterrupted until the outcome of the appeal is 20
complete. 21

(3) The Department shall ensure that providers of Administration services 22
to an individual affected by a loss of e ligibility are notified of the individual’s loss of 23
eligibility when notice is sent to the individual. 24

(4) The Department shall ensure that providers, including coordinators of 25
community services, have the ability to automatically exchange electronic da ta with the 26
Department through an application program interface with the Department’s Long Term 27
Services and Supports software system. 28

15–101. 29

(a) In this title the following words have the meanings indicated. 30

(h) “Program” means the Maryland Medical Assistance Program. 31

(i) “Program recipient” means an individual who receives benefits under the 32
Program. 33
4 SENATE BILL 742

15–103.9. 1

(A) (1) IN THIS SECTION THE F OLLOWING WORDS HAVE THE MEANINGS 2
INDICATED. 3

(2) “EX PARTE REDETERMINAT ION” MEANS A PROCESS BY W HICH 4
THE DEPARTMENT DETERMINES A PROGRAM RECIPIENT ’S ELIGIBILITY TO 5
CONTINUE TO RECEIVE SERVICES USING EXISTING DATA, WITHOUT REQUIRING THE 6
PROGRAM RECIPIENT TO SUBMIT ADDITIONAL INFORMATION. 7

(3) “HOME– AND COMMUNITY –BASED SERVICES ” MEANS SERVICES 8
AUTHORIZED UNDER A MEDICAID STATE PLAN OPTION OR WAIVER UNDER § 1115 9
OR § 1915(C), (I), OR (K) OF THE FEDERAL SOCIAL SECURITY ACT. 10

(4) “PROCEDURAL DISENROLLMENT” MEANS THE TERMINATION OF A 11
PROGRAM RECIPIENT ’S ELIGIBILITY TO REC EIVE SERVICES BASED ON REASONS 12
RELATED T O THE RENEWAL PROCES S AND NOT ON A DETER MINATION OF 13
INELIGIBILITY. 14

(B) THE DEPARTMENT SHALL COMP LY WITH THE REQUIREM ENTS OF 42 15
C.F.R. § 435.912 RELATED TO THE TIMEL Y DETERMINATION AND 16
REDETERMINATION OF PROGRAM ELIGIBILITY , INCLUDING PROCESSING AN 17
APPLICATION: 18

(1) IF A DETERMINATION OF DISABILITY IS NOT RE QUIRED, WITHIN 19
45 DAYS AFTER THE RECEIPT OF THE APPLICATION; AND 20

(2) IF A DETERMINATION OF DISABILITY IS REQUIR ED, WITHIN 90 21
DAYS AFTER THE RECEIPT OF THE APPLICATION. 22

(C) THE DEPARTMENT SHALL CO NDUCT EX PARTE REDET ERMINATIONS 23
AND USE ALL PROCEDURES AUTHORIZED UNDER 42 C.F.R. § 435.916 TO PREVENT 24
PROCEDURAL DISENROLL MENT OF INDIVIDUALS RECEIVING HOME – AND 25
COMMUNITY–BASED SERVICES. 26

(D) IN ACCORDANCE WITH 42 C.F.R. § 435.905 AND SUBJECT TO 27
SUBSECTION (E) OF THIS SECTION , THE DEPARTMENT SHALL PROV IDE, IN 28
ELECTRONIC AND PAPER FORMATS, AND ORALLY AS APPROPRIATE AN 29
ACCOMMODATION, THE FOLLOWING INFORMATION TO ALL APPLICANTS AND OTHER 30
INDIVIDUALS ON REQUEST: 31

(1) REQUIREMENTS FOR PROGRAM ELIGIBILITY; 32
SENATE BILL 742 5

(2) AVAILABLE PROGRAM SERVICES; AND 1

(3) THE RIGHTS AND RESPON SIBILITIES OF APPLIC ANTS AND 2
PROGRAM RECIPIENTS. 3

(E) (1) THE DEPARTMENT SHALL PROV IDE THE INFORMATION 4
REQUIRED UNDER SUBSECTION (D) OF THIS SECTION IN PLAIN LANGUAGE AND IN A 5
MANNER THAT IS TIMELY AND ACCESSIBLE TO INDIVIDUALS WHO ARE: 6

(I) LIMITED ENGLISH PROFICIENT THROUGH THE PROVISION 7
OF LANGUAGE SERVICES , INCLUDING ORAL INTER PRETATION AND WRITTE N 8
TRANSLATIONS, AT NO COST TO THE INDIVIDUAL; OR 9

(II) LIVING WITH DISABILIT IES THROUG H THE PROVISION OF 10
AUXILIARY AIDS AND S ERVICES AT NO COST T O THE INDIVIDUAL IN ACCORDANCE 11
WITH THE FEDERAL AMERICANS WITH DISABILITIES ACT AND § 504 OF THE 12
FEDERAL REHABILITATION ACT OF 1973. 13

