reglab/statecodes huggingface dataset:
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.66 - Maryland Medicaid Managed Care Program: Access (Recodified to be COMAR 10.67.05) › Section 10.09.66.06 - Geographical Access (Recodified)

Current through Register Vol. 51, No. 14, July 12, 2024
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.66 - Maryland Medicaid Managed Care Program: Access (Recodified to be COMAR 10.67.05) › Section 10.09.66.07 - Access Standards: Clinical and Pharmacy Access (Recodified)

Current through Register Vol. 51, No. 14, July 12, 2024
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.66 - Maryland Medicaid Managed Care Program: Access (Recodified to be COMAR 10.67.05) › Section 10.09.66.08 - Emergency Services Access (Recodified)

Current through Register Vol. 51, No. 14, July 12, 2024
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.66 - Maryland Medicaid Managed Care Program: Access (Recodified to be COMAR 10.67.05) › Section 10.09.66.09 - Access: Hospitals (Recodified)

Current through Register Vol. 51, No. 14, July 12, 2024
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.67 - Maryland Medicaid Managed Care Program: Benefits (Recodified to be COMAR 10.67.06) › Section 10.09.67.01 - Required Benefits Package - In General (Recodified)

Current through Register Vol. 51, No. 14, July 12, 2024
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.67 - Maryland Medicaid Managed Care Program: Benefits (Recodified to be COMAR 10.67.06) › Section 10.09.67.02 - Benefits - Primary Care Services (Recodified)

Current through Register Vol. 51, No. 14, July 12, 2024
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.67 - Maryland Medicaid Managed Care Program: Benefits (Recodified to be COMAR 10.67.06) › Section 10.09.67.03 - Benefits - Physician and Advanced Practice Nurse Specialty Care Services (Recodified)

Current through Register Vol. 51, No. 14, July 12, 2024
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.67 - Maryland Medicaid Managed Care Program: Benefits (Recodified to be COMAR 10.67.06) › Section 10.09.67.04 - Benefits - Pharmacy Services (Recodified)

Current through Register Vol. 51, No. 14, July 12, 2024
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.67 - Maryland Medicaid Managed Care Program: Benefits (Recodified to be COMAR 10.67.06) › Section 10.09.67.05 - Benefits - Home Health Services (Recodified)

Current through Register Vol. 51, No. 14, July 12, 2024
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.67 - Maryland Medicaid Managed Care Program: Benefits (Recodified to be COMAR 10.67.06) › Section 10.09.67.06 - Benefits - Habilitation Services for Medicaid Expansion Populations (Recodified)

Current through Register Vol. 51, No. 14, July 12, 2024
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.67 - Maryland Medicaid Managed Care Program: Benefits (Recodified to be COMAR 10.67.06) › Section 10.09.67.07 - Benefits - Inpatient Hospital Services (Recodified)

Current through Register Vol. 51, No. 14, July 12, 2024
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.67 - Maryland Medicaid Managed Care Program: Benefits (Recodified to be COMAR 10.67.06) › Section 10.09.67.08 - Benefits - Outpatient Hospital Services (Recodified)

Current through Register Vol. 51, No. 14, July 12, 2024
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.67 - Maryland Medicaid Managed Care Program: Benefits (Recodified to be COMAR 10.67.06) › Section 10.09.67.09 - Benefits - Transplants (Recodified)

Current through Register Vol. 51, No. 14, July 12, 2024
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.67 - Maryland Medicaid Managed Care Program: Benefits (Recodified to be COMAR 10.67.06) › Section 10.09.67.10 - Recodified

Current through Register Vol. 51, No. 14, July 12, 2024
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.67 - Maryland Medicaid Managed Care Program: Benefits (Recodified to be COMAR 10.67.06) › Section 10.09.67.11 - Benefits - Diagnostic and Laboratory Services (Recodified)

Current through Register Vol. 51, No. 14, July 12, 2024
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.67 - Maryland Medicaid Managed Care Program: Benefits (Recodified to be COMAR 10.67.06) › Section 10.09.67.12 - Benefits - Long-Term Care Facility Services (Recodified)

Current through Register Vol. 51, No. 14, July 12, 2024
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.67 - Maryland Medicaid Managed Care Program: Benefits (Recodified to be COMAR 10.67.06) › Section 10.09.67.13 - Benefits - Disposable Medical Supplies and Durable Medical Equipment (Recodified)

