reglab/statecodes huggingface dataset:
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.77 - Urgent Care Centers › Section 10.09.77.06 - Payment Procedures

Current through Register Vol. 51, No. 14, July 12, 2024
A. Payment
				  for free-standing urgent care centers is as follows:
(1) Urgent care centers are reimbursed a
				  facility fee, which is determined by the Program;
(2) In addition to the facility fee, the
				  Program shall reimburse for services rendered by the physician, nurse
				  practitioner, or physician assistant during the visit at the free-standing
				  urgent care center; and
(3) If the
				  service is free to individuals not covered by Medicaid:
(a) The provider:
(i) May charge the Program; and
(ii) Shall be reimbursed in accordance with
				  the provisions of this regulation; and
(b) The provider's reimbursement is not
				  limited to the provider's customary charge.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.77 - Urgent Care Centers › Section 10.09.77.07 - Recovery and Reimbursement

Current through Register Vol. 51, No. 14, July 12, 2024
A. If
				  the participant has insurance, or other coverage, or if any other person is
				  obligated, either legally or contractually, to pay for, or to reimburse the
				  participant for, services 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 Program, the provider may submit a
				  claim to the Program. The provider shall submit a copy of the insurance
				  carrier's notice or remittance advice with the invoice. If payment is made by
				  both the Program and 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 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 10.09.77 - Urgent Care Centers › Section 10.09.77.08 - Cause for Suspension or Removal and Imposition of Sanctions

Current through Register Vol. 51, No. 14, July 12, 2024
Causes for suspension or removal and imposition of
					 sanctions under this chapter are set forth in COMAR
					 10.09.36.08A.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.77 - Urgent Care Centers › Section 10.09.77.09 - Appeal Procedures

Current through Register Vol. 51, No. 14, July 12, 2024
Providers filing appeals from administrative decisions made
					 in connection with this chapter shall do so according to COMAR
					 10.09.36.09A.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.77 - Urgent Care Centers › Section 10.09.77.10 - Interpretive Regulation

Current through Register Vol. 51, No. 14, July 12, 2024
Except when the language of a specific regulation indicates
					 intent by the Department to provide reimbursement for covered services to
					 Program participants without regard to the availability of federal financial
					 participation, State regulations shall be interpreted in conformity with
					 applicable federal statutes and regulations.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.78 - Home Visiting Services › Section 10.09.78.02 - Certification Requirements

Current through Register Vol. 51, No. 14, July 12, 2024
The home visiting program provider shall have an active
					 accreditation status from one of the following evidence-based home visiting
					 models:
A. Healthy Families America
				  (HFA); or
B. Nurse Family
				  Partnership (NFP).
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.78 - Home Visiting Services › Section 10.09.78.03 - Conditions for Participation

Current through Register Vol. 51, No. 14, July 12, 2024
A.
				  General requirements for participation in the Program are that a provider shall
				  meet all conditions for participation as set forth in COMAR
				  10.09.36.03; and
B. Specific requirements for participation in
				  the home visiting program are that the provider shall provide proof of
				  accreditation by one of the following evidence-based home visiting models:
(1) Healthy Families America (HFA);
				  or
(2) Nurse Family Partnership
				  (NFP).
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.78 - Home Visiting Services › Section 10.09.78.04 - Covered Services

Current through Register Vol. 51, No. 14, July 12, 2024
The Program covers home visiting services rendered in the
					 program participant's home when the services:
A. Are rendered during the birthing parent's
				  prenatal period and postpartum periods; and
B. If not rendered in person, comply with the
				  telehealth requirements established in COMAR 10.09.49 and any subregulatory
				  guidance issued by the Department.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.78 - Home Visiting Services › Section 10.09.78.05 - Limitations

Current through Register Vol. 51, No. 14, July 12, 2024
The Program does not cover:
A. Expenses including:
(1) Administrative overhead;
(2) Lactation consulting services;
				  and
(3) Program start-up costs for
				  evidence-based model accreditation, initial training, or consultation;
				  or
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.78 - Home Visiting Services › Section 10.09.78.06 - Payment Procedures