(2) THE DEPARTMENT SHALL PROVIDE TAGLINES IN NON –ENGLISH 14
LANGUAGES TO INFORM INDIVIDUALS OF: 15

(I) THE AVAILABILITY OF THE ACCESSIBLE INFORMATION AND 16
LANGUAGE SERVICES UNDER THIS SECTION; AND 17

(II) HOW TO ACCESS THE INFORMATION AND SERVICES. 18

(F) IF THE DEPARTMENT DETERMINES THAT THE INFORMATION 19
NECESSARY TO CONFIRM A PROGRAM RECIPIENT’S ELIGIBILITY TO CON TINUE TO 20
RECEIVE SERVICES IS INCOMPLETE, THE DEPARTMENT SHALL CONT INUE TO 21
PROVIDE THE HOME – AND COMMUNITY –BASED SERVICES AND O THER SERVICES 22
UNDER THE PROGRAM UNTIL THE PROGRAM RECIPIENT HAS EXHAUSTED ALL DUE 23
PROCESS RIGHTS AND A FINAL DETERMINATION IS ISSUED. 24

(G) (1) IF A PROGRAM RECIPIENT IS PROCEDURALLY DISENRO LLED 25
FROM HOME – AND COMMUNITY –BASED SERVICES DUE T O A FAILURE BY THE 26
DEPARTMENT TO REDETER MINE ELIGIBILITY IN A TIMELY MANNER AFTER THE 27
RECIPIENT HAS TIMELY RETURNED INFORMATION REQUIRED UNDER 42 C.F.R. § 28
435.916(B)(2)(1)(B) AND 42 C.F.R. § 435.952(C) AND THE DELAY IN THE 29
REDETERMINATION WAS NO FAULT OF THE PROGRAM RECIPIENT , THE 30
DEPARTMENT SHALL REINSTATE THE PROGRAM RECIPIENT’S ELIGIBILITY AND THE 31
PROVISION OF HOME – AND COMMUNITY –BASED SERVICES AND A UTHORIZE 32
6 SENATE BILL 742

ENROLLMENT RETROACTIVELY TO THE DATE OF DISENROLLMENT PENDING THE 1
DEPARTMENT’S COMPLETION OF THE REDETERMINATION PROCESS. 2

(2) THIS SUBSECTION MAY N OT BE CONSTRUED TO L IMIT THE 3
DEPARTMENT’S AUTHORITY OR DIMINISH THE DEPARTMENT’S RESPONSIBILITY TO 4
REINSTATE THE ELIGIB ILITY OF AND THE PRO VISION OF HOME – AND 5
COMMUNITY–BASED SERVICES TO A PROGRAM RECIPIENT WHO HAS BEEN 6
DISENROLLED FOR A REASON OTHER THA N A FAILURE BY THE DEPARTMENT TO 7
REDETERMINE ELIGIBILITY IN A TIMELY MANNER. 8

(H) (G) SUBJECT TO FEDERAL AP PROVAL, THE DEPARTMENT SHALL 9
RESERVE A PORTION OF THE PAR TICIPANT CAPACITY IN THE HOME– AND 10
COMMUNITY–BASED SERVICES WAIVER UNDER § 1915(C) OF THE FEDERAL SOCIAL 11
SECURITY ACT WAIVERS FOR SERVICES NEEDED BY PROGRAM RECIPIENTS WI TH 12
DEVELOPMENTAL DISABILITIES WHO: 13

(1) WERE DISENROLLED FROM THE MARYLAND MEDICAID HOME 14
AND COMMUNITY–BASED SERVICES WAIVER PROGRAM ON OR AFTER JANUARY 1, 15
2024; 16

(2) HAVE HAD PROGRAM ELIGIBILITY REINSTATED; AND 17

(3) HAVE REQUESTED THE REINSTATEMENT OF WAIVER SERVICES. 18

(I) THE DEPARTMENT MAY NOT PLACE AN INDIVIDUAL ON A WAITING LIST 19
OR REQUIRE A NEW WAI VER APPLICATION IF T HE DISENROLLMENT OF THE 20
INDIVIDUAL RESULTED FROM A DELAY OR AN ERROR BY THE DEPARTMENT. 21

(J) (H) (1) THE DEPARTMENT MAY NOT PR OCEDURALLY DISENROLL 22
AN INDIVIDUAL FROM THE PROGRAM OR HOME– AND COMMUNITY–BASED SERVICES 23
SOLELY BASED ON MISS ING DOCUMENTATION , A MISSING SIGNATURE , OR 24
INCOMPLETE INFORMATION UNLESS THE DEPARTMENT HAS: 25

