reglab/statecodes huggingface dataset:
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 1 › Subtitle 08 - HEALTH FACILITIES GRANTS › Chapter 10.08.04 - Construction Funds for Public and Nonprofit Assisted Living Facilities › Section 10.08.04.09 - Use of Funds for Acquisition and Renovation

Current through Register Vol. 51, No. 14, July 12, 2024
A. If the applicant is acquiring a site with
				  existing improvements, and the existing improvements are to be renovated for or
				  used for an assisted living facility, the total project costs may be eligible
				  for State participation.
B. In the
				  circumstances outlined in §A of this regulation, at least two
				  State-approved appraisers shall provide appraisals of the site and existing
				  improvements to be acquired. State participation shall be limited to the lesser
				  of the appraised value approved by the Department of General Services based
				  upon the appraisals or the actual acquisition cost.
C. If an applicant proposes to acquire an
				  unimproved land site on which to construct a facility, the cost of the land is
				  not eligible for State participation.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 1 › Subtitle 08 - HEALTH FACILITIES GRANTS › Chapter 10.08.04 - Construction Funds for Public and Nonprofit Assisted Living Facilities › Section 10.08.04.10 - Residual Requirements of the Grantee

Current through Register Vol. 51, No. 14, July 12, 2024
A. Annual Requirements.
(1) For a period of 30 years following the
				  completion of conversion, acquisition, renovation, capital equipping, or
				  construction of an assisted living facility involving the State grant funds in
				  this chapter, a grantee shall file a written statement annually with the
				  Department containing the following material:
(a) A recent certified, audited
				  profit-and-loss statement and balance sheet for the facility;
(b) Volume of service at the assisted living
				  facility, such as days of service rendered to clients; and
(c) Other supplemental information required
				  by the Secretary.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 1 › Subtitle 08 - HEALTH FACILITIES GRANTS › Chapter 10.08.04 - Construction Funds for Public and Nonprofit Assisted Living Facilities › Section 10.08.04.11 - Right of Recovery

Current through Register Vol. 51, No. 14, July 12, 2024
In the event of default under the terms of the Act and this
					 chapter, an assisted living facility financed pursuant to this chapter is
					 subject to the State's right of recovery as set forth in the
					 Act.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 1 › Subtitle 08 - HEALTH FACILITIES GRANTS › Chapter 10.08.05 - Construction Funds for Federally Qualified Health Centers › Section 10.08.05.01 - Scope

Current through Register Vol. 51, No. 14, July 12, 2024
A. This chapter
				  governs the administration of State grant funds to counties, municipal
				  corporations, nonprofit corporations and other entities, hereinafter
				  "entities", that are authorized for funding under § 330 of the Public
				  Health Service Act (42
				  U.S.C. 254 b) administered by the United
				  States Department of Health and Human Services, Health Resources and Services
				  Administration, Bureau of Primary Health Care. These grants are for the
				  conversion, acquisition, renovation, equipping, and construction of federally
				  qualified health centers under the Federally Qualified Health Centers Grant
				  Program, Health-General Article, §§24-1301 -24-1307, Annotated Code
				  of Maryland.
B. It is the intent of
				  the Department that State grant funds be used:
(1) To assist eligible applicants with the
				  conversion, acquisition, renovation, equipping, and construction of federally
				  qualified health centers, eligible under the Act in accordance with this
				  chapter; and
(2) After the
				  applicant has secured all funds available from other sources.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 1 › Subtitle 08 - HEALTH FACILITIES GRANTS › Chapter 10.08.05 - Construction Funds for Federally Qualified Health Centers › Section 10.08.05.03 - Use of State Grant Funds

Current through Register Vol. 51, No. 14, July 12, 2024
State grant funds for federally qualified health centers
					 shall be used solely for approved projects that involve:
A. Conversion of public buildings or parts of
				  buildings;
B. Acquisition of
				  existing buildings or parts of buildings;
C. Renovation of a facility;
D. Purchase of capital equipment;
				  or
E. Planning, design, and
				  construction of a facility.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 1 › Subtitle 08 - HEALTH FACILITIES GRANTS › Chapter 10.08.05 - Construction Funds for Federally Qualified Health Centers › Section 10.08.05.04 - Eligible Applicants for State Grant Funds

Current through Register Vol. 51, No. 14, July 12, 2024
To be eligible to apply for State grant funds under the
					 Act, an applicant shall:
A. Be a
				  qualified entity;
B. Sponsor a
				  project involving work specified in Regulation .03 of this chapter;
				  and
C. Certify that the proposed
				  facility will meet the handicap-accessibility requirements of
				  42 U.S.C.
				  12101 et seq., or provide a certified waiver
				  from the Department of Housing and Community Development.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 1 › Subtitle 08 - HEALTH FACILITIES GRANTS › Chapter 10.08.05 - Construction Funds for Federally Qualified Health Centers › Section 10.08.05.05 - Application Procedure