Current through Register Vol. 51, No. 14, July 12, 2024
A. The
				  provider shall submit the request for payment in the format designated by the
				  Department.
B. The Program reserves
				  the right to return to the provider, before payment, all invoices not properly
				  signed, completed, and accompanied by properly completed forms required by the
				  Program.
C. The provider shall
				  charge the Program the provider's customary charge to the general public for
				  similar services.
D. The Program
				  will reimburse a provider for covered services:
(1) The lesser of the provider's customary
				  charge to the general public unless the service is free to individuals not
				  covered by Medicaid; or
(2) In
				  accordance with §I of this regulation.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.78 - Home Visiting Services › Section 10.09.78.07 - Recovery and Reimbursement

Current through Register Vol. 51, No. 14, July 12, 2024
Recovery and reimbursement regulations are set forth in
					 COMAR 10.09.36.07.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.78 - Home Visiting Services › Section 10.09.78.08 - 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
					 are set forth in COMAR 10.09.36.08.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.78 - Home Visiting Services › Section 10.09.78.09 - Appeal Procedures

Current through Register Vol. 51, No. 14, July 12, 2024
Providers filing appeals from administrative decisions made
					 in connection with this chapter shall do so according to COMAR
					 10.09.36.09
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.79 - Presumptive Eligibility for Correctional Facilities › Section 10.09.79.01 - Purpose and Scope

Current through Register Vol. 51, No. 14, July 12, 2024
This chapter establishes requirements for qualified State
					 and local corrections facilities to make presumptive eligibility determinations
					 effective July 1, 2017.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.79 - Presumptive Eligibility for Correctional Facilities › Section 10.09.79.03 - Requirements

Current through Register Vol. 51, No. 14, July 12, 2024
A. A correctional
				  facility based in Maryland is eligible to participate as a presumptive
				  eligibility entity.
B. The
				  eligibility worker shall:
(1) Using the
				  Department's eligibility verification system, verify the individual is not
				  actively enrolled in the Maryland Medical Assistance Program; and
(2) Complete the full Medical Assistance
				  application process;
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.79 - Presumptive Eligibility for Correctional Facilities › Section 10.09.79.04 - Presumptive Eligibility Criteria

Current through Register Vol. 51, No. 14, July 12, 2024
A. An individual shall apply for presumptive
				  eligibility through a participating correctional facility.
B. An individual who applies for presumptive
				  eligibility shall attest to:
(1) The
				  citizenship requirements in COMAR
				  10.09.24.05;
(2) The residency requirements in COMAR
				  10.09.24.05-3;
(3) The individual's pregnancy
				  status;
(4) The individual's family
				  size; and
(5) The individual's
				  household's gross monthly income.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.79 - Presumptive Eligibility for Correctional Facilities › Section 10.09.79.05 - Eligible Populations

Current through Register Vol. 51, No. 14, July 12, 2024
If an incarcerated inmate in a Maryland-based correctional
					 facility is determined to be eligible for one of the following coverage groups,
					 the individual may qualify for presumptive eligibility for correctional
					 facilities:
A. Parents and other
				  caretaker relatives whose household income is equal to or less than 133 percent
				  of the federal poverty level;
B.
				  Pregnant women whose income is equal to or less than 250 percent of the federal
				  poverty level;
C. Childless adults
				  19 years old or older and younger than 65 years old whose household income is
				  equal to or less than 133 percent of the federal poverty level; and
D. Former foster care individuals who are
				  younger than 26 years old.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.79 - Presumptive Eligibility for Correctional Facilities › Section 10.09.79.06 - Limitations

Current through Register Vol. 51, No. 14, July 12, 2024
Presumptive eligibility may not be granted to an individual
					 who:
A. Is currently enrolled in the
				  Maryland Medical Assistance Program or Medicare;
B. With the exception of pregnant women, had
				  a prior presumptive eligibility period during the last 12 months;
C. Does not meet the residency requirements
				  stated in COMAR
				  10.09.24.05-3; or
D. Does not meet the citizenship requirements
				  stated in COMAR 10.09.24.05.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.79 - Presumptive Eligibility for Correctional Facilities › Section 10.09.79.07 - Coverage Span

