reglab/statecodes huggingface dataset:
2023 Maryland Statutes › Health - General › Title 14 - General Day Care › Subtitle 4 - Maryland Youth Camp Act › Section 14-405 - Composition; Terms of Members; Removal of Members

(a)    (1)    The Council consists of 11 members.
(2)    Of the 11 Council members:
(i)    1 shall be a representative of the Department;
(ii)    1 shall be a camping leader with professional experience, but who is not a youth camp owner or manager;
(iii)    1 shall be actively engaged in the ownership or management of a youth camp operating for profit;
(iv)    1 shall be actively engaged in the ownership or management of a nonprofit youth camp;
(v)    1 shall be actively engaged in the ownership or management of an American Camping Association accredited youth camp;
(vi)    1 shall be actively engaged in the ownership or management of a youth camp that is not accredited by the American Camping Association;
(vii)    1 shall be a member of the public;
(viii)    2 shall be selected from the local health departments from 2 counties; and
(ix)    2 shall be selected from nationwide organizations involved in camping such as scouting and 4-H.
(3)    The Governor shall appoint the Council members with the advice of the Secretary and the advice and consent of the Senate.
(b)    (1)    The term of a member is 3 years.
(2)    The terms of members are staggered as required by the terms provided for members of the Council on July 1, 1986.
(3)    At the end of a term, a member continues to serve until a successor is appointed.
(4)    A member who is appointed after a term has begun serves only for the rest of the term and until a successor is appointed.
(5)    Members of the Council:
(i)    Are eligible for reappointment; but
(ii)    May not serve more than 2 full consecutive terms.
(c)    The Governor may remove a member for incompetence or misconduct.
2023 Maryland Statutes › Health - General › Title 14 - General Day Care › Subtitle 4 - Maryland Youth Camp Act › Section 14-407 - Investigations; Training Required for Camp Inspectors

(a)    In this section, “youth development organization or program” means an organization or a program that provides activities for minors.
(b)    The Department shall:
(1)    Investigate complaints received regarding the youth camp; and
(2)    Require appropriate training, including knowledge of outdoor camping, for a camp inspector.
(c)    (1)    Before a youth camp or youth development organization or program makes a formal offer of employment to a job applicant, the operator of the youth camp or youth development organization or program may request from the Department a determination as to whether the results of a federal criminal history records check would be the basis for prohibiting the hiring of the applicant.
(2)    On receipt of a request from the operator of a youth camp or youth development organization or program under paragraph (1) of this subsection, the Department shall issue a written determination to the youth camp or youth development organization or program as to whether the results of a federal criminal history records check would be the basis for prohibiting the hiring of the applicant.
(3)    A determination issued by the Department under paragraph (2) of this subsection is binding on the Department and the youth camp or youth development organization or program unless the applicant:
(i)    Has subsequently been convicted of a crime;
(ii)    Has pending criminal charges; or
(iii)    Had previously undisclosed criminal convictions.
(4)    The Department may set a reasonable fee to cover the cost of a criminal history records check required under this subsection.
2023 Maryland Statutes › Health - General › Title 14 - General Day Care › Subtitle 4 - Maryland Youth Camp Act › Section 14-408 - Denial, Suspension, or Revocation of Certificates

Subject to the hearing provisions of § 14-409 of this subtitle, the Department may deny a certificate to any applicant, or suspend or revoke a certificate, if the applicant or certificate holder:
(1)    Fraudulently or deceptively obtains or attempts to obtain a certificate for the applicant or certificate holder or for another;
(2)    Fraudulently or deceptively uses a certificate;
(3)    Violates this subtitle; or
(4)    Violates any regulation adopted by the Department under this subtitle.
2023 Maryland Statutes › Health - General › Title 14 - General Day Care › Subtitle 4 - Maryland Youth Camp Act › Section 14-409 - Hearings

Except as otherwise provided in § 10-226(c) of the State Government Article, before the Department takes any action under § 14-408 of this subtitle, the Department shall give the person against whom the action is contemplated an opportunity for a hearing before the Department.
2023 Maryland Statutes › Health - General › Title 14 - General Day Care › Subtitle 5 - Youth Sports Programs › Section 14-501 - Concussions, Head Injuries, or Sudden Cardiac Arrest in Youth Sports Programs

