reglab/statecodes huggingface dataset:
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.81 - Increased Community Services (ICS) Program › Section 10.09.81.30 - Covered Services - Attendant Care Services

Current through Register Vol. 51, No. 14, July 12, 2024
A. Definition. "Unit of service" means an
				  hour of service that is in the plan of service and rendered to a participant by
				  a qualified provider in the participant's home or in a community
				  setting.
B. Except as provided in
				  §C of this regulation, the ICS Program covers the following attendant care
				  services:
(1) Assistance with activities of
				  daily living;
(2) Delegated nursing
				  functions, such as assistance with the participant's administration of
				  medications or other remedies, when ordered by a physician, if this assistance
				  is:
(a) Specified in the participant's plan
				  of service; and
(b) Rendered in
				  accordance with the Maryland Nurse Practice Act, COMAR 10.27.11, and other
				  requirements of the Maryland Board of Nursing;
(3) Assistance with protecting a participant
				  from harm or neglect;
(4)
				  Assistance with instrumental activities of daily living, provided as incidental
				  to the services covered under §B(1)-(3) of this regulation; and
(5) Accompanying the participant outside of
				  the home during the participant's community activities.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.81 - Increased Community Services (ICS) Program › Section 10.09.81.31 - Covered Services - Nursing Supervision of Attendants

Current through Register Vol. 51, No. 14, July 12, 2024
A. Definition. "Unit of service" means an
				  hour of service rendered by a nurse monitor to a participant in the
				  participant's home or another community-based setting.
B. Nursing supervision services include the
				  following:
(1) Development of the
				  participant's plan for attendant care:
(a)
				  After consultation with the participant, family members, participant's personal
				  physician, case manager, and other providers; and
(b) In conformance with the participant's:
(i) AERS evaluation;
(ii) AERS plan of care; and
(iii) Plan of service;
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.81 - Increased Community Services (ICS) Program › Section 10.09.81.32 - Covered Services - Home-Delivered Meals

Current through Register Vol. 51, No. 14, July 12, 2024
A. Definition. "Unit of service" means one
				  meal delivered to the participant's home, including the cost of the food, food
				  preparation, and delivery.
B. The
				  meal shall be intended for consumption at home.
C. This service may not constitute the
				  participant's full nutritional regimen of three meals per day.
D. Each meal shall:
(1) Be nutritionally adequate for the
				  participant's age based on the Recommended Dietary Allowance (RDA) or Dietary
				  Reference Intake (DRI), as established by the Food and Nutrition Board of the
				  National Research Council; and
(2)
				  Meet either of the following:
(a) At least
				  one-third of the RDA or DRI; or
(b)
				  Therapeutic or restrictive diet requirements ordered by the participant's
				  physician, dietitian, or nutritionist, including any ordered nutritional
				  supplements.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.81 - Increased Community Services (ICS) Program › Section 10.09.81.33 - Covered Services - Dietitian and Nutritionist Services

Current through Register Vol. 51, No. 14, July 12, 2024
A. Definition. "Unit of service" means an
				  hour of service rendered one-on-one by a qualified provider for a participant
				  in the participant's home or the provider's office.
B. Dietitian and nutritionist services shall
				  include:
(1) The provision of a nutrition care
				  plan as part of the ICS Program multidisciplinary team process;
(2) Nutrition care planning, nutrition
				  assessment, and dietetic instruction; and
(3) Services within the scope of practice of
				  the nutritionist's or dietitian's license, as defined by:
(a) Health Occupations Article, Title 5,
				  Annotated Code of Maryland; and
(b)
				  Regulations under COMAR 10.56 for the Board of Dietetic Practice.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.81 - Increased Community Services (ICS) Program › Section 10.09.81.34 - Covered Services - Behavior Consultation Services

Current through Register Vol. 51, No. 14, July 12, 2024
A. Definition. "Unit of service" means an
				  hour of service rendered by a qualified individual during a home visit to a
				  participant, not including:
(1) The time spent
				  on related activities before or after the home visit; or
(2) The time spent on supervisory or
				  consultative services to the provider.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.81 - Increased Community Services (ICS) Program › Section 10.09.81.35 - Covered Services - Medical Day Care

Current through Register Vol. 51, No. 14, July 12, 2024
A. Definition. "Unit of service" means a day
				  of service rendered by a qualified provider to a participant in accordance with
				  COMAR 10.09.07.
B. The ICS Program
				  reimburses for a day of care which includes the following services:
(1) Health care services supervised by the
				  director, medical director, or health director, which emphasize primary
				  prevention, early diagnosis and treatment, rehabilitation and continuity of
				  care, including the following:
(a)
				  Participation in the development of the individual participant's plan of
				  care;
(b) Participation in the
				  determination of the participant's medical, psychosocial, and functional
				  status;
(c) Consultation with the
				  participant's personal physician; and
(d) Consultation with staff regarding a
				  participant's condition and health care needs;
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.81 - Increased Community Services (ICS) Program › Section 10.09.81.36 - Covered Services - Senior Center Plus