Current through Register Vol. 51, No. 14, July 12, 2024
A. Presumptive
				  eligibility begins on the day the presumptive eligibility worker determines the
				  individual is presumptively eligible.
B. Presumptive eligibility ends on the
				  earlier of:
(1) The day the individual is
				  determined eligible for Medical Assistance; or
(2) The last day of the month following the
				  month in which the correctional facility determined presumptive eligibility, if
				  an individual:
(a) Is found ineligible for
				  Medical Assistance; or
(b) Failed
				  to apply for Medical Assistance.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.79 - Presumptive Eligibility for Correctional Facilities › Section 10.09.79.08 - Presumptive Eligibility Appeal Rights

Current through Register Vol. 51, No. 14, July 12, 2024
An individual or an organization does not have appeal
					 rights for presumptive eligibility determinations.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.80 - Community-Based Substance Use Disorder Services › Section 10.09.80.02 - License Requirements

Current through Register Vol. 51, No. 14, July 12, 2024
To participate in the Program, a provider shall meet the
					 license requirements stated in COMAR
					 10.09.36.02 and 10.63.01.03.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.80 - Community-Based Substance Use Disorder Services › Section 10.09.80.03 - Conditions for Provider Participation

Current through Register Vol. 51, No. 14, July 12, 2024
A. A provider
				  shall be in compliance with COMAR
				  10.09.36.03 and
				  10.63.01.05.
B. A provider of
				  community-based substance use disorder services shall include:
(1) Community-based substance use disorder
				  providers that:
(a) Are licensed by the
				  Department as community-based substance use disorder providers pursuant to the
				  requirements listed in Regulation .05 of this chapter;
(b) Maintain verification of licenses and
				  credentials of all professionals employed by or under contract with the
				  provider in their respective personnel files; and
(c) Require any physician assistant employed
				  by the provider to have a delegation agreement with the supervising physician
				  in accordance with COMAR
				  10.09.55.02 and
				  .03;
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.80 - Community-Based Substance Use Disorder Services › Section 10.09.80.04 - Participant Eligibility and Referral

Current through Register Vol. 51, No. 14, July 12, 2024
A. A participant may self-refer or be
				  referred to substance use disorder treatment by a:
(1) Provider;
(2) Family member;
(3) Caregiver; or
(4) Local health authority.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.80 - Community-Based Substance Use Disorder Services › Section 10.09.80.05 - Covered Services

Current through Register Vol. 51, No. 14, July 12, 2024
A.
				  Comprehensive substance use disorder assessment at a minimum shall:
(1) Be delivered through:
(a) A BHA licensed substance use disorder
				  treatment provider; or
(b) An
				  opioid treatment program;
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.80 - Community-Based Substance Use Disorder Services › Section 10.09.80.06 - Limitations

Current through Register Vol. 51, No. 14, July 12, 2024
A. The Program
				  under this chapter does not cover the following:
(1) Community-based substance use disorder
				  services not specified in Regulation .04 of this chapter;
(2) Community-based substance use disorder
				  services not approved by a licensed physician or other licensed practitioner of
				  the healing arts, within the scope of his or her practice under State
				  law;
(3) Services not identified by
				  the Department as medically necessary or listed in Regulation .05 of this
				  chapter;
(4) Investigational and
				  experimental drugs and procedures;
(5) Substance use disorder visits solely for
				  the purpose of
(a) Prescribing
				  medication;
(b) Administering
				  medication;
(c) Drug or supply
				  pick-up;
(d) Collecting laboratory
				  specimens;
(e) Interpreting
				  laboratory tests or panels; or
(f)
				  Administering injections, unless the following are documented in the
				  participant's medical record:
(i) Medical
				  necessity; and
(ii) The
				  participant's inability to take appropriate oral
				  medications;
(6) Services that are provided in a hospital
				  inpatient or outpatient setting or in an intermediate care facility for
				  behavioral health;
(7) Services
				  beyond the provider's scope of practice; and
(8) Services that are separately billed but included
				  as part of another service;
(9)
				  Buprenorphine induction and buprenorphine maintenance therapy services that
				  are:
(a) Delivered by a participant's primary
				  care provider which are the responsibility of the Managed Care Organization as
				  specified in COMAR 10.09.70; or
(b)
				  Delivered without a primary diagnosis of substance use
				  disorder;
(10)
				  Presumptive and definitive drug testing when billed by:
(a) An opioid treatment program;
(b) An intensive outpatient program;
				  or
(c) A partial hospitalization
				  program provider;
(11)
				  Peer recovery support services that are not provided either in-person or via
				  telehealth; and
(12) Services not
				  authorized consistent with this chapter
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.80 - Community-Based Substance Use Disorder Services › Section 10.09.80.07 - Authorization Requirements