Current through Register Vol. 51, No. 14, July 12, 2024
A. An
				  applicant shall apply for a State grant by completing an application with the
				  Department on a form provided by the Department, and shall file the completed
				  application for State grant funds with the Office of Capital Planning,
				  Budgeting, and Engineering Services.
B. The Department shall provide any notice
				  and information to the State Clearinghouse for Intergovernmental Assistance
				  that may be required under COMAR 14.24.04.
C. The applicant shall comply with all
				  applicable federal and State laws and regulations in effect at the time of
				  application.
D. At the time of
				  filing the application, the applicant shall file a written statement with the
				  Department containing the following information or material:
(1) Current or intended program of
				  services;
(2) The number of
				  personnel employed or to be employed at the facility, by occupation, and all
				  perquisites, salaries, and any compensation paid, or to be paid, to the
				  personnel;
(3) Expenses incurred,
				  or to be incurred, in carrying out qualified facility operations;
(4) Schedule of rates charged, or to be
				  charged, for services rendered at the facility;
(5) Agreement to admit eligible persons on
				  the basis of their need for services without regard to race, religion, national
				  origin, color, or disability;
(6)
				  If an applicant is currently operating as a federally qualified health center,
				  a certified, audited profit-and-loss statement and balance sheet for the most
				  current year;
(7) If the applicant
				  is applying for poverty funding under Regulation .08D of this chapter, an
				  agreement that the majority of the individuals served by the applicant will be
				  poverty-designated clients, as defined in Regulation .08D(2) of this chapter,
				  for each year for a period of 30 years following the completion or acquisition
				  of the facility; and
(8) Letter
				  from Health Resources Services Administration (HRSA) granting federally
				  qualified health center status to the nonprofit and designated site or a letter
				  from HRSA stating that the "need" score in the applicant's letter of intent is
				  competitive and invites the applicant to submit a full application for
				  designation as a federally qualified health center.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 1 › Subtitle 08 - HEALTH FACILITIES GRANTS › Chapter 10.08.05 - Construction Funds for Federally Qualified Health Centers › Section 10.08.05.06 - Amount of State Grant Awards

Current through Register Vol. 51, No. 14, July 12, 2024
The Department shall determine the amount of the State
					 grant, if any, for an applicant's approved project after consideration of the
					 following:
A. All approved
				  applications;
B. Priorities of need
				  as established by the Department;
C. The total unallocated State funds
				  available in the Department's Administration-Sponsored Capital Programs for
				  federally qualified health centers;
D. The projected amount of anticipated
				  appropriations as provided in the Governor's Five-Year Capital Improvement
				  Program;
E. The reasonableness of
				  the total cost of the project; and
F. Current operating costs or the
				  reasonableness of a projected budget and revenues for the facility.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 1 › Subtitle 08 - HEALTH FACILITIES GRANTS › Chapter 10.08.05 - Construction Funds for Federally Qualified Health Centers › Section 10.08.05.07 - Recommendation of State Grant Awards

Current through Register Vol. 51, No. 14, July 12, 2024
A. The Department shall determine whether the
				  application is to be recommended to the Board of Public Works for award of
				  State grant funds after consideration of the following:
(1) The availability of State grant
				  funds;
(2) The receipt of
				  satisfactory evidence from the applicant of the following requirements:
(a) Sufficient total financial contribution
				  to complete the project;
(b)
				  Control of site, such as deed or lease;
(c) Compliance with applicable local zoning
				  requirements;
(d) Certified bid
				  tabulation, construction contract, contract of sale, or 30-year lease agreement
				  with landlord, contingent upon Board of Public Works approval; and
(e) Compliance with all other applicable
				  provisions of State or federal law.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 1 › Subtitle 08 - HEALTH FACILITIES GRANTS › Chapter 10.08.05 - Construction Funds for Federally Qualified Health Centers › Section 10.08.05.08 - Grant Limitations and Provisions

Current through Register Vol. 51, No. 14, July 12, 2024
A. Use of Federal Grants.
(1) Any federal grant that is received for an
				  eligible project shall be applied first to the cost of the project.
(2) Community Development Block Grants are
				  considered as local matching funds and are not considered as federal grant
				  funds.
(3) All other sources of
				  funds shall be expended before any or all of the State grant is expended on an
				  approved project.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 1 › Subtitle 08 - HEALTH FACILITIES GRANTS › Chapter 10.08.05 - Construction Funds for Federally Qualified Health Centers › Section 10.08.05.09 - Use of Funds for Acquisition and Renovation