Current through Register Vol. 51, No. 14, July 12, 2024
A. Definition. "Unit of service" means a day
				  of attendance by a participant for at least 4 hours, not including
				  transportation to and from the center.
B. Senior Center Plus services include a
				  program of structured group recreational activities, supervised care,
				  assistance with activities of daily living and instrumental activities of daily
				  living, and socialization provided in an out-of-home, outpatient setting.
				  Social and recreational activities designed for elderly and disabled
				  individuals, and one nutritious meal shall be provided by the center.
C. This program is designed to promote the
				  participants' optimal functioning and to improve their orientation and
				  cognitive ability.
D. A provider
				  may choose to provide transportation to and from the site of the Senior Center
				  Plus services. These transportation services:
(1) May not be included in the provider's
				  daily rate negotiated with the Maryland Department of Aging; and
(2) Shall be reimbursed through some other
				  funding source for transportation services.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.81 - Increased Community Services (ICS) Program › Section 10.09.81.37 - Covered Services - Assisted Living Facility

Current through Register Vol. 51, No. 14, July 12, 2024
A. Definition. "Unit of service" means a day
				  of service and does not include days that the participant was not residing in
				  the provider's assisted living facility, meaning that the participant:
(1) Had not yet moved into the
				  facility;
(2) Had moved out of the
				  facility;
(3) Was an inpatient at a
				  hospital, nursing facility, or other medical institution for one or more
				  nights; or
(4) Was absent from the
				  provider's facility for more than 7 nights during a calendar month at the
				  participant's choice for personal reasons, such as to visit family or take a
				  vacation.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.81 - Increased Community Services (ICS) Program › Section 10.09.81.38 - Conditions for Reimbursement

Current through Register Vol. 51, No. 14, July 12, 2024
The Maryland Medical Assistance Program shall reimburse for
					 the services specified in Regulations .22-.37 of this chapter, if the
					 service:
A. Is recommended in the
				  applicant's or participant's plan of service as necessary in order to:
(1) Prevent admission to a nursing
				  facility;
(2) Safely
				  deinstitutionalize the individual from a nursing facility into the community;
				  or
(3) Assure the participant's
				  health and safety in the community;
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.81 - Increased Community Services (ICS) Program › Section 10.09.81.39 - Limitations

Current through Register Vol. 51, No. 14, July 12, 2024
A. Reimbursement
				  may be made by the Maryland Medical Assistance Program only if the requirements
				  of this chapter are met.
B. The
				  total reimbursement by the Maryland Medical Assistance Program for
				  environmental accessibility adaptations and assistive technology combined is
				  limited to the amount specified at Regulation .40C(4)(f)(ii) or (h)(ii) of this
				  chapter during the participant's annual plan of service period, with exceptions
				  allowed at the Department's discretion in the following circumstances:
(1) The amount exceeds the limit, but will
				  allow the individual to return home from a nursing facility or avoid immediate
				  placement in a nursing facility, and does not exceed the participant's cost
				  neutrality under Regulation .38E of this chapter; or
(2) Expenditures in excess of the annual
				  limit will reduce the participant's ongoing Medicaid cost of care significantly
				  without exceeding the participant's cost neutrality.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.81 - Increased Community Services (ICS) Program › Section 10.09.81.40 - Payment Procedures - General

Current through Register Vol. 51, No. 14, July 12, 2024
A. Request for Payment.
(1) An approved provider shall:
(a) Submit a request for payment for the
				  services covered under this chapter according to procedures set forth in COMAR
				  10.09.36.04C;
				  and
(b) Include the following
				  information on the request:
(i) Date or dates
				  of service;
(ii) Participant's name
				  and Medical Assistance number;
(iii) Provider's name, location, and
				  identification number;
(iv) Nature,
				  procedure code or codes, and unit or units of the covered services provided;
				  and
(v) Amount of reimbursement
				  requested.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.81 - Increased Community Services (ICS) Program › Section 10.09.81.41 - Payment Procedures - Rates

Current through Register Vol. 51, No. 14, July 12, 2024
A.
				  Participant Training. A qualified provider shall bill the Department an
				  all-inclusive rate not to exceed $39.11 for each hour of covered
				  service.
B. Family Training. A
				  qualified provider shall bill the Department a rate for each hour of covered
				  services not to exceed:
(1) Self-employed -
				  $25.90 per hour for family training services rendered by an appropriately
				  licensed professional; and
(2)
				  Agency-employed - $37.75 per hour for family training services rendered by an
				  appropriately licensed professional.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.81 - Increased Community Services (ICS) Program › Section 10.09.81.42 - Recovery and Reimbursement