Current through Register Vol. 51, No. 14, July 12, 2024
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.67 - Maryland Medicaid Managed Care Program: Benefits (Recodified to be COMAR 10.67.06) › Section 10.09.67.14 - Benefits - Vision Care Services (Recodified)

Current through Register Vol. 51, No. 14, July 12, 2024
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.67 - Maryland Medicaid Managed Care Program: Benefits (Recodified to be COMAR 10.67.06) › Section 10.09.67.15 - Benefits - Podiatry Services (Recodified)

Current through Register Vol. 51, No. 14, July 12, 2024
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.67 - Maryland Medicaid Managed Care Program: Benefits (Recodified to be COMAR 10.67.06) › Section 10.09.67.16 - Benefits - Outpatient Rehabilitative Services (Recodified)

Current through Register Vol. 51, No. 14, July 12, 2024
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.67 - Maryland Medicaid Managed Care Program: Benefits (Recodified to be COMAR 10.67.06) › Section 10.09.67.17 - Benefits - Oxygen and Related Respiratory Equipment (Recodified)

Current through Register Vol. 51, No. 14, July 12, 2024
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.67 - Maryland Medicaid Managed Care Program: Benefits (Recodified to be COMAR 10.67.06) › Section 10.09.67.18 - Benefits - Dialysis Services (Recodified)

Current through Register Vol. 51, No. 14, July 12, 2024
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.67 - Maryland Medicaid Managed Care Program: Benefits (Recodified to be COMAR 10.67.06) › Section 10.09.67.19 - Benefits - Family Planning Services (Recodified)

Current through Register Vol. 51, No. 14, July 12, 2024
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.67 - Maryland Medicaid Managed Care Program: Benefits (Recodified to be COMAR 10.67.06) › Section 10.09.67.20 - Benefits - EPSDT Services (Recodified)

Current through Register Vol. 51, No. 14, July 12, 2024
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.67 - Maryland Medicaid Managed Care Program: Benefits (Recodified to be COMAR 10.67.06) › Section 10.09.67.21 - Benefits - Pregnancy-Related Services (Recodified)

Current through Register Vol. 51, No. 14, July 12, 2024
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.67 - Maryland Medicaid Managed Care Program: Benefits (Recodified to be COMAR 10.67.06) › Section 10.09.67.22 - Benefits - Case Management Services for HIV-Infected Individuals (Recodified)

Current through Register Vol. 51, No. 14, July 12, 2024
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.67 - Maryland Medicaid Managed Care Program: Benefits (Recodified to be COMAR 10.67.06) › Section 10.09.67.23 - Benefits - Hospice Care Services (Recodified)

Current through Register Vol. 51, No. 14, July 12, 2024
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.67 - Maryland Medicaid Managed Care Program: Benefits (Recodified to be COMAR 10.67.06) › Section 10.09.67.24 - Benefits - Diabetes Prevention and Care Services (Recodified)

Current through Register Vol. 51, No. 14, July 12, 2024
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.67 - Maryland Medicaid Managed Care Program: Benefits (Recodified to be COMAR 10.67.06) › Section 10.09.67.25 - Benefits - Blood and Blood Products (Recodified)

Current through Register Vol. 51, No. 14, July 12, 2024
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.67 - Maryland Medicaid Managed Care Program: Benefits (Recodified to be COMAR 10.67.06) › Section 10.09.67.26 - Benefits - Primary Mental Health Services (Recodified)

Current through Register Vol. 51, No. 14, July 12, 2024
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.67 - Maryland Medicaid Managed Care Program: Benefits (Recodified to be COMAR 10.67.06) › Section 10.09.67.26-1 - Clinical Trial Items and Services - Coverage for Routine Costs (Recodified)

Current through Register Vol. 51, No. 14, July 12, 2024
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.67 - Maryland Medicaid Managed Care Program: Benefits (Recodified to be COMAR 10.67.06) › Section 10.09.67.26-2 - Plastic and Restorative Surgery (Recodified)

Current through Register Vol. 51, No. 14, July 12, 2024
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.67 - Maryland Medicaid Managed Care Program: Benefits (Recodified to be COMAR 10.67.06) › Section 10.09.67.26-3 - Gender Transition Services (Recodified)