Current through Register Vol. 51, No. 14, July 12, 2024
A. If the applicant is acquiring a site with
				  existing improvements, and the existing improvements are to be renovated for or
				  used for a federally qualified health center, the total project costs may be
				  eligible for State participation.
B. In the circumstances outlined in §A
				  of this regulation, at least two State-approved appraisers shall provide
				  appraisals of the site and existing improvements to be acquired. State
				  participation shall be limited to the lesser of the appraised value approved by
				  the Department of General Services based upon the appraisals or the actual
				  acquisition cost.
C. If an
				  applicant proposes to acquire an unimproved land site on which to construct a
				  facility, the cost of the land is not eligible for State
				  participation.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 1 › Subtitle 08 - HEALTH FACILITIES GRANTS › Chapter 10.08.05 - Construction Funds for Federally Qualified Health Centers › Section 10.08.05.10 - Residual Requirements of the Grantee

Current through Register Vol. 51, No. 14, July 12, 2024
A. Annual Requirements.
(1) For 30 years following the completion of
				  conversion, acquisition, renovation, capital equipping, or construction of a
				  federally qualified health center involving the State grant funds in this
				  chapter, a grantee shall file a written statement annually with the Department
				  containing the following material:
(a) A
				  recent certified, audited profit-and-loss statement and balance sheet for the
				  facility;
(b) The volume of service
				  at the federally qualified health center, such as days of service rendered to
				  clients; and
(c) Other supplemental
				  information required by the Secretary.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 1 › Subtitle 08 - HEALTH FACILITIES GRANTS › Chapter 10.08.05 - Construction Funds for Federally Qualified Health Centers › Section 10.08.05.11 - Right of Recovery

Current through Register Vol. 51, No. 14, July 12, 2024
In the event of default under the terms of the Act and this
					 chapter, a federally qualified health center financed pursuant to this chapter
					 is subject to the State's right of recovery as set forth in the
					 Act.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 1 › Subtitle 08 - HEALTH FACILITIES GRANTS › Chapter 10.08.06 - Construction Funds for Conversion of Nursing Facilities › Section 10.08.06.01 - Scope

Current through Register Vol. 51, No. 14, July 12, 2024
A. This chapter
				  governs the administration of State grant funds for any county, municipal
				  corporation, or nonprofit organization for the conversion of nursing facility
				  beds to provide other health care services under the Nursing Facility
				  Conversion Grant Program, Health-General Article, §§24-1401 -24-1408,
				  Annotated Code of Maryland.
B. It
				  is the intent of the Department that State grant funds be used:
(1) To assist eligible applicants with the
				  conversion of existing nursing facilities eligible under the Act in accordance
				  with this chapter; and
(2) After
				  the applicant has secured all funds available from other sources.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 1 › Subtitle 08 - HEALTH FACILITIES GRANTS › Chapter 10.08.06 - Construction Funds for Conversion of Nursing Facilities › Section 10.08.06.03 - Use of State Grant Funds

Current through Register Vol. 51, No. 14, July 12, 2024
State grant funds for nursing facilities under the Act
					 shall be used solely for projects approved by the Department for the purpose of
					 converting existing nursing facility beds to provide:
A. Other health care services;
B. Purchase of capital equipment;
				  and
C. Planning, design,
				  construction, and renovation of a facility.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 1 › Subtitle 08 - HEALTH FACILITIES GRANTS › Chapter 10.08.06 - Construction Funds for Conversion of Nursing Facilities › Section 10.08.06.04 - Eligible Applicants for State Grant Funds

Current through Register Vol. 51, No. 14, July 12, 2024
A. To be eligible to apply for State grant
				  funds under the Act, an applicant shall:
(1)
				  Be a county, municipal corporation, or a nonprofit organization;
(2) Have a proposed project that is in accord
				  with the priorities of the Secretary;
(3) Be licensed by the Department;
(4) Be eligible for certification under, and
				  agree to participate in, Title XVIII and Title XIX of the Social Security
				  Act;
(5) Certify that the proposed
				  facility will meet the accessibility requirements of
				  42 U.S.C.
				  12101 et seq., or provide a certified waiver
				  from the Department of Housing and Community Development;
(6) Not have had any of the following
				  deficiencies cited in any survey conducted by the Department's Office of Health
				  Care Quality during the calendar year preceding the grant application year,
				  using the scope and severity matrix found in the Centers for Medicare and
				  Medicaid Services State Operations Manual for Survey and Certification, Part 7,
				  § 7400E:
(a) Two or more "G" level
				  deficiencies; or
(b) One or more
				  "H" or higher-level deficiencies; and
(7) Be approved by the Secretary to receive a
				  grant award.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 1 › Subtitle 08 - HEALTH FACILITIES GRANTS › Chapter 10.08.06 - Construction Funds for Conversion of Nursing Facilities › Section 10.08.06.05 - Application Procedure