Current through Register Vol. 51, No. 14, July 12, 2024
Recovery and reimbursement are as set forth in COMAR
					 10.09.36.07C.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.81 - Increased Community Services (ICS) Program › Section 10.09.81.43 - Cause for Suspension or Removal and Imposition of Sanctions

Current through Register Vol. 51, No. 14, July 12, 2024
Cause for suspension or removal and imposition of sanctions
					 is as set forth in COMAR
					 10.09.36.08C.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.81 - Increased Community Services (ICS) Program › Section 10.09.81.44 - Appeal Procedures for Providers

Current through Register Vol. 51, No. 14, July 12, 2024
Appeal procedures for providers are those set forth in
					 COMAR 10.09.36.09C.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.81 - Increased Community Services (ICS) Program › Section 10.09.81.45 - Appeal Procedures for Applicants and Participants

Current through Register Vol. 51, No. 14, July 12, 2024
Appeal procedures for applicants and participants are those
					 set forth in COMAR
					 10.09.24.13C and
					 10.01.04.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.81 - Increased Community Services (ICS) Program › Section 10.09.81.46 - Interpretive Regulation

Current through Register Vol. 51, No. 14, July 12, 2024
State regulations are interpreted as set forth in COMAR
					 10.09.36.10C.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.82 - Provider-Based Outpatient Oncology Facilities › Section 10.09.82.01 - Definitions

Current through Register Vol. 51, No. 14, July 12, 2024
A. In this chapter,
				  the following terms have the meanings indicated.
B. Terms Defined.
(1) "Department" means the Department of
				  Health and Mental Hygiene, the single State agency designated to administer the
				  Maryland Medical Assistance Program under Title XIX of the Social Security Act,
				  42 U.S.C. §
												1396 et seq.
(2) "Healthcare Common Procedure Coding
				  System (HCPCS)" means a set of health care procedure codes based on the
				  American Medical Association's Current Procedural Terminology (CPT).
(3) "Medically necessary" means that the
				  service or benefit is:
(a) Directly related
				  to diagnostic, preventive, curative, palliative, rehabilitative, or
				  ameliorative treatment of an illness, injury, disability, or health
				  condition;
(b) Consistent with
				  current accepted standards of good medical practice;
(c) The most cost efficient service that can
				  be provided without sacrificing effectiveness or access to care; and
(d) Not primarily for the convenience of the
				  consumer, family, or provider.
(4) "Medicare-certified facility" means a
				  facility which is certified for Medicare by the regional office of the Centers
				  for Medicare and Medicaid Services (CMS).
(5) "Provider-based outpatient oncology
				  facility" means an outpatient facility that is:
(a) Owned by a hospital;
(b) Located off-site from the hospital;
				  and
(c) Not regulated by the Health
				  Services Cost Review Commission (HSCRC).
(6) "Recipient" means an individual who is
				  certified as eligible for, and is receiving, Medical Assistance
				  benefits.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.82 - Provider-Based Outpatient Oncology Facilities › Section 10.09.82.02 - License Requirements

Current through Register Vol. 51, No. 14, July 12, 2024
In order to participate in the Program, the provider
					 shall:
A. Meet all requirements as set
				  forth in COMAR
				  10.09.36.02C;
				  and
B. Ensure that Clinical
				  Laboratory Improvement Amendments (CLIA) certification exists for all clinical
				  laboratory services performed and if located:
(1) In Maryland, comply with requirements of
				  Health-General Article, Title 17, Subtitles 2 and 3, Annotated Code of
				  Maryland, and COMAR 10.10.06; or
(2) Out-of-State, comply with other
				  applicable standards established by the state or locality in which the service
				  is provided.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.82 - Provider-Based Outpatient Oncology Facilities › Section 10.09.82.03 - Conditions for Participation

Current through Register Vol. 51, No. 14, July 12, 2024
A.
				  To participate in the Program, a provider shall meet all conditions for
				  participation as set forth in COMAR
				  10.09.36.03C.
B. Specific requirements for
				  participation with the Department as a provider-based outpatient oncology
				  facility require that the provider shall:
(1)
				  Be a Medicare-certified facility;
(2) Have clearly defined, written patient
				  care policies; and
(3) Maintain
				  adequate documentation of each recipient visit as part of the plan of care,
				  which at a minimum, shall include:
(a) Date
				  of service;
(b) A description of
				  the service provided; and
(c) A
				  legible signature and printed or typed name of the professional providing care,
				  with the appropriate title.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.82 - Provider-Based Outpatient Oncology Facilities › Section 10.09.82.04 - Covered Services