(a)    (1)    In this section the following words have the meanings indicated.
(2)    “Concussion” means a traumatic injury to the brain causing an immediate and, usually, short–lived change in mental status or an alteration of normal consciousness resulting from:
(i)    A fall;
(ii)    A violent blow to the head or body; or
(iii)    The shaking or spinning of the head or body.
(3)    “Sudden cardiac arrest” means a condition in which the heart suddenly and unexpectedly stops beating.
(4)    “Youth athlete” means an individual who participates in an athletic activity in association with a youth sports program conducted:
(i)    At a public school facility; or
(ii)    By a recreational athletic organization.
(5)    “Youth sports program” means a program organized for recreational athletic competition or instruction for participants who are under the age of 19 years.
(b)    (1)    A youth sports program shall make available information on concussions, head injuries, and sudden cardiac arrest developed by the State Department of Education under §§ 7–433 and 7–436 of the Education Article to coaches, youth athletes, and the parents or guardians of youth athletes.
(2)    A coach of a youth sports program shall review the information provided in paragraph (1) of this subsection.
(c)    (1)    A youth athlete who is suspected of sustaining a concussion or other head injury in a practice or game shall be removed from play at that time.
(2)    A youth athlete who has been removed from play may not return to play until the youth athlete has obtained written clearance from a licensed health care provider trained in the evaluation and management of concussions.
(d)    Before a youth sports program may use a facility owned or operated by a local government, the local government shall provide notice to the youth sports program of the requirements of this section.
2023 Maryland Statutes › Health - General › Title 15 - Assistance Programs › Subtitle 1 - Medical and Pharmacy Assistance Programs › Section 15-101.1 - Applicability of Other Provisions to a Managed Care Organization

(a)    Except as otherwise provided in this subtitle, a managed care organization is not subject to the insurance laws of the State or to the provisions of Title 19 of this article.
(b)    A managed care organization may not be required to offer a qualified plan, as defined in § 31–101 of the Insurance Article, in the Maryland Health Benefit Exchange.
2023 Maryland Statutes › Health - General › Title 15 - Assistance Programs › Subtitle 1 - Medical and Pharmacy Assistance Programs › Section 15-102 - Indigent and Medically Indigent -- Preventive and Home Care Services; Educational Opportunities

(a)    Subject to the limitations of the State budget, the Department shall provide preventive and home care services for indigent and medically indigent individuals.
(b)    (1)    The Program shall promote educational opportunities for recipients on:
(i)    Preventive health care;
(ii)    Good health habits; and
(iii)    The value of developing ongoing relationships with primary care and lower cost providers.
(2)    In educating Program recipients in accordance with the provisions of paragraph (1) of this subsection, the Program shall work with appropriate groups to assist in the education of Program recipients.
2023 Maryland Statutes › Health - General › Title 15 - Assistance Programs › Subtitle 1 - Medical and Pharmacy Assistance Programs › Section 15-102.2 - Applicability of Certain Provisions -- Claims of Subrogation

(a)    Except as otherwise provided in this section, the provisions of § 19-706.1 of this article (Rehabilitation and liquidation) shall apply to managed care organizations in the same manner they apply to health maintenance organizations.
(b)    (1)    A health care provider may not assert a claim of subrogation against an enrollee of a managed care organization or the State.
(2)    Notwithstanding paragraph (1) of this subsection, a health care provider may assert any claim it may have against the receiver of the insolvent managed care organization.
2023 Maryland Statutes › Health - General › Title 15 - Assistance Programs › Subtitle 1 - Medical and Pharmacy Assistance Programs › Section 15-102.3 - Applicability of Certain Provisions -- Examination of Financial Affairs and Status

(a)    The provisions of § 15–112(b)(1)(ii) and (2), (f) through (m), (r), (s), and (u) through (w) of the Insurance Article (Provider panels) shall apply to managed care organizations in the same manner they apply to carriers.
(b)    The provisions of § 15–1005 of the Insurance Article shall apply to managed care organizations in the same manner they apply to health maintenance organizations.
(c)    The provisions of §§ 4–311, 15–604, 15–605, and 15–1008 of the Insurance Article shall apply to managed care organizations in the same manner they apply to carriers.
(d)    (1)    The provisions of §§ 19–712(b), (c), and (d), 19–713.2, and 19–713.3 of this article apply to managed care organizations in the same manner they apply to health maintenance organizations.
(2)    The Insurance Commissioner shall consult with the Secretary before taking any action against a managed care organization under this subsection.
(e)    The provisions of § 15–112.1 of the Insurance Article apply to managed care organizations in the same manner they apply to carriers.
(f)    The Insurance Commissioner or an agent of the Commissioner shall examine the financial affairs and status of each managed care organization at least once every 5 years.
(g)    The provisions of § 15–1628.3 of the Insurance Article apply to pharmacy benefits managers that contract with managed care organizations in the same manner as they apply to pharmacy benefits managers that contract with carriers.
(h)    (1)    The provisions of § 6–102.1 of the Insurance Article apply to managed care organizations.
(2)    For each calendar year that the Insurance Commissioner assesses a health insurance provider fee under § 6–102.1 of the Insurance Article, a managed care organization shall pay the fee on a quarterly basis in accordance with a schedule adopted by the Insurance Commissioner.
(i)    The provisions of §§ 15–130 and 15–130.1 of the Insurance Article apply to managed care organizations and pharmacy benefits managers that contract with managed care organizations.
(j)    The provisions of § 33–105(f) of the Insurance Article apply to managed care organizations.
2023 Maryland Statutes › Health - General › Title 15 - Assistance Programs › Subtitle 1 - Medical and Pharmacy Assistance Programs › Section 15-102.5 - Mechanism to Provide for Equitable Distribution of Enrollees