Current through Register Vol. 51, No. 14, July 12, 2024
A. An
				  applicant shall apply for a State grant by:
(1) Completing an application with the
				  Department on a form provided by the Department; and
(2) Filing the completed application for
				  State grant funds with the Office of Capital Planning, Budgeting, and
				  Engineering Services.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 1 › Subtitle 08 - HEALTH FACILITIES GRANTS › Chapter 10.08.06 - Construction Funds for Conversion of Nursing Facilities › Section 10.08.06.06 - Amount of State Grant Awards

Current through Register Vol. 51, No. 14, July 12, 2024
The Department shall determine the amount of the State
					 grant, if any, for an applicant's approved project after consideration of the
					 following:
A. All approved
				  applications;
B. Priorities of need
				  as established by the Department;
C. The total unallocated State funds
				  available for grants under the Act;
D. The projected amount of anticipated
				  appropriations as provided in the Governor's Five-Year Capital Improvement
				  Program;
E. The reasonableness of
				  the total cost of the project; and
F. Current operating costs or the
				  reasonableness of a projected budget and revenues for the facility.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 1 › Subtitle 08 - HEALTH FACILITIES GRANTS › Chapter 10.08.06 - Construction Funds for Conversion of Nursing Facilities › Section 10.08.06.07 - Recommendation of State Grant Awards

Current through Register Vol. 51, No. 14, July 12, 2024
A. The Department shall determine whether the
				  application is to be recommended to the Board of Public Works for award of
				  State grant funds after consideration of the following:
(1) The availability of State grant
				  funds;
(2) The receipt of
				  satisfactory evidence from the applicant of the following requirements:
(a) Documentation from the Maryland Health
				  Care Commission that:
(i) A certificate of
				  need is not required for a decrease in bed capacity or conversion to an
				  alternative health care facility or service proposed by the project;
				  or
(ii) An applicant has obtained a
				  certificate of need, if required pursuant to Health-General Article,
				  §19-120, Annotated Code of Maryland, for the proposed changes in bed
				  capacity or license category, or to establish the new health care facility or
				  service;
(b) Sufficient
				  total financial contribution to complete the project;
(c) Control of site, such as deed or
				  lease;
(d) Compliance with
				  applicable local zoning requirements;
(e) Certified bid tabulation, construction
				  contract; and
(f) Compliance with
				  all other applicable provisions of State or federal law.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 1 › Subtitle 08 - HEALTH FACILITIES GRANTS › Chapter 10.08.06 - Construction Funds for Conversion of Nursing Facilities › Section 10.08.06.08 - Grant Limitations and Provisions

Current through Register Vol. 51, No. 14, July 12, 2024
A. Use of Federal Grants.
(1) Any federal grant that is received for an
				  eligible project shall be applied first to the cost of the project.
(2) Community development block grants are
				  considered as local matching funds and are not considered as federal grant
				  funds.
(3) All other sources of
				  funds shall be expended before any or all of the State grant is expended on an
				  approved project.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 1 › Subtitle 08 - HEALTH FACILITIES GRANTS › Chapter 10.08.06 - Construction Funds for Conversion of Nursing Facilities › Section 10.08.06.09 - Residual Requirements of the Grantee

Current through Register Vol. 51, No. 14, July 12, 2024
A. Annual Requirements.
(1) For a period of 30 years following the
				  conversion of nursing facility beds involving the State grant funds in this
				  chapter, a grantee shall file a written statement annually with the Department
				  containing the following material:
(a) A
				  recent certified, audited profit-and-loss statement and balance sheet for the
				  facility;
(b) Volume of service in
				  the portion of the building converted with State grant funds, such as days of
				  service rendered to clients; and
(c) Other supplemental information required
				  by the Secretary.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 1 › Subtitle 08 - HEALTH FACILITIES GRANTS › Chapter 10.08.06 - Construction Funds for Conversion of Nursing Facilities › Section 10.08.06.10 - Right of Recovery

Current through Register Vol. 51, No. 14, July 12, 2024
In the event of default under the terms of the Act and this
					 chapter, a nursing facility financed pursuant to this chapter is subject to the
					 State's right of recovery as set forth in the Act.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.01 - Advanced Practice Nurse Services › Section 10.09.01.01 - 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) "Advanced practice nurse" means a:
(a) Certified nurse practitioner;
(b) Certified nurse midwife; or
(c) Certified registered nurse
				  anesthetist.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.01 - Advanced Practice Nurse Services › Section 10.09.01.02 - License and Certification Requirements