Current through Register Vol. 51, No. 14, July 12, 2024
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.67 - Maryland Medicaid Managed Care Program: Benefits (Recodified to be COMAR 10.67.06) › Section 10.09.67.26-4 - Audiology (Recodified)

Current through Register Vol. 51, No. 14, July 12, 2024
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.67 - Maryland Medicaid Managed Care Program: Benefits (Recodified to be COMAR 10.67.06) › Section 10.09.67.26-5 - Remote Patient Monitoring (Recodified)

Current through Register Vol. 51, No. 14, July 12, 2024
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.67 - Maryland Medicaid Managed Care Program: Benefits (Recodified to be COMAR 10.67.06) › Section 10.09.67.27 - Benefits - Limitations (Recodified)

Current through Register Vol. 51, No. 14, July 12, 2024
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.67 - Maryland Medicaid Managed Care Program: Benefits (Recodified to be COMAR 10.67.06) › Section 10.09.67.28 - Benefits - Self-Referral Services (Recodified)

Current through Register Vol. 51, No. 14, July 12, 2024
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.67 - Maryland Medicaid Managed Care Program: Benefits (Recodified to be COMAR 10.67.06) › Section 10.09.67.29 - Optional Services (Recodified)

Current through Register Vol. 51, No. 14, July 12, 2024
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.67 - Maryland Medicaid Managed Care Program: Benefits (Recodified to be COMAR 10.67.06) › Section 10.09.67.30 - Recodified

Current through Register Vol. 51, No. 14, July 12, 2024
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.67 - Maryland Medicaid Managed Care Program: Benefits (Recodified to be COMAR 10.67.06) › Section 10.09.67.31 - Benefits - Telemedicine Services (Recodified)

Current through Register Vol. 51, No. 14, July 12, 2024
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.68 - Maryland Medicaid Managed Care Program: Program Integrity (Recodified to be COMAR 10.67.07) › Section 10.09.68.01 - Requirements to Detect and Prevent Fraud, Waste and Abuse (Recodified)

Current through Register Vol. 51, No. 14, July 12, 2024
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.68 - Maryland Medicaid Managed Care Program: Program Integrity (Recodified to be COMAR 10.67.07) › Section 10.09.68.02 - Access to Information (Recodified)

Current through Register Vol. 51, No. 14, July 12, 2024
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.68 - Maryland Medicaid Managed Care Program: Program Integrity (Recodified to be COMAR 10.67.07) › Section 10.09.68.03 - Reporting (Recodified)

Current through Register Vol. 51, No. 14, July 12, 2024
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.69 - Maryland Medicaid Managed Care Program: Rare and Expensive Case Management › Section 10.09.69.01 - Purpose

Current through Register Vol. 51, No. 14, July 12, 2024
A. The purpose of
				  the Rare and Expensive Case Management (REM) program is to provide case
				  management services and subspecialty care for Maryland Medicaid Managed Care
				  Program eligible individuals with rare and expensive conditions.
B. The program is designed to provide
				  Maryland Medicaid Managed Care Program eligible individuals diagnosed with
				  qualifying rare and expensive conditions the following benefits when the
				  individual elects to participate in the program:
(1) Case management services; and
(2) REM optional services.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.69 - Maryland Medicaid Managed Care Program: Rare and Expensive Case Management › Section 10.09.69.03 - REM Eligibility

Current through Register Vol. 51, No. 14, July 12, 2024
A. An
				  individual is eligible to participate in the REM program if the individual:
(1) Is eligible for Maryland Medicaid Managed
				  Care as specified in COMAR
				  10.09.63.01;
(2) Has one or more of the diagnoses
				  specified in Regulation .17 of this chapter; and
(3) Elects to participate in the REM
				  program.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.69 - Maryland Medicaid Managed Care Program: Rare and Expensive Case Management › Section 10.09.69.04 - Participant Enrollment and Disenrollment

Current through Register Vol. 51, No. 14, July 12, 2024
A. Anyone may
				  refer an individual into the REM program including, but not limited to a:
(1) Family member;
(2) Physician;
(3) Discharge planner;
(4) Hospital;
(5) Clinic;
(6) Social worker; and
(7) Managed care organization
				  (MCO).
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.69 - Maryland Medicaid Managed Care Program: Rare and Expensive Case Management › Section 10.09.69.05 - Benefits