(a)    Subject to § 15-103(f) of this subtitle, a health maintenance organization that requires its panel providers to participate in a managed care organization shall establish a mechanism, subject to review by the Secretary, which provides for equitable distribution of enrollees and which ensures that a provider will not be assigned a disproportionate number of enrollees.
(b)    Nothing in this section may be interpreted as prohibiting a provider from voluntarily accepting additional enrollees.
2023 Maryland Statutes › Health - General › Title 15 - Assistance Programs › Subtitle 1 - Medical and Pharmacy Assistance Programs › Section 15-102.6 - Applicability of Other Provisions; Regulations

(a)    (1)    Subject to paragraph (2) of this subsection, the provisions of Title 7 of the Insurance Article apply to managed care organizations.
(2)    Before approving a transaction under § 7–306 of the Insurance Article, the Insurance Commissioner shall consult with the Secretary.
(3)    The Insurance Commissioner:
(i)    Shall adopt regulations establishing a reporting materiality threshold; and
(ii)    May adopt regulations necessary to implement the provisions of this subsection.
(4)    The provisions of this subsection may not apply to any transaction preempted by federal law.
(b)    The provisions of Title 4, Subtitle 5 of the Insurance Article apply to managed care organizations.
2023 Maryland Statutes › Health - General › Title 15 - Assistance Programs › Subtitle 1 - Medical and Pharmacy Assistance Programs › Section 15-102.8 - Claims Processing Charge for Medicaid Claims Paid by Department to District of Columbia Hospitals

(a)    The Department may impose a claims processing charge on all Medicaid claims processed, approved, and paid by the Department to hospitals located in the District of Columbia for the provision of inpatient and outpatient hospital services.
(b)    The amount to be paid under subsection (a) of this section may not exceed 6% of the amount of claims paid.
(c)    The Department shall adopt regulations to implement this section.
2023 Maryland Statutes › Health - General › Title 15 - Assistance Programs › Subtitle 1 - Medical and Pharmacy Assistance Programs › Section 15-103.2 - Rfps for Comparing Performance and Cost of Different Managed Care Dental Programs

(a)    The Department shall issue a request for proposals for the administration of dental services for Program recipients for the purpose of comparing and evaluating the performance and cost of dental services provided by a managed care organization and the performance and cost of dental services provided by a dental managed care organization that is separate from a managed care organization.
(b)    The Department shall provide access to Program recipients for dental services to increase utilization of dental services in accordance with utilization targets that the Department by regulation establishes in an oral health care plan.
(c)    The access required under subsection (b) of this section may be through a managed care organization or a dental managed care organization that is separate from a managed care organization.
2023 Maryland Statutes › Health - General › Title 15 - Assistance Programs › Subtitle 1 - Medical and Pharmacy Assistance Programs › Section 15-103.3 - Healthchoice Performance Incentive Fund

(a)    There is a HealthChoice Performance Incentive Fund established in the Department.
(b)    (1)    The Department shall pay all fines collected under § 15–103(b)(12)(v) of this subtitle and penalties collected under § 15–103.7(e)(2)(iv) of this subtitle to the Comptroller of the State.
(2)    The Comptroller shall distribute the fines to the Fund.
(c)    (1)    The Fund shall be used exclusively for the provider reimbursement budget under the HealthChoice Program, including providing financial incentives designed to improve the quality of care to managed care organizations that exceed performance targets.
(2)    The Fund is a continuing nonlapsing fund not subject to § 7–302 of the State Finance and Procurement Article.
(3)    Except as provided in paragraph (4) of this subsection, any unspent portions of the Fund may not be transferred or revert to the General Fund of the State, but shall remain in the Fund to be used for the purposes specified in this section.
(4)    At the end of each fiscal year, any amount in excess of $5 million shall revert to the General Fund.
(d)    (1)    The Secretary or the Secretary’s designee shall administer the Fund.
(2)    The Secretary shall adopt regulations to carry out the provisions of this section, including the distribution of money from the Fund to managed care organizations.
(e)    The Legislative Auditor shall audit the accounts and transactions of the Fund as provided in § 2–1220 of the State Government Article.
2023 Maryland Statutes › Health - General › Title 15 - Assistance Programs › Subtitle 1 - Medical and Pharmacy Assistance Programs › Section 15-103.4 - Credentialing of Health Care Providers

(a)    A managed care organization may deem a health care provider credentialed for a period of not more than 6 months from the date of receipt of a completed application if:
(1)    The health care provider:
(i)    Has been credentialed by another entity in the State that is required to credential health care providers; and
(ii)    Has submitted an application to participate in the managed care organization’s provider panel; and
(2)    The managed care organization verifies that the health care provider was credentialed and remains in good standing with at least one entity that credentialed the health care provider.
(b)    An entity that has credentialed a health care provider may not refuse a request by a managed care organization to verify that the health care provider is credentialed and in good standing.
(c)    Nothing in this section may be construed to relieve the managed care organization from fully credentialing its health care providers.
2023 Maryland Statutes › Health - General › Title 15 - Assistance Programs › Subtitle 1 - Medical and Pharmacy Assistance Programs › Section 15-103.5 - Rate Review and Comparison; Reports