(I) EXHAUSTED ALL EX PART E VERIFICATION PROCE SSES 26
REQUIRED UNDER 42 C.F.R. § 435.916; 27

(II) PROVIDED A CLEAR, SPECIFIC, AND ACCESSIBLE WRITTEN 28
NOTICE IDENTIFYING THE EXACT INFORMATION REQUIRED; AND 29

(III) PROVIDED THE PROGRAM RECIPIENT WITH A REASONABLE 30
OPPORTUNITY TO SUPPLY THE INFORMATION; AND 31

SENATE BILL 742 7

(IV) VERIFIED THAT THE IND IVIDUAL RECEIVED THE NOTICE 1
REQUIRED UNDER ITEM (II) OF THIS PARAGRAPH AN D DOCUMENTED THE 2
VERIFICATION. 3

(2) IF THE DEPARTMENT VIOLATES PARAGRA PH (1) OF THIS 4
SUBSECTION, A PROGRAM RECIPIENT’S HOME– AND COMMUNITY–BASED SERVICES 5
SHALL CONTINUE WITHOUT INTERRUPTION. 6

(K) (I) IF THE DEPARTMENT DISENROLLS A PROGRAM RECIPIENT IN 7
VIOLATION OF THIS SECTION, THE DEPARTMENT SHALL: 8

(1) AUTOMATICALLY REINSTA TE PROGRAM AND HOME – AND 9
COMMUNITY–BASED SERVICES RETRO ACTIVE TO THE DATE O F DISENROLLMENT ; 10
AND 11

(2) TREAT THE PROGRAM RECIPIENT AS CONTINUOUSLY ENROLLED. 12

SECTION 2. AND BE IT FURTHER ENACTED, That the Laws of Maryland read 13
as follows: 14

Article – Health – General 15

15–103.9. 16

(L) (J) (1) ON OR BEFORE JANUARY 1, 2027, AND QUARTERLY 17
THEREAFTER, THE DEPARTMENT SHALL: 18

(I) SUBMIT TO THE GENERAL ASSEMBLY, IN ACCORDANCE 19
WITH § 2–1257 OF THE STATE GOVERNMENT ARTICLE, A REPORT REGARD ING 20
PROGRAM RECIPIENTS WH O RECEIVE HOME – AND COMMUNITY–BASED SERVICES; 21
AND 22

(II) POST EACH REPORT SUBM ITTED UNDER ITEM (I) OF THIS 23
PARAGRAPH ON THE DEPARTMENT’S WEBSITE. 24

(2) THE REPORTS REQUIRED UNDER PARAGRAPH (1) OF THIS 25
SUBSECTION SHALL INCLUDE: 26

(I) THE TOTAL NUMBER OF PROGRAM RECIPIENTS FOR WHOM 27
A REDETERMINATION OF ELIGIBILITY WAS INITIATED; 28

(II) THE TOTAL NUMBER OF PROGRAM RECIPIENTS FOR WHOM 29
PROGRAM COVERAGE IS RENEWED; 30

8 SENATE BILL 742

(III) OF THE PROGRAM RECIPIENTS WH OSE ELIGIBILITY IS 1
RENEWED, THE TOTAL NUMBER WHOSE COVERAGE WAS RENEWED BASED ON AN EX 2
PARTE REDETERMINATION; 3

(IV) THE TOTAL NUMBER OF PROGRAM RECIPIENTS WH OSE 4
ELIGIBILITY WAS REIN STATED IN ACCORDANCE WITH SUBSECTION (F) OF THIS 5
SECTION; 6

(IV) (V) THE TOTAL NUMBER OF PROGRAM RE CIPIENTS 7
WHOSE ELIGIBILITY WAS TERMINATED; 8

(V) (VI) THE TOTAL NUMBER OF PROGRAM RECIPIENTS 9
WHOSE ELIGIBILITY WAS TERMINATED FOR PROCEDURAL REASONS; 10

(VII) THE TOTAL NUMBER OF PROGRAM RECIPIENTS WH OSE 11
ELIGIBILITY WAS TERM INATED DUE TO A FAIL URE BY TH E DEPARTMENT TO 12
REDETERMINE ELIGIBILITY IN A TIMELY MANNER; AND 13

(VI) (VIII) THE MEAN AND MEDIAN P ROCESSING TIMES FOR 14
REDETERMINATIONS OF ELIGIBILITY. 15

SECTION 2. 3. AND BE IT FURTHER ENACTED, That this Act shall take effect 16
October 1, 2026. Section 2 of this Act shall remain effective for a period of 3 years and, at 17
the end of September 30, 2029, Section 2 of this Act, with no further action required by the 18
General Assembly, shall be abrogated and of no further force and effect. 19

Approved: 20
________________________________________________________________________________
Governor. 21
________________________________________________________________________________
President of the Senate. 22
________________________________________________________________________________
Speaker of the House of Delegates. 23