Current through Register Vol. 51, No. 14, July 12, 2024
A REM participant is eligible for the following:
A. Fee-for-service Medical Assistance
				  benefits available to a Medical Assistance participant not enrolled in an
				  MCO;
B. Services described in
				  Regulations .10 and .11 of this chapter when determined medically necessary by
				  the Department;
C. A case
				  management assessment performed by a REM case manager who shall:
(1) Gather all relevant information to
				  determine the participant's condition and needs including the participant's
				  medical records;
(2) Consult with
				  the participant's current service providers; and
(3) Evaluate the relevant information and
				  complete a needs analysis including medical, psychosocial, environmental, and
				  functional assessments; and
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.69 - Maryland Medicaid Managed Care Program: Rare and Expensive Case Management › Section 10.09.69.06 - Requirements for Provider Qualification

Current through Register Vol. 51, No. 14, July 12, 2024
A. A case manager providing case management
				  under this chapter shall be:
(1) An RN;
				  or
(2) A social worker.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.69 - Maryland Medicaid Managed Care Program: Rare and Expensive Case Management › Section 10.09.69.07 - Conditions for Participation-General Requirements

Current through Register Vol. 51, No. 14, July 12, 2024
A provider rendering services pursuant to this chapter
					 shall:
A. Meet the applicable
				  conditions for participation set forth in COMAR 10.09.36;
B. Meet the provider qualification
				  requirements specified in Regulation .06 of this chapter for its provider
				  type;
C. Meet the specific
				  conditions for provider participation set forth in this chapter;
D. Provide services in accordance with the
				  applicable requirements of this chapter and all other relevant State and local
				  laws and regulations;
E. Verify the
				  qualifications of all subcontracted or employed professionals and individuals
				  engaged by the provider agency to render services covered under this chapter
				  and provide a copy of their current licensure and credentials on request to the
				  Department;
F. Provide services to
				  REM program participants in a manner consistent with the REM participant's plan
				  of care; and
G.
				  When the Department determines it is necessary, participate in the
				  interdisciplinary team meetings for the purpose of:
(1) Developing and implementing a
				  participant's treatment plan or plan of care with the Department; or
(2) Accessing a specific service.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.69 - Maryland Medicaid Managed Care Program: Rare and Expensive Case Management › Section 10.09.69.08 - Specific Conditions for Provider Participation

Current through Register Vol. 51, No. 14, July 12, 2024
A. Case Management Providers. To participate
				  in the Program, a case management provider shall meet the conditions set forth
				  in Regulations .05 and .06 of this chapter.
B. Chiropractic Service
				  Providers. To participate in the Program, the chiropractic service provider
				  shall:
(1) Meet the:
(a) Conditions set forth in Regulation .06 of
				  this chapter; and
(b) Requirements
				  for chiropractic providers specified in COMAR 10.43.04;
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.69 - Maryland Medicaid Managed Care Program: Rare and Expensive Case Management › Section 10.09.69.09 - Covered Services - General Requirements

Current through Register Vol. 51, No. 14, July 12, 2024
For participants in the REM program, the Program covers and
					 shall reimburse for services specified in Regulations .10 and .11 of this
					 chapter when these services are:
A.
				  Medically necessary;
B. Prescribed
				  by a:
(1) Physician;
(2) Physician assistant; or
(3) Nurse practitioner;
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.69 - Maryland Medicaid Managed Care Program: Rare and Expensive Case Management › Section 10.09.69.10 - Covered Services

Current through Register Vol. 51, No. 14, July 12, 2024
A.
				  Chiropractic services are covered for REM participants when:
(1) Services are provided to a REM
				  participant who is 21 years old or older;
(2) Services are provided by a physician or
				  chiropractor;
(3) The qualifying
				  REM diagnosis or related illness shows deterioration or worsening symptoms and
				  other traditional treatments have been ineffective;
(4) The treatment enhances or restores the
				  participant's level of functioning; or
(5) Symptoms resulting from the REM diagnosis
				  or related illness impairs a participant's activities of daily
				  living.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.69 - Maryland Medicaid Managed Care Program: Rare and Expensive Case Management › Section 10.09.69.12 - Limitations