(a)    For the calendar year prior to the report date under subsection (b) of this section, the Department shall review the rates paid to providers under the federal Medicare fee schedule and compare the rates under the Medicare fee schedule to the fee–for–service rates paid to similar providers for the same services under the Maryland Medical Assistance Program and the rates paid to managed care organization providers for the same services under the Maryland Medical Assistance Program.
(b)    On or before January 1, 2010, and each January 1 thereafter, the Department shall report, in accordance with § 2–1257 of the State Government Article, to the Senate Finance Committee and the House Health and Government Operations Committee on:
(1)    The review and comparison under subsection (a) of this section;
(2)    Whether the fee–for–service rates and managed care organization provider rates will exceed the rates paid under the Medicare fee schedule for the period covered by the review required under subsection (a) of this section;
(3)    An analysis of the fee–for–service reimbursement rates paid in other states and how those rates compare with those in the State;
(4)    A schedule for bringing the State’s fee–for–service reimbursement rates to a level that assures that all health care providers are reimbursed adequately to provide access to care; and
(5)    An analysis of the estimated costs of implementing the schedule and any proposed changes to the fee–for–service reimbursement rates for the Maryland Medical Assistance Program and the Maryland Children’s Health Program.
2023 Maryland Statutes › Health - General › Title 15 - Assistance Programs › Subtitle 1 - Medical and Pharmacy Assistance Programs › Section 15-103.6 - Regulations to Ensure Parity of Specialty Mental Health and Substance Use Disorder Services With Federal Acts

(a)    (1)    Subject to paragraph (2) of this subsection, on or before June 30, 2017, the Department shall adopt regulations necessary to ensure that the Program is in compliance with the federal Mental Health Parity and Addiction Equity Act and the federal Patient Protection and Affordable Care Act.
(2)    Except as provided in § 15–103.8 of this subtitle, the Department is not required to adopt regulations under paragraph (1) of this subsection for any change that may be made through a process other than the regulatory process.
(b)    The regulations adopted under subsection (a) of this section shall include standards regarding treatment limitations for specialty mental health and substance use disorder services that comply with the federal Mental Health Parity and Addiction Equity Act and the federal Patient Protection and Affordable Care Act, as amended by the federal Health Care and Education Reconciliation Act of 2010, and relate to:
(1)    The scope of benefits for:
(i)    Telehealth services; and
(ii)    Residential treatment programs that are not institutions for mental disease;
(2)    Service notification and authorization requirements;
(3)    Licensed specialty mental health or substance use disorder program billing for:
(i)    Services provided by physicians, advanced practice nurses, and physician assistants;
(ii)    Services provided by a licensed specialty mental health or substance use disorder program at a location that is not the primary location at which the program is licensed; and
(iii)    Separate levels of service provided within a single day or week; and
(4)    Reimbursement rates.
(c)    The treatment limitations for specialty mental health and substance use disorder services comply with the federal Mental Health Parity and Addiction Equity Act and the federal Patient Protection and Affordable Care Act, as amended by the federal Health Care and Education Reconciliation Act of 2010, if the operable processes, strategies, evidentiary standards, or other factors used in applying a treatment limitation to specialty mental health or substance use disorder services, as written and applied, are comparable to and no more restrictive than, and are applied no more stringently than, the processes, strategies, evidentiary standards, or other factors used in applying the treatment limitation to medical and surgical services.
2023 Maryland Statutes › Health - General › Title 15 - Assistance Programs › Subtitle 1 - Medical and Pharmacy Assistance Programs › Section 15-103.8 - Psychiatric Inpatient Care -- Admissions Restrictions -- Annual Report by Department

(a)    Notwithstanding any other provision of law, the Department may not limit or restrict a Program recipient’s admission for inpatient care at a special psychiatric hospital or an acute general care hospital with separately identified inpatient psychiatric service unless the Department:
(1)    Bases the limit or restriction on the medical necessity of the admission; and
(2)    Establishes the limit or restriction through regulation.
(b)    On or before July 1 each year, beginning in 2024, the Department shall report to the Senate Finance Committee and the House Health and Government Operations Committee, in accordance with § 2–1257 of the State Government Article, on, for the immediately preceding fiscal year:
(1)    The average length of stay for Program recipients for Serious Mental Illness Institute of Mental Disease services and for Substance Use Disorder Institute of Mental Disease services as reported to the Centers for Medicare and Medicaid Services;
(2)    Any corrective action plans and any limits on days of stay required by the Centers for Medicare and Medicaid Services;
(3)    Any federal funding withheld and any additional State funding required due to subsection (a) of this section;
(4)    Data on the effect of subsection (a) of this section on the length of emergency department stays among Program recipients; and
(5)    Data on whether Program recipients receiving Institute of Mental Disease services were transferred to another facility and the type of facility to which they were transferred.
2023 Maryland Statutes › Health - General › Title 15 - Assistance Programs › Subtitle 1 - Medical and Pharmacy Assistance Programs › Section 15-104 - Contracts With Department of Human Services

The Secretary may contract with the Department of Human Services to provide medical services to those individuals for whom:
(1)    Funds are appropriated to the Department of Human Services; and
(2)    The Department of Human Services is responsible under the appropriation.
2023 Maryland Statutes › Health - General › Title 15 - Assistance Programs › Subtitle 1 - Medical and Pharmacy Assistance Programs › Section 15-105.1 - Reimbursement Procedures Under Program -- Electronic Reimbursement