Current through Register Vol. 51, No. 14, July 12, 2024
A. The provider shall:
(1) Meet all license requirements as set
				  forth in COMAR
				  10.09.36.02; and
(2) Be licensed and hold all certifications
				  as required by the Board.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.01 - Advanced Practice Nurse Services › Section 10.09.01.03 - Conditions for Participation

Current through Register Vol. 51, No. 14, July 12, 2024
To participate in the Program, a provider shall:
A. Meet all conditions for participation as
				  set forth in COMAR
				  10.09.36.03; and
B. If delivering services via telehealth,
				  comply with 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 10.09.01 - Advanced Practice Nurse Services › Section 10.09.01.04 - Covered Services

Current through Register Vol. 51, No. 14, July 12, 2024
A. Subject
				  to §B of this regulation, the Program covers medically necessary services
				  rendered to participants as follows:
(1) For
				  nurse practitioners:
(a) Medically necessary
				  services within the provider's scope of practice as described in COMAR
				  10.27.07; or
(b) If out-of-State,
				  nurse practitioner services authorized in the state in which the services are
				  provided;
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.01 - Advanced Practice Nurse Services › Section 10.09.01.05 - Limitations

Current through Register Vol. 51, No. 14, July 12, 2024
Under this chapter, the Program does not cover the
					 following:
A. Services not medically
				  necessary;
B. Services prohibited
				  by the Maryland Nurse Practice Act or by the Board;
C. Advanced practice nursing services
				  included as part of the cost of
(1) An
				  inpatient facility;
(2) A hospital
				  outpatient department; or
(3) A
				  freestanding clinic;
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.01 - Advanced Practice Nurse Services › Section 10.09.01.06 - Payment Procedures

Current through Register Vol. 51, No. 14, July 12, 2024
A. The provider
				  shall submit the re quest for payment in the format designated by the
				  Department.
B. The Department
				  reserves the right to return to the provider, before payment, all requests for
				  payment not properly completed.
C.
				  The provider shall charge the Program the provider's:
(1) Customary charge to the general public
				  for similar services; and
(2)
				  Acquisition cost for injectable drugs or dispensed medical supplies.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.01 - Advanced Practice Nurse Services › Section 10.09.01.07 - Recovery and Reimbursement

Current through Register Vol. 51, No. 14, July 12, 2024
Recovery and reimbursement are as set forth in COMAR
					 10.09.36.07.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.01 - Advanced Practice Nurse Services › Section 10.09.01.08 - Causes 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 are as 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 10.09.02 - Physicians' Services › Section 10.09.02.02 - License Requirements

Current through Register Vol. 51, No. 14, July 12, 2024
A. The
				  provider shall meet all license requirements as set forth in COMAR
				  10.09.36.02A.
B. A doctor of medicine or
				  osteopathy shall be licensed and legally authorized to practice medicine and
				  surgery in the state in which the service is provided.
C. The provider shall ensure that all X-ray
				  or other radiological equipment is inspected and meets the standards
				  established by COMAR 10.14.02 or other applicable standards established by the
				  state in which the service is provided.
D. The provider shall ensure that Clinical
				  Laboratory Improvement Amendments (CLIA) certification exists for all clinical
				  laboratory services performed, and:
(1) If
				  located 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) If located 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 10.09.02 - Physicians' Services › Section 10.09.02.03 - 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:
(1) Meet all the conditions for
				  participation as set forth in COMAR 10.09.36; and
(2) If delivering services via telehealth,
				  comply with 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 10.09.02 - Physicians' Services › Section 10.09.02.04 - Covered Services

Current through Register Vol. 51, No. 14, July 12, 2024
The Program covers the following medically necessary
					 services rendered to participants:
A.
				  Physicians' services rendered in the physician's office, the participant's
				  home, a hospital, a skilled or intermediate care nursing facility, a
				  freestanding clinic, or elsewhere when these services are:
(1) Performed by the physician or one of the
				  following:
(a) Another licensed physician
				  either in the physician's employ or one who renders services through a
				  reciprocal agreement as a substitute physician,
(b) A certified registered physician's
				  assistant, licensed registered nurse, certified psychologist, or a certified
				  social worker, provided that the individual performing the service is in the
				  physician's employ and is under the physician's direct supervision and performs
				  the service within the scope of the individual's license or certification for
				  the purpose of assisting in the provision of physicians' services,
(c) A certified nurse midwife -who performs
				  medically necessary services within the provider's scope of practice as
				  described in COMAR 10.27.05; and
(d) A certified nurse practitioner who
				  performs medically necessary services within the provider's scope of practice
				  as described in COMAR 10.27.07.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.02 - Physicians' Services › Section 10.09.02.05 - Limitations