Current through Register Vol. 51, No. 14, July 12, 2024
A. For
				  services outlined in Regulation .04 of this chapter, the community-based
				  substance use disorder program shall notify the ASO and obtain authorization to
				  provide substance use disorder services from ASO.
B. The ASO agent shall authorize services
				  that are:
(1) Medically necessary;
				  and
(2) Of a type, frequency, and
				  duration that are consistent with expected results and
				  cost-effectiveness.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.80 - Community-Based Substance Use Disorder Services › Section 10.09.80.08 - 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 10.09.36.04.
B.
				  Billing time limitations for claims submitted under this chapter are set forth
				  in COMAR 10.09.36.06.
C. Unless the
				  care is free to other patients, a provider shall bill the Program their usual
				  and customary charge to the general public.
D. For dates of service from November 1, 2021
				  through June 30, 2022, rates for the services outlined in this regulation shall
				  be as follows:
(1) For services outlined in
				  this regulation, as delivered through a BHA licensed substance use disorder
				  treatment provider:
(a) Comprehensive
				  substance use disorder assessment - $179.55;
(b) Level 1 group substance use disorder
				  counseling - $49.32 per session;
(c) Level 1 individual substance use disorder
				  counseling - $25.29 per 15-minute increment with a maximum of six 15-minute
				  increments per day;
(d) Level 2.1
				  Intensive Outpatient treatment - $158.05 per diem;
(e) Level 2.5 Partial Hospitalization half
				  day session - $164.37 per diem;
(f)
				  Level 2.5 Partial Hospitalization full day session - $265.52 per
				  diem;
(g) Ambulatory Withdrawal
				  Management -$88.51 per diem;
(h)
				  Point of care presumptive drug test read with direct optical observation only -
				  $10.02 per test;
(i) Point of care
				  presumptive drug test read with instrument-assisted direct optical observation
				  - $10.02 per test;
(j) Point of
				  care presumptive drug test read with instrumented chemistry analyzers - $49.40
				  per test; and
(k) Periodic
				  medication management through office-based evaluation and management visits,
				  according to COMAR
				  10.09.02.07D.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.80 - Community-Based Substance Use Disorder Services › Section 10.09.80.09 - Interpretive Regulation

Current through Register Vol. 51, No. 14, July 12, 2024
This chapter shall be interpreted as set forth in COMAR
					 10.09.36.10H.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.80 - Community-Based Substance Use Disorder Services › Section 10.09.80.10 - Cause for Suspension or Removal and Imposition of Sanctions

Current through Register Vol. 51, No. 14, July 12, 2024
A. Causes for
				  suspension or removal and imposition of sanctions shall be as set forth in
				  COMAR 10.09.36.08.
B. If the
				  Department determines that a provider, any agent or employee of the provider,
				  or any person with an ownership interest in the provider has failed to comply
				  with applicable federal or State laws or regulations, the Department may
				  initiate one or more of the following actions against the responsible party:
(1) Suspension from the Program;
(2) Withholding of payment by the
				  Program;
(3) Removal from the
				  Program; or
(4) Disqualification
				  from future participation in the Program, either as a provider or as a person
				  providing services for which Program payment will be
				  claimed.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.80 - Community-Based Substance Use Disorder Services › Section 10.09.80.11 - Appeal Procedures

Current through Register Vol. 51, No. 14, July 12, 2024
Appeals procedures shall be as set forth in accordance with
					 COMAR 10.09.36.09.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.80 - Community-Based Substance Use Disorder Services › Section 10.09.80.12 - Interpretive Regulation