Current through Register Vol. 51, No. 14, July 12, 2024
The Program covers the following services when medically
					 necessary:
A. Radiation
				  therapy;
B. Chemotherapy;
C. IV Infusion;
D. Blood transfusions;
E. Medical supplies;
F. Drugs; and
G. Bone marrow biopsies.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.82 - Provider-Based Outpatient Oncology Facilities › Section 10.09.82.05 - Limitations

Current through Register Vol. 51, No. 14, July 12, 2024
The following services are not covered:
A. Any service or treatment that is not
				  medically necessary;
B.
				  Experimental or investigational services;
C. Services that are specifically included as
				  part of another service; and
D.
				  Professional fees provided by physicians billed separately from the facility's
				  charges.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.82 - Provider-Based Outpatient Oncology Facilities › Section 10.09.82.06 - Payment Procedures

Current through Register Vol. 51, No. 14, July 12, 2024
A. General
				  policies for payment procedures that are applicable to all providers are set
				  forth in COMAR
				  10.09.36.04C.
B. Specific Payment Procedures for
				  a Provider-Based Outpatient Oncology Facility.
(1) The provider shall submit a request for
				  payment on the form designated by the Department for dates of service on or
				  after July 1, 2012.
(2) Except for
				  drugs which shall be billed to the Program using the National Drug Code (NDC)
				  and appropriate the HCPCS, the Department shall reimburse the facility at an
				  amount that is equal to 80 percent of the Medicare rate of
				  reimbursement.
(3) The Department
				  shall authorize payment on Medicare claims if:
(a) The provider accepts Medicare;
(b) Medicare makes direct payment to the
				  provider; and
(c) Medicare has
				  determined the services are medically necessary.
(4)The provider may not bill the Program or
				  the recipient for:
(a) Completion of forms or
				  reports;
(b) Broken or missed
				  appointments; or
(c) Providing a
				  copy of a recipient's medical record when requested by another licensed
				  provider on behalf of the recipient.
(5) The Program makes no direct payments to
				  recipients.
(6) The billing time
				  limitations are set forth in COMAR 10.09.36.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.82 - Provider-Based Outpatient Oncology Facilities › Section 10.09.82.07 - Recovery and Reimbursement

Current through Register Vol. 51, No. 14, July 12, 2024
A.
				  If the recipient has insurance, or if any other person is obligated either
				  legally or contractually to pay for or to reimburse for any service covered by
				  this chapter, the provider shall seek payment from that source first. If an
				  insurance carrier rejects the claim or pays less than the amount allowed by the
				  Medical Assistance Program, the provider may submit a claim to the Department.
				  The provider shall submit a copy of the insurance carrier's notice or
				  remittance advice with the claim. If payment is made by both the Program and by
				  the insurance or other source for the same service, the provider shall refund
				  to the Department, within 60 days of receipt, the amount paid by the Program,
				  or by the insurance or other source, whichever is less.
B. The provider shall reimburse the
				  Department for any overpayment.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.82 - Provider-Based Outpatient Oncology Facilities › Section 10.09.82.08 - Cause for Suspension or Removal and Imposition of Sanctions

Current through Register Vol. 51, No. 14, July 12, 2024
General policies governing cause for suspension or removal
					 and imposing sanctions that are applicable to all providers are set forth in
					 COMAR 10.09.36.08C.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.82 - Provider-Based Outpatient Oncology Facilities › Section 10.09.82.09 - Appeal Procedures

Current through Register Vol. 51, No. 14, July 12, 2024
General policies governing appeal procedures that are
					 applicable to all providers are set forth in COMAR
					 10.09.36.09C.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.82 - Provider-Based Outpatient Oncology Facilities › Section 10.09.82.10 - Interpretive Regulation

Current through Register Vol. 51, No. 14, July 12, 2024
General policies governing the interpretive regulations
					 that are applicable to all providers are set forth in COMAR
					 10.09.36.10C.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.83 - Third Party Liability › Section 10.09.83.01 - Definitions