Current through Register Vol. 51, No. 14, July 12, 2024
A. The
				  Department shall pay for services specified in this chapter delivered to a REM
				  participant only if the services have been ordered by the participant's
				  physician or nurse practitioner, and preauthorized, when necessary, by the
				  Department or its designee.
B. For
				  REM participants, the Department may not pay for the following comparable case
				  management services:
(1) HIV targeted case
				  management as described in COMAR 10.09.32, except for HIV Diagnostic Evaluation
				  Services as described in COMAR
				  10.09.32.03CC and
				  .04A; and
(2) Model Waiver case
				  management as described in COMAR 10.09.27.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.69 - Maryland Medicaid Managed Care Program: Rare and Expensive Case Management › Section 10.09.69.13 - Preauthorization Requirements

Current through Register Vol. 51, No. 14, July 12, 2024
A. Except for
				  initial assessments unless otherwise specified, preauthorization by the
				  Department or its designee is required for all services under Regulation .11 of
				  this chapter.
B. The Department or
				  its designee shall issue preauthorization when the Department:
(1) Determines that services are medically
				  necessary; and
(2) Authorizes the
				  services before the initiation or continuance of the requested
				  service.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.69 - Maryland Medicaid Managed Care Program: Rare and Expensive Case Management › Section 10.09.69.14 - Payment Procedures-Request for Payment

Current through Register Vol. 51, No. 14, July 12, 2024
A. A provider
				  shall submit a request for payment for the services covered under this chapter
				  according to the procedures set forth in COMAR 10.09.36.
B. Billing time limitations for the services
				  covered under this chapter are the same as those set forth in COMAR
				  10.09.36.
C. The Department shall
				  pay for covered services at the lower of:
(1)
				  The lowest price, including negotiated contract prices, that is offered to any
				  other purchaser for the same or similar service during the same time period,
				  after extending to the Program all rebates, coupons, and negotiated
				  discounts;
(2) The actual charge
				  billed by the provider; or
(3) Any
				  fee schedule developed for reimbursement of the same service provided under
				  Medical Assistance.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.69 - Maryland Medicaid Managed Care Program: Rare and Expensive Case Management › Section 10.09.69.15 - Appeals Procedures

Current through Register Vol. 51, No. 14, July 12, 2024
A. A
				  provider shall submit a request for payment for the services covered under this
				  chapter according to the procedures set forth in COMAR 10.09.36.
B. Billing time limitations for the services
				  covered under this chapter are the same as those set forth in COMAR
				  10.09.36.
C. The Department shall
				  pay for covered services at the lower of:
(1)
				  The lowest price, including negotiated contract prices, that is offered to any
				  other purchaser for the same or similar service during the same time period,
				  after extending to the Program all rebates, coupons, and negotiated
				  discounts;
(2) The actual charge
				  billed by the provider; or
(3) Any
				  fee schedule developed for reimbursement of the same service provided under
				  Medicaid.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.69 - Maryland Medicaid Managed Care Program: Rare and Expensive Case Management › Section 10.09.69.16 - Appeals Procedures

Current through Register Vol. 51, No. 14, July 12, 2024
Recovery and reimbursement under this chapter are set forth
					 in COMAR 10.09.36.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.69 - Maryland Medicaid Managed Care Program: Rare and Expensive Case Management › Section 10.09.69.18 - Appeals Procedures

Current through Register Vol. 51, No. 14, July 12, 2024
Appeal procedures are as set forth in COMAR
					 10.09.36.09 and
					 10.01.04.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.70 - Maryland Medicaid Managed Care Program: Non-Capitated Covered Services (Recodified to be COMAR 10.67.08) › Section 10.09.70.01 - Scope (Recodified)

Current through Register Vol. 51, No. 14, July 12, 2024
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.70 - Maryland Medicaid Managed Care Program: Non-Capitated Covered Services (Recodified to be COMAR 10.67.08) › Section 10.09.70.02 - Behavioral Health Non-Capitated Covered Services (Recodified)

Current through Register Vol. 51, No. 14, July 12, 2024
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.70 - Maryland Medicaid Managed Care Program: Non-Capitated Covered Services (Recodified to be COMAR 10.67.08) › Section 10.09.70.03 - Nonbehavioral Health Fee-For-Service Benefits (Recodified)

Current through Register Vol. 51, No. 14, July 12, 2024
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.71 - Maryland Medicaid Managed Care Program: MCO Dispute Resolution Procedures (Recodified to be COMAR 10.67.09) › Section 10.09.71.01 - MCO Enrollee Services (Recodified)