Current through Register Vol. 51, No. 14, July 12, 2024
A. Services
				  which are not covered are:
(1) Physician
				  services not medically justified;
(2) Nonemergency dialysis services related to
				  chronic kidney disorders unless they are provided in a Medicare-certified
				  facility;
(3) Physician inpatient
				  hospital services rendered during any period that is in excess of the length of
				  stay authorized by the Utilization control agent (UCA);
(4) Physician services denied by Medicare as
				  not medically necessary;
(5)
				  Services which are investigational or experimental;
(6) Autopsies;
(7) Physician services included as part of
				  the cost of an inpatient facility, hospital outpatient department, or
				  free-standing clinics;
(8) Payment
				  to physicians for specimen collections, except by venipuncture, and capillary
				  or arterial puncture;
(9)
				  Injectable medications, and visits solely for the administration of injectable
				  medications, unless medical necessity and the patient's inability to take
				  appropriate oral medications are documented in the patient's medical
				  records;
(10) Vaccine
				  administration unless covered under Regulation .04 of this chapter;
(11) Visits solely to accomplish one or more
				  of the following:
(a) Prescription, drug or
				  food supplement pick-up, collection of specimens for laboratory
				  procedures,
(b) Recording of an
				  electrocardiogram,
(c) Ascertaining
				  the patient's weight;
(12) Interpretation of laboratory tests or
				  panels;
(13) Medical Assistance
				  prescriptions and injections for central nervous system stimulants and
				  anorectic agents when used for weight control;
(14) Drugs and supplies dispensed by the
				  physician which are acquired by the physician at no cost;
(15) Disposable medical supplies;
(16) Services prohibited by the Board of
				  Physician Quality Assurance;
(17)
				  Services which are provided outside the United States;
(18) Services which do not involve direct patient
				  contact;
(19) Sterilization
				  reversal procedures;
(20)
				  Prescriptions for drugs written on prescription pads that do not prevent
				  copying, modification, or counterfeiting;
(21) Physician-administered drugs from manufacturers
				  that do not participate in the Federal Drug Rebate Program; and
(22) Any covered service that requires a
				  preauthorization, including physician-administered drugs and injectable
				  medications, that is rendered without an approved preauthorization from the
				  Program.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.02 - Physicians' Services › Section 10.09.02.06 - Preauthorization Requirements

Current through Register Vol. 51, No. 14, July 12, 2024
A. The
				  following procedures or services require preauthorization:
(1) Cosmetic surgery;
(2) Contact lens evaluation and
				  fitting;
(3) Lipectomy and
				  panniculectomy;
(4)
				  Transplantations of vital organs;
(5) Services rendered to an inpatient before
				  one preoperative day;
(6) Surgical
				  procedures for the treatment of obesity;
(7) Surgical procedures for the purpose of
				  gender reassignment; and
(8)
				  Elective services from a noncontiguous state.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.02 - Physicians' Services › Section 10.09.02.07 - Payment Procedures

Current through Register Vol. 51, No. 14, July 12, 2024
A. The provider
				  shall submit the request for payment on the form designated by the
				  Department.
B. The Department
				  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 Department.
C.
				  Except as provided in §F of this regulation, the Provider shall charge the
				  Program the provider's customary charge to the general public for similar
				  services. If the service is free to individuals not covered by Medicaid:
(1) The provider:
(a) May charge the Program; and
(b) Shall be reimbursed in accordance with
				  §D of this regulation; and
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.02 - Physicians' Services › Section 10.09.02.08 - 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 Medical Assistance 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 10.09.02 - Physicians' Services › Section 10.09.02.09 - Cause for Suspension or Removal and Imposition of Sanctions

Current through Register Vol. 51, No. 14, July 12, 2024
A. If the
				  Department determines that a provider, physician, 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;
(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 10.09.02 - Physicians' Services › Section 10.09.02.10 - Appeal Procedures

Current through Register Vol. 51, No. 14, July 12, 2024
Providers filing appeals from administrative decisions made
					 in connection with these regulations 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 10.09.02 - Physicians' Services › Section 10.09.02.11 - Interpretive Regulation

Current through Register Vol. 51, No. 14, July 12, 2024
Except when the language of a specific regulation indicates
					 an 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 10.09.03 - Pharmacy Services › Section 10.09.03.02 - License Requirements