Current through Register Vol. 51, No. 14, July 12, 2024
This chapter shall be interpreted as set forth in COMAR
					 10.09.36.10.
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 10.09.81.01 - Purpose

Current through Register Vol. 51, No. 14, July 12, 2024
The purpose of the Increased Community Services (ICS)
					 Program is to enable certain nursing facility residents to access home and
					 community-based services by allowing those nursing facility residents to
					 contribute to the cost of care through a monthly assessment and thus enabling
					 those individuals to live at home with ICS and other Medicaid services instead
					 of in a nursing facility.
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 10.09.81.03 - Participant Eligibility

Current through Register Vol. 51, No. 14, July 12, 2024
A. General
				  Requirements.
(1) To be eligible for
				  participation in the ICS Program, an applicant or participant shall be
				  determined by the Department to meet the conditions of §§B"E of this
				  regulation.
(2) A participant's
				  eligibility for ICS services shall be reevaluated by the Department every 12
				  months or more frequently if needed due to a significant change in the
				  participant's condition, needs, or financial status.
(3) The Department shall have 45 days from
				  the date of a complete application to make an eligibility
				  determination.
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 10.09.81.05 - Specific Conditions for Provider Participation - Participant Training

Current through Register Vol. 51, No. 14, July 12, 2024
To participate in the ICS Program as a provider of
					 participant training under Regulation .22 of this chapter, a provider
					 shall:
A. Be a self-employed trainer
				  or an agency that employs qualified trainers in accordance with §§B
				  and C of this regulation;
B.
				  Demonstrate experience in 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 10.09.81 - Increased Community Services (ICS) Program › Section 10.09.81.06 - Specific Conditions for Provider Participation - Family Training

Current through Register Vol. 51, No. 14, July 12, 2024
To participate in the ICS Program as a provider of family
					 training services under Regulation .23 of this chapter, a provider
					 shall:
A. Be:
(1) One of the following self-employed
				  professionals:
(a) Registered nurse or nurse
				  practitioner licensed according to COMAR 10.27.01 and 10.27.07;
(b) Occupational therapist licensed according
				  to COMAR 10.46.01;
(c)
				  Speech-language pathologist licensed according to COMAR 10.41.03; or
(d) Physical therapist licensed according to
				  COMAR 10.38.01; or
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 10.09.81.07 - Specific Conditions for Provider Participation - Case Management Services

Current through Register Vol. 51, No. 14, July 12, 2024
To participate in the ICS Program as a provider of case
					 management services under Regulation .24 of this chapter, a provider
					 shall:
A. Be enrolled as a case
				  management provider in accordance with COMAR
				  10.09.55.15D
				  -3;
B. Accept all referrals from the Department,
				  or other designated agency; and
C.
				  Be monitored by the Department.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.81 - Increased Community Services (ICS) Program › Section 10.09.81.08 - Specific Conditions for Provider Participation - Transition Services

Current through Register Vol. 51, No. 14, July 12, 2024
To participate in the ICS Program as a provider of
					 transition services under Regulation .25 of this chapter, a provider shall be
					 the case management provider in accordance with Regulation .07 of this chapter
					 and shall:
A. Assist individuals to
				  transition from a nursing facility to a community-based residence;
				  and
B. Arrange and coordinate the
				  services necessary to facilitate the transition.
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 10.09.81.09 - Specific Conditions for Provider Participation - Environmental Assessments

Current through Register Vol. 51, No. 14, July 12, 2024
To participate in the ICS Program as a provider of
					 environmental assessments under Regulation .26 of this chapter, a 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 case manager, based on services preauthorized in the
				  plan of service; and
C. Document
				  the provider's findings and recommendations on a form approved by the Maryland
				  Medical Assistance Program.
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 10.09.81.10 - Specific Conditions for Provider Participation - Environmental Accessibility Adaptations

Current through Register Vol. 51, No. 14, July 12, 2024
A. To
				  participate in the ICS Program as a provider of environmental accessibility
				  adaptations under Regulation .27 of this chapter, a provider shall:
(1) Be the store, vendor, or contractor, from
				  which the adaptation is purchased;
(2) Provide or arrange for any required
				  installation, servicing, or training; and
(3) Provide services according to a written
				  schedule indicating an estimated start date and completion date.
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 10.09.81.11 - Specific Conditions for Provider Participation - Personal Emergency Response Systems