Current through Register Vol. 51, No. 14, July 12, 2024
A. In this chapter,
				  the following terms have the meanings indicated.
B. Terms Defined.
(1) "Claim" means a demand for payment,
				  whether or not the right is reduced to judgment, liquidated, unliquidated,
				  fixed, contingent, matured, unmatured, disputed, undisputed, legal, equitable,
				  secured or unsecured.
(2)
				  "Department" means the Department of Health and Mental Hygiene, the single
				  State agency designated to administer the Maryland Medical Assistance Program
				  under Title XIX of the Social Security Act,
				  42 U.S.C. §
												1396 et seq.
(3) "Program" means the Maryland Medical
				  Assistance Program.
(4) "Provider"
				  means an individual, association, partnership, corporation, or unincorporated
				  group licensed or certified to provide health care services for recipients and
				  who, through appropriate agreement with the Department, has been identified as
				  a Program provider by the issuance of an individual account number.
(5) "Recipient" means:
(a) An individual who is certified as
				  eligible for, and is receiving, Program benefits;
(b) An individual who was certified as
				  eligible for and received Program benefits; or
(c) The successor in interest of a person
				  identified in §B(6)(a) or (b) of this regulation.
(6) "Third party" means any individual,
				  entity or program that is or may be liable to pay all or part of the
				  expenditures for Program benefits.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.83 - Third Party Liability › Section 10.09.83.02 - Program's Right of Subrogation

Current through Register Vol. 51, No. 14, July 12, 2024
A. The Department may not pay medical claims
				  that are payable by a third party.
B. The Department is assigned any and all
				  rights to payments by any third party that result from medical care received by
				  the recipient, together with the rights of any other individuals eligible for
				  Program benefits for whom the recipient can make assignment. This assignment
				  shall be effective to the extent of the amount of medical assistance actually
				  paid by the Program.
C. If a
				  recipient has a cause of action against a third party, including a claim under
				  Insurance Article, §
										19-509 or
				  19-510, Annotated Code of
				  Maryland, the Department shall be subrogated to that cause of action to the
				  extent of any payments made by the Department on behalf of the recipient that
				  result from the occurrence that gave rise to the cause of action.
D. The Department's subrogation claim shall
				  be limited to that portion of the claim that represents compensation for the
				  medical expenses paid by the Program until the date of an award, settlement or
				  judgment.
E. Judicial Allocation of
				  Medical Expenses from an Award or Settlement.
(1) A recipient may not agree, in settlement
				  of the recipient's cause of action, to an allocation of medical expenses less
				  than the amounts set forth in §F of this regulation, without prior
				  approval of the Department.
(2) If
				  an action decided by the court does not determine the allocation of medical
				  expenses in such action, the allocation shall be determined in accordance with
				  §F of this regulation.
(3)
				  Provided that the Department is provided at least 10 days advance written
				  notice of any hearing at which the allocation of medical expenses shall be
				  heard, the Department shall defer to the court's determination of the
				  allocation of medical expenses.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.83 - Third Party Liability › Section 10.09.83.03 - Recipient Responsibility

Current through Register Vol. 51, No. 14, July 12, 2024
A. A
				  recipient shall cooperate with and assist the Department in identifying and
				  providing information concerning third parties who may be liable to pay for
				  care and services received by the recipient under the Program.
B. A recipient is required to assist and
				  cooperate fully with the Department in the Department's efforts to secure the
				  Department's rights in Regulation .02 of this chapter, including but not
				  limited to:
(1) Notifying the Program's
				  Division of Recoveries and Financial Services in writing within 10 days of
				  filing suit or commencing an action against a third party;
(2) Notifying the Program's Division of
				  Recoveries and Financial Services in writing before negotiating or entering a
				  settlement with a third party;
(3)
				  Subject to Regulation .05 of this chapter, paying to the Program within 30 days
				  all funds received from a third party to the extent necessary to satisfy the
				  subrogation rights of the Department;
(4) Disclosing information regarding health
				  insurance or other third party resources when applying for Program
				  benefits;
(5) Notifying providers
				  of health and casualty coverage and other third party resources when requesting
				  medical care;
(6) Notifying the
				  Program of any health insurance obtained after becoming eligible for
				  Medicaid;
(7) Notifying the
				  Program's Division of Recoveries and Financial Services of any casualty or
				  liability insurance that may cover medical treatment received due to an injury;
				  and
(8) Executing and delivering to
				  the Program such documents as reasonably requested by the Program to pursue the
				  Department's subrogation claim.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.83 - Third Party Liability › Section 10.09.83.04 - Notice to the Department

Current through Register Vol. 51, No. 14, July 12, 2024
A. An
				  attorney representing a recipient in a cause of action that gives rise to the
				  Department's right of subrogation under Regulation .02 of this chapter shall
				  notify the Program's Division of Recoveries and Financial Services in writing
				  before:
(1) Filing a claim;
(2) Commencing an action; or
(3) Negotiating a settlement.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.83 - Third Party Liability › Section 10.09.83.05 - Judgment, Award, or Settlement of a Medical Assistance Claim