Current through Register Vol. 51, No. 14, July 12, 2024
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.71 - Maryland Medicaid Managed Care Program: MCO Dispute Resolution Procedures (Recodified to be COMAR 10.67.09) › Section 10.09.71.02 - MCO Enrollee Complaint Process (Recodified)

Current through Register Vol. 51, No. 14, July 12, 2024
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.71 - Maryland Medicaid Managed Care Program: MCO Dispute Resolution Procedures (Recodified to be COMAR 10.67.09) › Section 10.09.71.02-1 - Member Complaints - Time Frames for MCOs to Respond to the Department (Recodified)

Current through Register Vol. 51, No. 14, July 12, 2024
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.71 - Maryland Medicaid Managed Care Program: MCO Dispute Resolution Procedures (Recodified to be COMAR 10.67.09) › Section 10.09.71.03 - Provider Complaint Process (Recodified)

Current through Register Vol. 51, No. 14, July 12, 2024
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.71 - Maryland Medicaid Managed Care Program: MCO Dispute Resolution Procedures (Recodified to be COMAR 10.67.09) › Section 10.09.71.03-1 - Independent Review Organization (IRO) (Recodified)

Current through Register Vol. 51, No. 14, July 12, 2024
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.71 - Maryland Medicaid Managed Care Program: MCO Dispute Resolution Procedures (Recodified to be COMAR 10.67.09) › Section 10.09.71.03-2 - Provider Complaints - Time Frames for MCOs to Respond to the Department (Recodified)

Current through Register Vol. 51, No. 14, July 12, 2024
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.71 - Maryland Medicaid Managed Care Program: MCO Dispute Resolution Procedures (Recodified to be COMAR 10.67.09) › Section 10.09.71.04 - MCO Actions and Decisions (Recodified)

Current through Register Vol. 51, No. 14, July 12, 2024
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.71 - Maryland Medicaid Managed Care Program: MCO Dispute Resolution Procedures (Recodified to be COMAR 10.67.09) › Section 10.09.71.05 - MCO Appeal Process for Enrollees (Recodified)

Current through Register Vol. 51, No. 14, July 12, 2024
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.72 - Maryland Medicaid Managed Care Program: Departmental Dispute Resolutions Procedures (Repealed) › Section 10.09.72.01

Current through Register Vol. 51, No. 14, July 12, 2024
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.72 - Maryland Medicaid Managed Care Program: Departmental Dispute Resolutions Procedures (Repealed) › Section 10.09.72.02

Current through Register Vol. 51, No. 14, July 12, 2024
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.72 - Maryland Medicaid Managed Care Program: Departmental Dispute Resolutions Procedures (Repealed) › Section 10.09.72.03

Current through Register Vol. 51, No. 14, July 12, 2024
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.72 - Maryland Medicaid Managed Care Program: Departmental Dispute Resolutions Procedures (Repealed) › Section 10.09.72.04

Current through Register Vol. 51, No. 14, July 12, 2024
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.72 - Maryland Medicaid Managed Care Program: Departmental Dispute Resolutions Procedures (Repealed) › Section 10.09.72.05

Current through Register Vol. 51, No. 14, July 12, 2024
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.72 - Maryland Medicaid Managed Care Program: Departmental Dispute Resolutions Procedures (Repealed) › Section 10.09.72.06

Current through Register Vol. 51, No. 14, July 12, 2024
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.73 - Maryland Medicaid Managed Care Program: Sanctions (Recodified to be COMAR 10.67.10) › Section 10.09.73.01 - Sanction by the Department (Recodified)

Current through Register Vol. 51, No. 14, July 12, 2024
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.73 - Maryland Medicaid Managed Care Program: Sanctions (Recodified to be COMAR 10.67.10) › Section 10.09.73.01-1 - Sanction by Center for Medicare and Medicaid Services (CMS) (Recodified)

Current through Register Vol. 51, No. 14, July 12, 2024
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.73 - Maryland Medicaid Managed Care Program: Sanctions (Recodified to be COMAR 10.67.10) › Section 10.09.73.02 - Appeal (Recodified)

Current through Register Vol. 51, No. 14, July 12, 2024
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.73 - Maryland Medicaid Managed Care Program: Sanctions (Recodified to be COMAR 10.67.10) › Section 10.09.73.03 - Incentives (Recodified)