Current through Register Vol. 51, No. 14, July 12, 2024
To participate in the ICS Program as a provider of personal
					 emergency response systems under Regulation .28 of this chapter, a provider
					 shall:
A. Be the store, vendor,
				  organization, or company which sells, rents, installs, services, or runs the
				  device or service;
B. Provide or
				  arrange for any installation, servicing, training, or monitoring required for
				  the device or system; and
C. Assure
				  that any response center is:
(1) Responsible
				  for monitoring or 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.
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 10.09.81.12 - Specific Conditions for Provider Participation - Assistive Technology

Current through Register Vol. 51, No. 14, July 12, 2024
To participate in the ICS Program as a provider of
					 assistive technology services under Regulation .29 of this chapter, a provider
					 shall:
A. Be one of the following
				  entities:
(1) The store, vendor,
				  organization, or company which sells or rents the equipment or system;
				  or
(2) A Maryland Medical
				  Assistance Program provider of disposable medical supplies and durable medical
				  equipment under COMAR 10.09.12;
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 10.09.81.13 - Specific Conditions for Provider Participation - Attendant Care Services

Current through Register Vol. 51, No. 14, July 12, 2024
A. To participate
				  in the ICS Program as a provider of attendant care services under Regulation
				  .30 of this chapter, unless otherwise exempted under §F of this
				  regulation, an attendant shall:
(1) Be a
				  participant-employed or agency-employed attendant;
(2) Be at least 18 years old;
(3) Be legally eligible for employment
				  rendering attendant care services in the State;
(4) Be able to communicate, read, write, and
				  follow directions in English;
(5)
				  Be currently certified from a nationally recognized organization in the
				  following areas:
(a) Cardiopulmonary
				  resuscitation; and
(b) Basic first
				  aid;
(6) Receive
				  instruction and training on the attendant care services required in the
				  participant's plan of service from the nurse monitor before rendering
				  services;
(7) Be supervised by a
				  nurse monitor in accordance with the requirements of Regulation .31 of this
				  chapter;
(8) Accept instruction and
				  training from:
(a) The participant;
(b) The nurse monitor;
(c) The case manager;
(d) A treating physician;
(e) Other involved professionals;
				  or
(f) A Department
				  representative;
(9)
				  Submit to a pre-employment criminal background investigation for which the
				  individual shall:
(a) Submit an application
				  for a criminal history record check to the Criminal Justice Information System
				  Office, Department of Public Safety and Correctional Services;
(b) Direct the Department of Public Safety
				  and Correctional Services to send the criminal history report to the
				  Department; and
(c) Pay for the
				  criminal history record check and report; and
(10) Agree to submit written documentation of
				  services rendered to each participant to the case manager on a form designated
				  by the Department.
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 10.09.81.14 - Specific Conditions for Provider Participation - Nursing Supervision of Attendants

Current through Register Vol. 51, No. 14, July 12, 2024
A. To
				  participate in the ICS Program as a provider of nursing supervision of
				  attendants under Regulation .31 of this chapter, a provider shall be:
(1) A self-employed registered nurse or nurse
				  practitioner licensed according to COMAR 10.27.01 and 10.27.07; or
(2) An agency or clinic which employs
				  registered nurses or nurse practitioners licensed according to COMAR 10.27.01
				  and 10.27.07.
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 10.09.81.15 - Specific Conditions for Provider Participation - Home Delivered Meals

Current through Register Vol. 51, No. 14, July 12, 2024
To participate in the ICS Program as a provider of
					 home-delivered meals under Regulation .32 of this chapter, a provider
					 shall:
A. Be approved and monitored by
				  the Department; and
B. Use a
				  cooking facility or food preparation site that:
(1) Has a food service license issued by the
				  local health department, in accordance with COMAR 10.15.03, or an appropriate
				  license from the state in which the site is located; and
(2) Is approved for each licensing renewal
				  based on inspections performed by State sanitarians in accordance with COMAR
				  10.15.03, or by the licensing authority in the state in which the site is
				  located.
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 10.09.81.16 - Specific Conditions for Provider Participation - Dietitian and Nutritionist Services