(a)    This section does not apply to a person providing pharmacy benefit manager services.
(b)    If a pharmacy is required to submit a request for payment electronically to the Department under § 15-105(b) of this subtitle, then the pharmacy may choose to be reimbursed electronically, and in that event, the Department shall reimburse the pharmacy electronically under the Program.
2023 Maryland Statutes › Health - General › Title 15 - Assistance Programs › Subtitle 1 - Medical and Pharmacy Assistance Programs › Section 15-106 - Review of Health Care Under Program

(a)    (1)    In cooperation with the professional organizations whose members provide health care under the Program, the Secretary shall establish a system of review for all health care that is provided.
(2)    The review shall include a study of the quality of care and the proper use of the services by the Program recipient or the provider.
(b)    A member of an appointed committee of any of these professional organizations or an appointed member of a committee of a medical staff of a licensed hospital shall have the immunity from liability described under § 5-628 of the Courts and Judicial Proceedings Article.
2023 Maryland Statutes › Health - General › Title 15 - Assistance Programs › Subtitle 1 - Medical and Pharmacy Assistance Programs › Section 15-107 - Cost Reports of Program Participants

(a)    The Department may require facilities that participate in the Program to submit cost reports, as defined by the Department, within the time set by the Department.
(b)    If a report is not submitted within that time, the Department shall withhold from the facility up to 10 percent of current interim payments for the calendar month in which the report is due and any later calendar months until the report is submitted.
2023 Maryland Statutes › Health - General › Title 15 - Assistance Programs › Subtitle 1 - Medical and Pharmacy Assistance Programs › Section 15-109.1 - Plan for Dissemination of Advance Directive Information

(a)    The Department, in consultation with the Office of the Attorney General, shall:
(1)    Develop and implement a plan for making the advance directive information sheet developed under § 5–615 of this article widely available; and
(2)    Make the information sheet described in item (1) of this subsection available in a conspicuous location in each local health department, in each local department of social services, and in community health centers.
(b)    The Department shall implement the plan on or before January 1, 2017.
(c)    During the development of the plan under subsection (a) of this section and the information sheet under § 5–615 of this article, the Office of the Attorney General shall consult with any interested party including the State Advisory Council on Quality Care at the End of Life.
(d)    The Department shall offer:
(1)    The information sheet developed under § 5–615 of this article as part of the monthly enrollment packet mailed to a recipient by the enrollment broker; and
(2)    The use of electronic advance directives to a recipient through an advance directives service that:
(i)    Is approved by the Maryland Health Care Commission and the Department; and
(ii)    Meets the technology, security, and privacy standards established by the Maryland Health Care Commission.
2023 Maryland Statutes › Health - General › Title 15 - Assistance Programs › Subtitle 1 - Medical and Pharmacy Assistance Programs › Section 15-109.2 - Benefits and Services for Incarcerated or Institutionalized Individuals. [Effective When Contingency Met]

** CONTINGENCY – NOT IN EFFECT – CHAPTER 82 OF 2005 **
To the extent authorized by federal law or regulation, if a Program recipient who is at least 21 years old but is under the age of 65 years is incarcerated or is admitted to an institution for the treatment of mental disease, the Department:
(1)    Shall suspend Program benefits for that individual while the individual is incarcerated or is in the institution; and
(2)    May not terminate Program benefits for that individual based on the incarceration of the individual or on the admission of the individual to the institution.
2023 Maryland Statutes › Health - General › Title 15 - Assistance Programs › Subtitle 1 - Medical and Pharmacy Assistance Programs › Section 15-110 - Reimbursement -- Acute General and Chronic Care Hospitals

The Department shall reimburse acute general and chronic care hospitals that participate in the Program for care provided to Program recipients in accordance with rates that the Health Services Cost Review Commission approves under Title 19, Subtitle 2 of this article, if the United States Department of Health and Human Services approves this method of reimbursement.
2023 Maryland Statutes › Health - General › Title 15 - Assistance Programs › Subtitle 1 - Medical and Pharmacy Assistance Programs › Section 15-111 - Reimbursement -- Day Care for the Elderly and Medically Handicapped Adults

(a)    The Department may authorize reimbursement of a licensed day care center for the elderly or medically handicapped adults for medical care that the center provides to a Program recipient who is certified as requiring nursing home care.
(b)    (1)    Reimbursement under this section is subject to the availability of federal funds.
(2)    The reimbursement rate for medical day care:
(i)    May not exceed a maximum per diem rate established by regulation of the Department; and
(ii)    Shall cover the following:
1.    Administrative overhead;
2.    Drugs, supplies, and equipment;
3.    Food;
4.    Medical services;
5.    Staff; and
6.    Transportation.
2023 Maryland Statutes › Health - General › Title 15 - Assistance Programs › Subtitle 1 - Medical and Pharmacy Assistance Programs › Section 15-112 - Reimbursement -- Physicians