Current through Register Vol. 51, No. 14, July 12, 2024
A. A
				  pharmacy may not qualify as a provider without first having obtained a permit
				  from the Department pursuant to Health Occupations Article, Title 12, Annotated
				  Code of Maryland, or from the appropriate agency in the state in which the
				  pharmacy is located.
B. A pharmacy
				  that provides compounded prescriptions for home intravenous therapy shall be
				  licensed under the provisions of COMAR 10.34.19.
C. A doctor of medicine or osteopathy shall
				  be licensed and legally authorized to practice medicine and surgery and to
				  dispense drugs in the state in which the service is provided.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.03 - Pharmacy Services › Section 10.09.03.03 - Conditions for Participation

Current through Register Vol. 51, No. 14, July 12, 2024
To participate in the Program, the provider shall:
A. Meet the licensure requirements in
				  Regulation .02 of this chapter;
B.
				  Apply for participation in the Program using the application form designated by
				  the Department;
C. Be approved for
				  participation by the Department;
D.
				  Accept, as payment in full, the amounts paid by the Program plus any copayment
				  required by Regulation .05C(5) of this chapter;
E. Maintain adequate records and
				  prescriptions for a minimum of 6 years, and make them available for inspection,
				  upon request, to the Department or its designee;
F. Ensure that all prescriptions contain
				  sufficient information to justify the invoice charges;
G. Provide services without regard to race,
				  creed, color, age, sex, national origin, marital status, physical or mental
				  handicap;
H. Agree that the
				  provider may not employ knowingly a person who has been disqualified from the
				  Program to compound or dispense Medical Assistance prescriptions, unless prior
				  written approval has been received from the Department;
I. Verify the participant's eligibility
				  before dispensing covered drugs;
J.
				  Place no restriction on the participant's right to select providers of the
				  participant's choice;
K. Agree that
				  if the Program denies payment or requests repayment on the basis that an
				  otherwise covered service was not medically necessary, the provider may not
				  seek payment for that service from the participant;
L. Maintain a record of the individual who
				  picks up a prescription that includes:
(1)
				  The prescription number;
(2) The
				  name of the individual picking up the prescription;
(3) The signature of the individual picking
				  up the prescription; and
(4) The
				  date the prescription was picked up;
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.03 - Pharmacy Services › Section 10.09.03.04 - Covered Services

Current through Register Vol. 51, No. 14, July 12, 2024
A. The
				  Department shall cover:
(1) Legend drugs
				  except certain drugs for which federal financial participation is prohibited
				  pursuant to 42 CFR §
												441.25;
(2) Schedule V cough preparations;
(3) Contraceptives;
(4) Hypodermic needles and
				  syringes;
(5) Supplemental vitamins
				  and mineral products given by nasogastric, jejunostomy, or gastrostomy tube in
				  the home;
(6) Enteric coated
				  aspirin when prescribed for:
(a) The
				  treatment of arthritic conditions as certified on the prescription in the
				  prescriber's own handwriting or by the dispenser after consultation with the
				  prescriber; and
(b) At least 250
				  tablets of 325 milligrams each, whether for initial prescriptions or
				  refills.
(7) Nonlegend
				  ferrous sulfate oral preparations in the following strengths, dosage forms, and
				  quantities only:
(a) Drops (125 milligrams
				  per milliliter) in units of 50 milliliter dropper bottles;
(b) Elixir (220 milligrams per 5 milliliters)
				  in quantities of at least 473 milliliters;
(c) Syrup (90 milligrams per 5 milliliters)
				  in quantities of at least 473 milliliters; and
(d) Tablets (300 milligrams to 325
				  milligrams) in quantities of at least 100 tablets;
(8) Nonlegend chewable tablets of any ferrous
				  salt if:
(a) The tables are combined with
				  vitamin C, multivitamins, multivitamins and minerals, or other
				  minerals;
(b) The participant is
				  under 12 years old; and
(c) The
				  quantity dispensed is at least 60 tablets and not more than a 100-day
				  supply;
(9) Nonlegend
				  ergocalciferol liquid (8,000 international units per milliliter); and
(10) Any nonlegend drug determined by the
				  Program to be cost effective.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.03 - Pharmacy Services › Section 10.09.03.05 - Limitations

