Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.36 - General Medical Assistance Provider Participation Criteria › Section 10.09.36.03 - Conditions for Participation

Current through Register Vol. 51, No. 14, July 12, 2024
A. To
				  participate in the Program, the provider shall:
(1) Ensure compliance with all the Medical
				  Assistance provisions listed in the Code of Maryland Regulations (COMAR)
				  designated for their provider type;
(2) Apply for participation in the Program
				  using the application form designated by the Department;
(3) Be approved for participation by the
				  Department;
(4) Allow the Department
				  or its agents to conduct unannounced on-site inspections of any and all
				  provider locations;
(5) Allow the
				  Department or its agents to require all providers to consent to criminal
				  background checks, including fingerprinting;
(6) Have a current provider agreement with
				  the Program in effect and fully comply with the terms and conditions stated in
				  the provider agreement;
(7) Comply
				  with all standards of practice, professional standards and levels of service as
				  set forth in all applicable federal and State laws, statues, rules, and
				  regulations as well as all administrative policies, procedures, transmittals,
				  and guidelines issued by the Department;
(8) Charge the Program the provider's
				  customary charge to the general public for similar items or services. If the
				  item or 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 Department's rate provisions; and
(b) The provider's reimbursement is not
				  limited to the provider's customary charge.
(9) Maintain adequate records for a minimum
				  of 6 years and make them available, upon request, to the Department or its
				  designee;
(10) Accept payment by
				  the Program as payment in full for covered services rendered and make no
				  additional charge to any person for covered services;
(11) Provide services without regard to race,
				  color, age, sex, national origin, religion, sexual orientation, marital status,
				  or physical or mental disability;
(12) Verify the participant's eligibility by:
(a) Viewing the participant's Medical
				  Assistance card and another identification card; and
(b) Calling the Program's Eligibility
				  Verification Interactive Voice Response System (EVS/IVR) or accessing the
				  web-based participant eligibility system;
(13) Place no restriction on a participant's
				  right to select health care providers of the participant's choice, except that
				  a participant in a managed care program shall be required to obtain certain
				  specified Program services from or through the participant's care manager, in
				  accordance with the restrictions imposed by the managed care program;
(14) Not knowingly employ or contract with a
				  person, partnership, or corporation which has been disqualified from the
				  Program to provide or supply services to Medical Assistance participants unless
				  prior written approval has been received from the Department;
(15) Notify the Department or its designee of
				  patient activity or circumstance that affects placement, eligibility, or
				  reimbursement, on the form and at the time specified by the
				  Department;
(16) Maintain the
				  confidentiality of all participant information by not releasing the information
				  without authorization by the participant or as authorized by law;
(17) Have an individual rendering number for
				  practitioners recognized by the Program;
(18) Obtain a referral from a participant's
				  care manager in a manner prescribed by the Department before rendering
				  services, when:
(a) The participant is
				  enrolled in a managed care program; and
(b) The service is included under the managed
				  care program's referral requirements.
(19) Supply a signed service order or
				  prescription that includes the individual rendering number of the ordering or
				  prescribing practitioner, as well as the full name and Medical Assistance
				  number of the participant, when ordering services to be supplied by other
				  providers, such as hospital admission, diagnostic testing, supplies, or
				  pharmacy services;
(20) Ensure that
				  Clinical Laboratory Improvement Amendments (CLIA) certification exists for all
				  clinical laboratory services performed;
(21) Provide a participant's medical records
				  at no charge when the records are requested by another physician or licensed
				  provider on behalf of the participant; and
(22) Comply with the requirements of COMAR
				  10.01.04.12 regarding the
				  designation of an authorized representative;
(23) Place no restriction on a participant's
				  fair hearing appeal rights as a condition of rendering services; and
(24) Comply with provider audits authorized
				  by State and federal law to ensure compliance with Program
				  requirements.