After consultation with the State Board of Pharmacy, the Secretary may authorize reimbursement of a physician for the dispensing of drugs to Program recipients, on the same basis as a licensed pharmacist if:
(1)    The physician dispenses drugs on a regular basis in the physician’s office; and
(2)    There is no pharmacy within 10 miles of that office.
2023 Maryland Statutes › Health - General › Title 15 - Assistance Programs › Subtitle 1 - Medical and Pharmacy Assistance Programs › Section 15-113 - Reimbursement -- Public Institutions

(a)    In this section, “inmate of a public institution” has the meaning stated in Title 42, § 435.1009 of the Code of Federal Regulations (1978 edition).
(b)    (1)    If an inmate of a public institution is eligible for federally funded Medicaid benefits, the Department shall pay the custodial authority for any medical care that is provided to the inmate during the month when the individual became an inmate.
(2)    Payments under this subsection shall be made in accordance with applicable rules and regulations for the Program.
(c)    The Department shall be reimbursed for the nonfederal cost of medical care by either the State or local authority that is responsible for the inmate of a public institution.
2023 Maryland Statutes › Health - General › Title 15 - Assistance Programs › Subtitle 1 - Medical and Pharmacy Assistance Programs › Section 15-115 - Placement in Skilled or Intermediate Nursing Facility

(a)    The Department may not place a Program recipient in a skilled or intermediate nursing facility if, because of the condition of the Program recipient, the placement would cause undue risk to the Program recipient.
(b)    To provide a basis for evaluating the placement of Program recipients who need skilled or intermediate nursing care in skilled or intermediate nursing facilities, a Program recipient may be placed only in a nursing facility that has a transfer agreement with a general hospital.
2023 Maryland Statutes › Health - General › Title 15 - Assistance Programs › Subtitle 1 - Medical and Pharmacy Assistance Programs › Section 15-117 - Reimbursement -- Reserved Beds

(a)    In this section, “leave of absence” includes:
(1)    A visit with friends or relatives; and
(2)    A leave to participate in a State approved therapeutic or rehabilitative program.
(b)    To ensure that a bed is reserved for a Program recipient who is on leave of absence from a nursing facility that has made a provider agreement with the Department, the facility shall receive payment for each day that the Program recipient is absent and a bed is reserved and made available for the return of that Program recipient.
(c)    (1)    Payments under subsection (b) of this section may not be made for more than 18 days in any calendar year.
(2)    Notwithstanding any rule or regulation, a leave of absence is not subject to any requirement that it may not exceed a particular number of days a visit, except that the leave of absence may not exceed a total of 18 days during any calendar year.
(d)    Payments required under this section:
(1)    Shall be made according to the per diem payment procedures that the Department sets; and
(2)    May not include payment for nursing services.
(e)    A nursing facility may not make additional charges against a Program recipient because the Program recipient is absent temporarily from the nursing facility.
2023 Maryland Statutes › Health - General › Title 15 - Assistance Programs › Subtitle 1 - Medical and Pharmacy Assistance Programs › Section 15-118 - Drugs

(a)    (1)    Unless the prescriber directs otherwise on the form or on an attached signed certification of need, the generic form of the drug authorized under § 12-504 of the Health Occupations Article shall be used to fill the prescription.
(2)    If the appropriate generic drug is not generally available, the Department may waive the requirement for generic substitution under paragraph (1) of this subsection.
(b)    (1)    Except as provided under paragraph (2) of this subsection, the Program shall establish maximum reimbursement levels for the drug products for which there is a generic equivalent authorized under § 12-504 of the Health Occupations Article, based on the cost of the generic product.
(2)    If a prescriber directs a specific brand name drug, the reimbursement level shall be based on the cost of the brand name product.
(c)    (1)    Except as provided under paragraph (4) of this subsection and unless the change is made by an emergency regulation, the Program shall notify all pharmacies under contract with the Program in writing of changes in the Pharmaceutical Benefit Program rules or requirements at least 30 days before the change is effective.
(2)    Changes that require 30 days’ advance written notice under paragraph (1) of this subsection are:
(i)    Exclusion of coverage for classes of drugs as specified by contract;
(ii)    Changes in prior or preauthorization procedures; and
(iii)    Selection of new prescription claims processors.
(3)    If the Program fails to provide advance notice as required under paragraph (1) of this subsection, it shall honor and pay in full any claim under the Program rules or requirements that existed before the change for 30 days after the postmarked date of the notice.
(4)    Notwithstanding any other provision of law, the notice requirements of this subsection do not apply to the addition of new generic drugs authorized under § 12-504 of the Health Occupations Article.
(d)    The Secretary shall adopt regulations to carry out the provisions of this section.
(e)    Except for a prescription for a prescription drug that contains a substance listed in Schedule II or that is determined by the Secretary to present an emerging threat in the State because of increasing abuse or diversion, the provisions of § 21-220(b)(1) of this article shall apply to the Program.
2023 Maryland Statutes › Health - General › Title 15 - Assistance Programs › Subtitle 1 - Medical and Pharmacy Assistance Programs › Section 15-121 - Claims Against Estates