Current through Register Vol. 51, No. 14, July 12, 2024
A. Except as
				  provided in §§B-E of this regulation, a third party shall have no
				  further liability if it settles or compromises a dispute in good faith and
				  without knowledge that the individual is a recipient of Program
				  benefits.
B. A recipient, or the
				  recipient's attorney, guardian, or personal representative, who receives money
				  as a result of a judgment, award, or settlement of an action or claim in which
				  the Department has a subrogation claim shall:
(1) Deduct applicable attorney fees and
				  litigation costs from the total judgment, award, or settlement;
(2) Subject to §C of this regulation,
				  hold and forward to the Department the remainder of the judgment, award, or
				  settlement for the benefit of the Department to the extent required for the
				  Department's subrogation claim.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.83 - Third Party Liability › Section 10.09.83.06 - Program Claim

Current through Register Vol. 51, No. 14, July 12, 2024
A. In a case
				  where the Department is subrogated to the rights of the recipient, the
				  Department has a claim to the proceeds of the recovery from the persons liable,
				  whether the proceeds of the recovery are by way of judgment, settlement, or
				  otherwise and shall, to the extent permitted by federal law, be satisfied in
				  full.
B. The claim is in the amount
				  of all Program benefits paid minus any deductions required by law.
C. The claim is effective when:
(1) Filed with a court of competent
				  jurisdiction in the State; and
(2)
				  Notice of filing of the claim is served by the Department upon the third party,
				  personally or by registered, certified, or insured mail, return receipt
				  requested.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.83 - Third Party Liability › Section 10.09.83.07 - Conflict with Federal Requirements

Current through Register Vol. 51, No. 14, July 12, 2024
If any provision of this chapter related to subrogation,
					 assignment, or lien conflicts with federal law concerning the Program or
					 receipt of federal funds to finance the Program, the provision does not apply
					 to the extent of the conflict.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.84 - Community First Choice › Section 10.09.84.01 - Purpose

Current through Register Vol. 51, No. 14, July 12, 2024
The purpose of
					 Community First Choice is to provide certain home and community-based services
					 and supports, as an alternative to institutional placements, to individuals who
					 have been determined to require an institutional level of care.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.84 - Community First Choice › Section 10.09.84.02 - Definitions

Current through Register Vol. 51, No. 14, July 12, 2024
A. In this chapter,
				  the following terms have the meanings indicated.
B. Terms Defined.
(1) "Activities of daily living (ADLs)" means
				  tasks or activities that include, but are not limited to:
(a) Bathing and completing personal hygiene
				  routines;
(b) Dressing and changing
				  clothes;
(c) Eating;
(d) Mobility, including:
(i) Transferring from a bed, chair, or other
				  structure;
(ii) Moving, turning,
				  and positioning the body while in bed or in a wheelchair; and
(iii) Moving about indoors or outdoors;
				  and
(e) Toileting,
				  including:
(i) Bladder and bowel
				  requirements;
(ii) Routines
				  associated with the achievement or maintenance of continence; and
(iii) Incontinence care.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.84 - Community First Choice › Section 10.09.84.03 - Requirements for Provider Licensing or Certification

Current through Register Vol. 51, No. 14, July 12, 2024
The following health
					 professionals providing services under this chapter shall be licensed to
					 practice in the jurisdiction in which services are rendered:
A. Physicians;
B. Registered nurses;
C. Licensed practical nurses;
D. Certified medication
					 technicians;
E. Certified nursing
					 assistants;
F. Occupational
					 therapists;
G. Physical
					 therapists;
H. Speech
					 pathologists;
I. Nutritionists;
					 and
J. Dietitians.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.84 - Community First Choice › Section 10.09.84.04 - Participant Eligibility

Current through Register Vol. 51, No. 14, July 12, 2024
A. To
				  participate in the Program, a participant shall:
(1) Be determined by the Department to need
				  the level of care provided in a hospital, nursing facility, an intermediate
				  care facility for individuals with intellectual disabilities, an institution
				  providing psychiatric services for individuals younger than 21 years old, or an
				  institution for mental diseases for individuals 65 years old or
				  older;
(2) Be eligible for Medicaid
				  under an eligibility group defined in COMAR 10.09.24, except for Regulations
				  .03C, .03-1 - .03-3, and .05-2; and
(3) Reside at home.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.84 - Community First Choice › Section 10.09.84.05 - Conditions for Provider Participation - General Requirements