Current through Register Vol. 51, No. 14, July 12, 2024
A. Except as
				  specifically identified as being covered under Regulation .04 of this chapter,
				  the following are not covered:
(1) Nonlegend
				  drugs;
(2) Medical supplies and
				  durable equipment;
(3) Any original
				  prescription for a controlled substance dispensed more than 30 days after the
				  date it was ordered;
(4) Drugs
				  supplied to hospital inpatients;
(5) Drugs and supplies dispensed by the
				  provider with an actual acquisition cost of $0;
(6) Experimental or investigational
				  drugs;
(7) Except where authorized
				  by the Department to be covered under this Regulation, injectables dispensed by
				  a provider for administration by the prescriber;
(8) Food supplements or infant formulas,
				  including supplemental vitamin and mineral products when administered
				  orally;
(9) Sugar or salt
				  substitutes;
(10) Cosmetics,
				  medicine chest supplies, and sundries including all soaps, all body powders,
				  all body oils or body lotions, cotton balls, adhesive strip bandages,
				  cotton-tipped applicators, suntan products, deodorants, dentifrices, tissues,
				  convenience packages of covered items, hot water bottles, ice caps, heating
				  pads, soft cervical collars;
(11)
				  Alcoholic beverages;
(12) Ostomy
				  supplies;
(13) Those services
				  authorized for payment to a prescriber, hospital, nursing facility, hospital
				  outpatient department, or freestanding clinic;
(14) Oral drugs or injections for central
				  nervous system stimulants, anorexigenics, and any other agents when used for
				  weight control;
(15) Drug products
				  for which federal financial participation is prohibited pursuant to
				  42 CFR §
												441.25;
(16) Ovulation stimulants;
(17) Effective January 1, 2006, any Part D
				  drug for individuals who are eligible for Medicare Part D benefits;
(18) Drugs or products used for hair growth
				  or other cosmetic purposes;
(19)
				  Any drug or supply that is covered and reimbursed by the Department under any
				  other chapter of this subtitle; and
(20) Any drug or product the Department
				  determines is not medically necessary.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.03 - Pharmacy Services › Section 10.09.03.05-1 - Expanded Limitations

Current through Register Vol. 51, No. 14, July 12, 2024
A. A drug
				  is not covered for State-only recipients if:
(1) The manufacturer has not provided the
				  same rebate to the State for State-only participants' purchases of drugs as is
				  required under Section 1927(c) of Title XIX of the Social Security Act
				  (42 U.S.C. §
												1396r-8(c));
(2) The Program has provided notice to the
				  manufacturer of the manufacturer's failure to provide adequate rebates and its
				  opportunity to request a waiver from the rebate requirement under §A(3) of
				  this regulation; and
(3) The
				  manufacturer has failed to demonstrate to the Secretary that the drug's
				  availability is essential to State-Only participants.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.03 - Pharmacy Services › Section 10.09.03.06 - Preauthorization Requirements

Current through Register Vol. 51, No. 14, July 12, 2024
A. The
				  provider shall obtain preauthorization from the Department or its designee for
				  any prescription for:
(1) Antibiotic liquids
				  requiring reconstitution for amounts exceeding a 14-day supply;
(2) Nonmaintenance drugs for more than a 34
				  day supply;
(3) A usual and
				  customary charge exceeding $2,500;
(4) Female hormones for biologic males when used for
				  treating sexual aggression;
(5)
				  Vitamin and mineral products when given by nasogastric, jejunostomy, or
				  gastrostomy tube in the home;
(6)
				  Drugs rejected by the point-of-sale system because of edits established by the
				  Program to ensure appropriate utilization of medication before the prescription
				  is dispensed, if the Department does not allow provider level
				  overrides;
(7) Where a prescriber
				  has filed an official report of an adverse event or product problem with the
				  Program or the United States Food and Drug Administration regarding a generic
				  drug, the brand name drug used as an alternative to that generic
				  drug;
(8) Drugs identified by the
				  Program that are subject to fraud or abuse; or
(9) Drugs not on the preferred drug list
				  developed under Regulation .12 of this chapter except for:
(a) Antiretrovirals; or
(b) Any other drugs or classes of drugs as
				  determined by the Department.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.03 - Pharmacy Services › Section 10.09.03.07 - Payment Procedures

Current through Register Vol. 51, No. 14, July 12, 2024
A. The
				  provider shall produce records to verify any charge to the Program upon
				  request.
B. The provider shall bill
				  all appropriate insurance carriers before requesting payment from the
				  Department.
C. Billing time
				  limitations for claims submitted pursuant to this chapter are set forth in
				  COMAR 10.09.36.
D. The provider
				  shall submit a request for payment on a form designated by the
				  Department.
E. The Department may
				  return to the provider all invoices not properly completed.
F. The pharmacy provider shall charge the
				  Program the provider's usual and customary charge to the general public for
				  similar prescriptions.
G. The
				  physician or osteopath shall charge the Program his actual acquisition cost for
				  the drugs dispensed.
H.
				  Determination of Allowable Cost.
(1) For
				  covered legend drugs and nonlegend drugs, allowable cost shall be:
(a) The NADAC; or
(b) When the NADAC is unavailable, the lowest
				  of the:
(i) WAC plus 0 percent;
(ii) FUL; and
(iii) SAAC.