(a)    In accordance with applicable federal law and rules and regulations, including those under Title XIX of the Social Security Act, the Department may make claim against the estate of a deceased Program recipient for the amount of any medical assistance payments under this title.
(b)    The claim shall be waived by the Department if, in its judgment, enforcement of the claim will cause substantial hardship to the surviving dependents of the deceased.
2023 Maryland Statutes › Health - General › Title 15 - Assistance Programs › Subtitle 1 - Medical and Pharmacy Assistance Programs › Section 15-121.1 - Subrogation of Department to Program Recipient's Claim Under 19-505 and 19-506 of the Insurance Article

(a)    If a Program recipient has a claim for any medical, hospital or disability benefits under §§ 19-505 and 19-506 of the Insurance Article, the Department shall be subrogated to that claim to the extent of any payments made by the Department on behalf of the Program recipient that results from the occurrence that gave rise to the claim less:
(1)    Applicable attorney’s fees; and
(2)    Any rights for loss of income.
(b)    (1)    An attorney representing a Program recipient under this subtitle on a claim to which the Department has a right of subrogation shall notify the Department prior to filing the claim.
(2)    This subsection may not be construed to create a cause of action for notifying or failing to notify the Department.
(c)    (1)    Any Program recipient or attorney, guardian, or personal representative of a Program recipient who receives money for a claim to which the Department has a subrogation claim shall, after receiving written notice of the subrogation claim, hold that money, for the benefit of the Department, to the extent required for the subrogation claim, after deducting applicable attorney’s fees.
(2)    A person who, after written notice of a subrogation claim from the Department and possible liability under this paragraph, disposes of the money, without the written approval of the Department, is liable to the Department for any amount that, because of the disposition, is not recoverable by the Department.
(3)    The Department may compromise or settle and release its subrogation claim if, in its judgment, collection of the claim will cause substantial hardship to the Program recipient or in a wrongful death action, the surviving dependent of a deceased Program recipient.
2023 Maryland Statutes › Health - General › Title 15 - Assistance Programs › Subtitle 1 - Medical and Pharmacy Assistance Programs › Section 15-121.2 - Subrogation of Department to Program Recipient's Claim Under 19-509 and 19-510 of the Insurance Article

(a)    If a Program recipient has a claim for any medical, hospital, or disability benefits under §§ 19-509 and 19-510 of the Insurance Article, the Department shall be subrogated to that claim to the extent of any payments made by the Department on behalf of the Program recipient that results from the occurrence that gave rise to the claim, less applicable attorney’s fees.
(b)    (1)    An attorney representing a Program recipient under this subtitle on a claim to which the Department has a right of subrogation shall notify the Department prior to filing the claim.
(2)    This subsection may not be construed to create a cause of action for notifying or failing to notify the Department.
(c)    (1)    Any Program recipient, attorney, guardian, or personal representative of a Program recipient who receives money for a claim to which the Department has a subrogation claim shall, after receiving written notice of the subrogation claim, hold that money, for the benefit of the Department, to the extent required for the subrogation claim, after deducting applicable attorney’s fees.
(2)    A person who, after written notice of a subrogation claim from the Department and possible liability under this paragraph, disposes of the money, without the written approval of the Department, is liable to the Department for any amount that, because of the disposition, is not recoverable by the Department.
(3)    The Department may compromise or settle and release its subrogation claim if, in its judgment, collection of the claim will cause substantial hardship to the Program recipient or in a wrongful death action, the surviving dependent of a deceased Program recipient.
2023 Maryland Statutes › Health - General › Title 15 - Assistance Programs › Subtitle 1 - Medical and Pharmacy Assistance Programs › Section 15-122 - Responsibility of Spouse Under Program

(a)    (1)    The spouse of a Program recipient is responsible for payments for the health care needs of the Program recipient to the extent that the spouse is able to pay any of the cost of care. Except as provided in paragraph (2) of this subsection, the total liability shall be limited to the amount spent for the care under the Program.
(2)    In any case in which eligibility was based on the spouse’s refusal to pay for the Program recipient’s care, the liability of the spouse may include:
(i)    The amount spent for care by the Program;
(ii)    Administrative and enforcement costs incurred by the Program related to pursuing reimbursement from the spouse; and
(iii)    Any penalties established by the Secretary by regulation for a violation of this section not to exceed $50 per day for each day a violation exists.
(b)    (1)    The Secretary shall adopt rules and regulations that set standards for payment by the spouse based on the ability of the spouse to pay all or part of the cost of care. To determine reasonably the ability to pay, the Secretary shall evaluate available income, ordinary living expenses, special expenses, and assets, other than the homestead of the spouse and its appurtenances.
(2)    Notwithstanding the standards established under paragraph (1) of this subsection, the spouse may also be liable for costs and penalties under subsection (a)(2) of this section.
(c)    (1)    The Secretary may collect the money owed.
(2)    The Central Collection Unit in the Department of Budget and Management shall collect delinquent accounts and debts.
2023 Maryland Statutes › Health - General › Title 15 - Assistance Programs › Subtitle 1 - Medical and Pharmacy Assistance Programs › Section 15-122.1 - Certain Providers Excluded From Repaying Depreciation Allowance