Current through Register Vol. 51, No. 14, July 12, 2024
A. To participate
				  as a provider of a service covered under this chapter, a provider:
(1) Shall meet all of the conditions for
				  participation as a Medicaid provider as set forth in COMAR 10.09.36, except as
				  otherwise specified in this chapter;
(2) Shall obtain written verification of the
				  qualifications of all individuals who render services on the provider's behalf
				  and provide a copy of the current license or credentials on request;
(3) Shall implement the reporting and
				  follow-up of incidents and complaints in accordance with the Department's
				  established policy by:
(a) Reporting
				  incidents and complaints within 24 hours of knowledge of the event;
(b) Submitting a written report within 7
				  calendar days on a form designated by the Department; and
(c) Notifying the local department of social
				  services immediately if the provider has a reason to believe that the
				  participant has been subjected to abuse, neglect, self-neglect, or
				  exploitation, in accordance with COMAR 07.02.16;
(4) Shall agree to cooperate with required
				  inspections, reviews, and audits by authorized governmental agents;
(5) Shall agree to provide services, and to
				  subsequently bill the Department in accordance with the reimbursement
				  methodology specified in this chapter, for only those services covered under
				  this chapter which have been:
(a)
				  Preauthorized in the participant's plan of service;
(b) Provided in a manner consistent with the
				  participant's plan of service; and
(c) Identified in the provider agreement as
				  within the scope of the provider's Medicaid participation;
(6) Shall agree to maintain and have
				  available written documentation of services, including dates and hours of
				  services provided to participants, for a period of 6 years from the date of
				  service, in a manner approved by the Department;
(7) Shall agree not to suspend, terminate,
				  increase, or reduce services for an individual without authorization from the
				  Department and only after consultation and input from the participant or, when
				  applicable, the participant's representative;
(8) Shall submit a transition plan to the
				  case manager or supports planner and participant or, when applicable, the
				  participant's representative when suspending or terminating services;
(9) Shall verify Medicaid eligibility at the
				  beginning of each month that services will be rendered;
(10) May not be a Medicaid provider or
				  principal of a Medicaid provider that has overpayments that remain due to the
				  Department; and
(11) Shall be free
				  from conflicts of interest.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.84 - Community First Choice › Section 10.09.84.06 - Specific Conditions for Provider Participation - Personal Assistance

Current through Register Vol. 51, No. 14, July 12, 2024
A. Personal
				  assistance service providers shall:
(1) Be
				  licensed as a Residential Service Agency under COMAR 10.07.05 to provide Level
				  Two or Level Three home care services;
(2) Employ a registered nurse who shall:
(a) Assess each new participant who requires
				  personal assistance services;
(b)
				  Participate in developing the worker instructions and in assigning appropriate
				  personnel;
(c) Delegate nursing
				  tasks, as appropriate, to a CNA or a CMT in accordance with COMAR 10.27.11;
				  and
(d) Participate in instructing
				  the workers who will provide the assistance, when indicated;
(3) Employ workers who will accept
				  instruction on the personal assistance services required in the participant's
				  plan of service from the following:
(a) The
				  participant or, when applicable, the participant's representative;
(b) The nurse monitor;
(c) A treating physician or nurse
				  practitioner; or
(d) An individual
				  from the Department;
(4) Allow participants
				  to have a significant role in the delivery of their specific care including:
(a) Directing the services and supports
				  identified in their plan of service; and
(b) Exercising as much control as desired to
				  select, train, schedule, determine duties, and dismiss the personal assistance
				  worker in their home;
(5) Notify the Department in writing at least
				  45 days in advance of any:
(a) Voluntary
				  closure;
(b) Change of ownership;
(c) Change of location;
(d) Sale of the business;
(e) Change in the name under which the
				  provider is doing business; or
(f)
				  Change in provider tax identification number;
(6) Include in the notice to the Department
				  the method for informing participants and representatives of its intent to
				  close, change ownership, change location, or sell its business;
(7) Include in the notice to the Department,
				  and inform participants and representatives, of the transition plan developed
				  by the agency to ensure continuity of services to participants;
(8)
				  If applicable, apply for a new license whenever ownership is to be transferred
				  from the person or organization named on the license to another person or
				  organization in time to assure continuity of services;
(9) Submit a Medicaid provider application to
				  the Department if the new owner chooses to participate in the
				  Program;
(10) At least monthly,
				  collect and maintain the participant's signature, or that of the participant's
				  representative when applicable, verifying services rendered; and
(11) Conduct a criminal history records check
				  on all direct service workers including nurses, in accordance with the
				  procedure for a State criminal history records check established under
				  Health-General Article, Title 19, Subtitle 19, Annotated Code of
				  Maryland.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.84 - Community First Choice › Section 10.09.84.07 - Specific Conditions for Provider Participation - Supports Planning

Current through Register Vol. 51, No. 14, July 12, 2024
To participate in the Program as a supports planning
					 provider under Regulation .15 of this chapter, a provider shall:
A. Agree to be monitored by the Department;
				  and
B. Be:
(1) Identified by the Department through a
				  solicitation process; or
(2) The area agency on
				  aging that is enrolled to provide case management services under COMAR
				  10.09.54.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.84 - Community First Choice › Section 10.09.84.08 - Specific Conditions for Provider Participation - Consumer Training