Current through Register Vol. 51, No. 14, July 12, 2024
To participate in the ICS Program as a provider of
					 dietitian and nutritionist services under Regulation .33 of this chapter, a
					 provider shall be a:
A. Dietitian or
				  nutritionist who is licensed in accordance with COMAR 10.56.01 and Health
				  Occupations Article, Title 5, Annotated Code of Maryland; or
B. Professional group or agency which employs
				  an individual who is licensed in accordance with §A of this
				  regulation.
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 10.09.81.17 - Specific Conditions for Participation - Behavior Consultation Services

Current through Register Vol. 51, No. 14, July 12, 2024
To participate in the ICS Program as a provider of behavior
					 consultation services, as specified in Regulation .34 of this chapter, a
					 provider shall:
A. Be:
(1) A health services agency that:
(a) Employs a qualified individual or
				  individuals to render behavior consultation services; and
(b) Assures supervision of, or consultation
				  to, the individual rendering behavior consultation services by a licensed
				  mental health professional or by a bachelor's level nurse with 4 years of
				  experience in psychogeriatrics or with an appropriate graduate degree;
				  or
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 10.09.81.18 - Specific Conditions for Provider Participation - Medical Day Care

Current through Register Vol. 51, No. 14, July 12, 2024
To participate in the ICS Program as a provider of medical
					 day care services under Regulation .35 of this chapter, a provider
					 shall:
A. Be licensed according to
				  COMAR 10.12.04; and
B. Meet the
				  requirements of COMAR 10.09.07.
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 10.09.81.19 - Specific Conditions for Participation - Senior Center Plus

Current through Register Vol. 51, No. 14, July 12, 2024
To participate in the ICS Program as a provider of Senior
					 Center Plus services, as specified in Regulation .36 of this chapter, a
					 provider shall:
A. Be approved and
				  monitored by the Maryland Department of Aging as a nutrition service
				  provider;
B. Meet all local and
				  State requirements to operate as a nutrition site, which include but are not
				  limited to inspection and approval of the facility by the local fire marshal,
				  periodic fire drills, and inspection and approval by the local sanitarian to
				  assure compliance with health department requirements for food service
				  facilities;
C. Assure that the
				  facility is accessible to individuals with disabilities;
D. Maintain adequate records on participants,
				  including progress notes and outcomes;
E. Provide at least one staff person per
				  eight clients, with additional staffing if required by the Maryland Department
				  of Aging depending on participants' functional levels;
F. Employ as the center's manager or in
				  another staff position an individual who:
(1)
				  Is a licensed health professional or a licensed social worker;
(2) Has at least 3 years' experience in
				  direct patient care at an adult day care center, nursing facility, or
				  health-related facility;
(3) Is
				  literate and able to communicate in English; and
(4) Participates in training specified and
				  approved by the Maryland Department of Aging;
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 10.09.81.20 - Specific Conditions for Participation - Assisted Living

Current through Register Vol. 51, No. 14, July 12, 2024
A. To participate in the ICS Program as an
				  assisted living services provider, a provider shall:
(1) Be licensed by the Department at the time
				  that services are rendered, in accordance with COMAR 10.07.14, to provide
				  assisted living services:
(a) At the Level 2
				  moderate level of care or Level 3 high level of care; and
(b) For the level of care needed by each
				  participant residing in the facility, including any needed resident-specific
				  waiver in accordance with COMAR
				  10.07.14.09B;
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 10.09.81.21 - Covered Services - General

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 when, pursuant to
					 the requirements of this chapter, these services have been preapproved by the
					 Department in the participant's plan of service and documented as:
A. Necessary to prevent institutionalization
				  in a nursing facility; and
B.
				  Cost-neutral to the ICS Program, in accordance with Regulation .38E of this
				  chapter.
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 10.09.81.22 - Covered Services - Participant Training

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 to a participant,
				  not including the time spent by the provider:
(1) Planning, preparing, or setting up the
				  training;
(2) Following up after
				  the training; or
(3) Traveling to
				  and from the training.
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 10.09.81.23 - Covered Services - Family Training