(a)    In this section, “participating provider” means any facility that participates in the Program and is:
(1)    A skilled nursing facility;
(2)    A comprehensive care facility; or
(3)    An intermediate care facility.
(b)    A participating provider shall not be required to repay the State for any depreciation for which the provider has been reimbursed as an allowable expense and which could otherwise be recaptured by the State upon a sale, scrapping, trade-in, donation, exchange, demolition, or abandonment of a facility, or involuntary conversion of a facility such as condemnation, fire, theft, or other casualty.
(c)    This section has no effect if its operation would cause this State to lose any federal funds.
2023 Maryland Statutes › Health - General › Title 15 - Assistance Programs › Subtitle 1 - Medical and Pharmacy Assistance Programs › Section 15-122.2 - Intercepting State Tax Refund for Converted Funds

(a)    In this section, “converted funds” means the amount received in payment by a person from an insurer for the cost of health services provided to a child which was not used to reimburse the Department for Medicaid costs incurred.
(b)    Each year the Department may refer to the Central Collection Unit of the Department of Budget and Management for certification to the State Comptroller the name of any person who has received converted funds for the interception of any State tax refund.
(c)    The Department shall notify the person certified under subsection (b) of this section that a certification has been made by the Department.
(d)    The certification by the Central Collection Unit shall include, if known:
(1)    The full name of the person certified and any other names known to be used by that person;
(2)    The address and the Social Security number of the person certified; and
(3)    The amount of the converted funds.
(e)    The State Comptroller shall:
(1)    Pay to the Department any income tax refund due to the person certified in an amount not more than the amount certified by the Department;
(2)    Pay to the person certified any part of the income tax refund over the amount of the converted funds; and
(3)    Notify the person certified of:
(i)    The amount paid to the Department; and
(ii)    The rights of the person certified under subsection (b) of this section.
(f)    (1)    On receipt of a notice of intercept from the State Comptroller, any person certified by the Department who disputes the existence or amount of the converted funds may file an appeal in accordance with Title 10 of the State Government Article.
(2)    If the Department finds that an excessive amount was withheld from the person’s income tax refund, the Department promptly shall pay to the taxpayer the excess amount withheld.
(g)    The Comptroller shall honor refund interception requests in the following order:
(1)    A refund interception request to collect an unpaid State, county, or municipal tax;
(2)    A refund interception request under § 10-113 of the Family Law Article for arrears of support payments;
(3)    A refund interception request for converted funds under this subtitle; and
(4)    Any other refund interception request.
(h)    The Secretary and the State Comptroller may adopt regulations to carry out this section.
2023 Maryland Statutes › Health - General › Title 15 - Assistance Programs › Subtitle 1 - Medical and Pharmacy Assistance Programs › Section 15-122.3 - Personal Needs Allowance -- Disabled Person With Guardian

(a)    (1)    In this section the following words have the meanings indicated.
(2)    “Available income” means the portion of income of a Program recipient that the Program recipient is required to contribute to the cost of care for the Program recipient under the Program.
(3)    “Disabled person” has the meaning stated in § 13–101 of the Estates and Trusts Article.
(4)    “Guardian” means:
(i)    A guardian of the person; or
(ii)    A guardian of the property.
(5)    “Guardian of the person” means a person who has been appointed by a court as a guardian of the person of a disabled person under § 13–705 of the Estates and Trusts Article.
(6)    “Guardian of the property” means a person who has been appointed by a court as a guardian of the property of a disabled person under § 13–201 of the Estates and Trusts Article.
(7)    “Guardianship services” means services provided to a recipient who is a disabled person by a guardian while acting in the capacity as a guardian.
(8)    “Recipient” means a Program recipient who receives long–term care services and supports under the Program.
(b)    Subject to subsection (c) of this section, when determining the available income of a recipient who is a disabled person and has a guardian, the Department shall include as part of the personal needs allowance guardianship fees payable for guardianship services.
(c)    The personal needs allowance for guardianship fees shall be as follows:
(1)    If one person is serving as both the guardian of the person and the guardian of the property of the recipient, the personal needs allowance shall be $50 per month; and
(2)    If one person is serving as the guardian of the person of the recipient and a different person is serving as the guardian of the property of the recipient, the personal needs allowance shall be $50 per month for each guardian.
2023 Maryland Statutes › Health - General › Title 15 - Assistance Programs › Subtitle 1 - Medical and Pharmacy Assistance Programs › Section 15-123 - Fraud

(a)    (1)    In this section the following words have the meanings indicated.
(2)    “Convicted” includes being convicted after a plea of nolo contendere.
(3)    “Fraud” includes the commission of or an attempt or conspiracy to commit the crimes of:
(i)    Concealment of medical records;
(ii)    Violation of Title 8, Subtitle 5, Part II of the Criminal Law Article;
(iii)    False representations relating to Medicaid health plans;
(iv)    Misappropriation by a fiduciary; and
(v)    Theft.
(b)    A health care provider who is convicted of fraud in connection with the Program or a similar federal or State program is ineligible for further payment under the Program.