Current through Register Vol. 51, No. 14, July 12, 2024
To participate in the Program as a provider of consumer
					 training under Regulation .16 of this chapter, a provider shall:
A. Be a self-employed trainer or an agency
				  that employs qualified trainers in accordance with §B of this
				  regulation;
B. Have demonstrated
				  experience with the skill being taught; and
C. Be willing to meet at the participant's
				  home to provide services.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.84 - Community First Choice › Section 10.09.84.09 - Specific Conditions for Provider Participation - Personal Emergency Response Systems

Current through Register Vol. 51, No. 14, July 12, 2024
To participate in the Program as a provider of personal
					 emergency response systems under Regulation .17 of this chapter, a provider
					 shall:
A. Be the store, vendor,
				  organization, or company which sells, rents, installs, services, or operates
				  the device or service;
B. Provide
				  or arrange for any installation, maintenance, training, or monitoring required
				  for the device or system;
C. Ensure
				  that any response center is:
(1) Responsible
				  for monitoring and responding to a notification of an emergency by the system;
				  and
(2) Adequately staffed 24 hours
				  a day, 7 days a week by properly trained staff; and
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.84 - Community First Choice › Section 10.09.84.10 - Specific Conditions for Provider Participation - Items or Services that Substitute for Human Assistance

Current through Register Vol. 51, No. 14, July 12, 2024
A.
				  To participate in the program as a provider of items or services that
				  substitute for human assistance, the provider shall:
(1) Be approved and monitored by the
				  Department;
(2) Provide or arrange
				  for any installation, maintenance, training, or monitoring required for the
				  proper operation of the device or system, if applicable; and
(3) Receive a referral from the participant,
				  participant's case manager, or supports planner, based on services
				  preauthorized in the plan of service.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.84 - Community First Choice › Section 10.09.84.11 - Specific Conditions for Provider Participation - Environmental Assessments

Current through Register Vol. 51, No. 14, July 12, 2024
To participate in the Program as a provider of
					 environmental assessments under Regulation .19 of this chapter, the provider
					 shall:
A. Be a licensed occupational
				  therapist, or an agency or professional group employing a licensed occupational
				  therapist;
B. Receive a referral
				  from the participant's supports planner, based on services preauthorized in the
				  plan of service; and
C. Document
				  the provider's findings and recommendations on a form approved by the
				  Program.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.84 - Community First Choice › Section 10.09.84.12 - Specific Conditions for Provider Participation - Nurse Monitoring

Current through Register Vol. 51, No. 14, July 12, 2024
To participate in the Program as a nurse monitoring
					 provider under Regulation .20 of this chapter, a provider shall:
A. Be designated by the Department through a
				  process approved by the Centers for Medicare and Medicaid Services in
				  accordance with § 1915(b)(4) of the Social Security Act;
B. Employ or contract with registered nurses
				  who hold a current professional license to practice in Maryland;
C. Agree to accept all referrals from the
				  Department; and
D. Agree to be
				  monitored by the Department.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.84 - Community First Choice › Section 10.09.84.13 - Covered Services - General

Current through Register Vol. 51, No. 14, July 12, 2024
The Program shall reimburse for the services specified in
					 Regulations .14-.21 of this chapter, when, pursuant to the requirements of this
					 chapter, these services have been preauthorized by the Department in the
					 participant's plan of service, billed in accordance with the payment procedures
					 in Regulation .24 of this chapter, and documented as necessary to prevent
					 institutionalization.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.84 - Community First Choice › Section 10.09.84.14 - Covered Services - Personal Assistance

Current through Register Vol. 51, No. 14, July 12, 2024
A. The Program covers personal assistance
				  services that are approved in the plan of service and rendered to a participant
				  by a qualified provider in the participant's home or a community
				  setting.
B. The Program covers the
				  following services when provided by a personal assistance provider:
(1) Assistance with activities of daily
				  living;
(2) Delegated nursing
				  functions if this assistance is:
(a) Specified
				  in the participant's plan of service; and
(b) Rendered in accordance with the Maryland
				  Nurse Practice Act, COMAR 10.27.11, and other requirements of the Maryland
				  Board of Nursing;
(3)
				  Assistance with tasks requiring judgment to protect a participant from harm or
				  neglect;
(4) Assistance with or
				  completion of instrumental activities of daily living, provided in conjunction
				  with the services covered under §B(1)-(3) of this regulation;
				  and
(5) Assistance with the
				  participant's self-administration of medications, or administration of
				  medications or other remedies, when ordered by a physician.