Current through Register Vol. 51, No. 14, July 12, 2024
A. Definitions.
(1) "Family member" means an individual who:
(a) Lives with or provides assistance to the
				  participant; and
(b) Is not paid to
				  provide the care.
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 10.09.81.24 - Covered Services - Case Management

Current through Register Vol. 51, No. 14, July 12, 2024
A. Definition. "Unit of service" means a
				  15-minute increment of service rendered by a qualified provider to a
				  participant or the participant's representative.
B. Case management services shall be targeted
				  to address the individualized needs of the participant and be sensitive to the
				  educational background, culture, and general environment of the
				  participant.
C. Case management
				  services include time spent by a qualified provider conducting any of the
				  following activities:
(1) Assisting with an
				  initial or annual ICS Program eligibility process;
(2) Assisting with an application and
				  maintaining all public and private benefits, resources, and
				  entitlements;
(3) Conducting an
				  assessment of needs, and developing a person-centered plan of services, to
				  include all services needed to live safely in the community;
(4) Assisting with referral, access, and
				  coordination of services, both Medicaid and non-Medicaid, to address the
				  individual's needs including, but not limited to:
(a) Community integration;
(b) Medical services;
(c) Social services;
(d) Educational services;
(e) Behavioral health;
(f) Legal services; and
(g) Housing;
(5) Contacting ICS Program providers and
				  Medicaid State Plan providers not less than monthly and documenting that
				  services were received in the amount, type, frequency, and duration described
				  in the plan of services;
(6)
				  Ensuring timely receipt of all other services and documenting
				  follow-up;
(7) Facilitating
				  referral to other programs if the individual is denied ICS Program services;
				  and
(8) Using information
				  technology systems developed by the Department.
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 10.09.81.25 - Covered Services - Transition Services

Current through Register Vol. 51, No. 14, July 12, 2024
A. Definition. "Unit of service" means a
				  one-time service that is:
(1) Not otherwise
				  available under the ICS Program;
(2) Approved in the plan of service;
				  and
(3) Rendered to a participant
				  by a qualified provider to assist the participant in transitioning from a
				  nursing facility or assisted living facility to independent living.
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 10.09.81.26 - Covered Services - Environmental Assessments

Current through Register Vol. 51, No. 14, July 12, 2024
A. Definition. "Unit of service" means the
				  completion of:
(1) An on-site environmental
				  assessment of the participant's home; and
(2) A form approved by the Maryland Medical
				  Assistance Program.
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 10.09.81.27 - Covered Services - Environmental Accessibility Adaptations

Current through Register Vol. 51, No. 14, July 12, 2024
A. Definition.
				  "Unit of service" means one or more physical adaptations to a participant's
				  home or place of residence which is completed as one job by a qualified
				  provider and which constitute a single accessibility adaptation.
B. If the owner of the home is the
				  participant, environmental accessibility adaptations may be made only if
				  approved by the participant, in the participant's plan of service.
C. If the owner is not the participant,
				  environmental accessibility adaptations may be made only if approved by the
				  owner of the home, who agrees that the participant will be allowed to remain in
				  the residence for at least 1 year, and if approved by the participant, in the
				  participant's plan of service.
D.
				  Environmental accessibility adaptations shall include those physical
				  adaptations or modifications to the participant's home which are required to
				  make it accessible to the participant because of the:
(1) Physical structure of the residence;
				  or
(2) Participant's specific
				  functional 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 10.09.81.28 - Covered Services - Personal Emergency Response Systems

Current through Register Vol. 51, No. 14, July 12, 2024
A. Definition. "Unit of service" means any of
				  the following:
(1) Purchase and
				  installation;
(2) Maintenance or
				  repair; or
(3) Monthly cost of a
				  covered system or rented device or equipment.
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 10.09.81.29 - Covered Services - Assistive Technology

Current through Register Vol. 51, No. 14, July 12, 2024
A. Definition. "Unit of service" means a
				  device or appliance that is purchased as one item, including:
(1) Any required training in the use of the
				  device; and
(2) An assessment for
				  the use of the device, if the assessment is:
(a) Performed directly by the provider;
				  and
(b) Routinely included as part
				  of the provider's cost for the item.