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 10.09.77.01 - Definitions

Current through Register Vol. 51, No. 14, July 12, 2024
A. In this chapter,
				  the following terms have the meanings indicated.
B. Terms Defined.
(1) "Department" means the State Department
				  of Health and Mental Hygiene, the single State agency designated to administer
				  the Medical Assistance Program under Title XIX of the Social Security Act,
				  42 U.S.C. §
												1396 et seq.
(2) "Free-standing clinic" means a health
				  care facility that is not licensed as a hospital, part of a hospital, or
				  nursing home and is not administratively part of a physician's, dentist's, or
				  osteopath's office, but which has a separate staff functioning under the
				  direction of a clinic administrator or health officer and is organized and
				  operated to provide ambulatory health services.
(3) "Free-standing urgent care center" means
				  a location, distinct from a hospital emergency room, a physician's office, or a
				  free-standing clinic, whose purpose is to diagnose and treat illness or injury
				  for unscheduled, ambulatory patients seeking immediate medical
				  attention.
(4) "Hospital" means an
				  institution which falls within the jurisdiction of Health-General Article,
				  Title 19, Subtitle 3, Annotated Code of Maryland, and is licensed pursuant to
				  COMAR 10.07.01.
(5) "Medical
				  Assistance Program" means a program of comprehensive medical and other
				  health-related care for indigent and medically indigent persons.
(6) "Medically necessary" means that the
				  service or benefit is:
(a) Directly related
				  to diagnostic, preventive, curative, palliative, rehabilitative, or
				  ameliorative treatment of an illness, injury, disability, or health
				  condition;
(b) Consistent with
				  currently accepted standards of good medical practice;
(c) The most cost efficient service that can
				  be provided without sacrificing effectiveness or access to care; and
(d) Not primarily for the convenience of the
				  consumer, family, or provider.
(7) "Medicare" means the insurance program
				  administered by the federal government under Title XVIII of the Social Security
				  Act, U.S.C. §1395 et seq.
(8)
				  "Participant" means an individual who is certified as eligible for and is
				  receiving Medical Assistance benefits.
(9) "Patient" means a participant awaiting or
				  undergoing health care or treatment.
(10) "Physician" means an individual legally
				  licensed to practice medicine in the state in which the physician's practice is
				  located.
(11) "Program" means the
				  Maryland Medical Assistance Program.
(12) "Provider" means a free-standing urgent
				  care center which, through appropriate agreement with the Department, has been
				  identified as a Program provider by the issuance of a Medical Assistance
				  provider number.
(13) "Urgent care"
				  means the delivery of ambulatory care, such as for acute illnesses or minor
				  traumas, in a facility dedicated to the delivery of unscheduled, walk-in care
				  outside of a hospital emergency department, a free-standing clinic, or a
				  physician's office.