Current through Register Vol. 51, No. 14, July 12, 2024
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.74 - Maryland Medicaid Managed Care Program: Contribution to Graduate Medical Education Costs (Recodified to be COMAR 10.67.11) › Section 10.09.74.01 - Scope (Recodified)

Current through Register Vol. 51, No. 14, July 12, 2024
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.74 - Maryland Medicaid Managed Care Program: Contribution to Graduate Medical Education Costs (Recodified to be COMAR 10.67.11) › Section 10.09.74.02 - GME Allocation Payment (Recodified)

Current through Register Vol. 51, No. 14, July 12, 2024
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.75 - Maryland Medicaid Managed Care Program: Corrective Managed Care (Recodified to be COMAR 10.67.12) › Section 10.09.75.01 - General (Recodified)

Current through Register Vol. 51, No. 14, July 12, 2024
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.75 - Maryland Medicaid Managed Care Program: Corrective Managed Care (Recodified to be COMAR 10.67.12) › Section 10.09.75.02 - Corrective Managed Care Plan (Recodified)

Current through Register Vol. 51, No. 14, July 12, 2024
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.75 - Maryland Medicaid Managed Care Program: Corrective Managed Care (Recodified to be COMAR 10.67.12) › Section 10.09.75.03 - Enrollee Notice (Recodified)

Current through Register Vol. 51, No. 14, July 12, 2024
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.75 - Maryland Medicaid Managed Care Program: Corrective Managed Care (Recodified to be COMAR 10.67.12) › Section 10.09.75.04 - Effective Date of Enrollment (Recodified)

Current through Register Vol. 51, No. 14, July 12, 2024
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.75 - Maryland Medicaid Managed Care Program: Corrective Managed Care (Recodified to be COMAR 10.67.12) › Section 10.09.75.05 - Enrollee Appeal (Recodified)

Current through Register Vol. 51, No. 14, July 12, 2024
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.76 - School-Based Health Centers (SBHC) › Section 10.09.76.02 - 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 10.09.36.02.
B. A physician, nurse
				  practitioner, or physician assistant providing services in an SBHC shall be
				  licensed and legally authorized to practice in the state in which the service
				  is provided.
C. A dentist or dental
				  hygienist providing services in an SBHC shall be licensed and legally
				  authorized to practice 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 10.09.76 - School-Based Health Centers (SBHC) › Section 10.09.76.03 - 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 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 10.09.76 - School-Based Health Centers (SBHC) › Section 10.09.76.04 - Covered Services

Current through Register Vol. 51, No. 14, July 12, 2024
An SBHC, designated by the Department as meeting the
					 criteria specified in Regulation .03 of this chapter, is eligible for
					 reimbursement by the Program for the following services:
A. Comprehensive well-child care, including
				  the administration of vaccines in accordance with the Maryland Healthy Kids
				  Preventive Health Schedule, when:
(1)
				  Performed by EPSDT certified providers; and
(2) Rendered according to EPSDT standards set
				  forth in COMAR
				  10.09.23.03;
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.76 - School-Based Health Centers (SBHC) › Section 10.09.76.05 - Limitations

Current through Register Vol. 51, No. 14, July 12, 2024
The Program does not cover the following:
A. Services not specified in Regulation .04
				  of this chapter;
B. Services not
				  medically necessary;
C.
				  Investigational and experimental drugs and procedures;
D. Basic school health services as defined in
				  COMAR 13A.05.05.05-.15;
E. Nursing
				  or other health services provided as part of a participant's individualized
				  educational program (IEP) as defined in COMAR
				  10.09.50.01B or
				  individualized family service plan (IFSP) as defined in COMAR
				  10.09.50.01B;
F. Skilled nursing services provided to
				  enable a participant to be safely maintained in the school setting such as:
(1) Nasogastric tube feedings;
(2) Catheterization;
(3) Oral, nasotracheal, or tracheal
				  suctioning; and
(4) Nebulizer
				  treatments;
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.76 - School-Based Health Centers (SBHC) › Section 10.09.76.06 - Reimbursement Methodology

Current through Register Vol. 51, No. 14, July 12, 2024
A. The
				  provider shall charge the Program the provider's customary charge to the
				  general public for similar services and charge the provider's acquisition cost
				  for injectable drugs or dispensed medical supplies.
B. 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
				  §B of this regulation; and
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.76 - School-Based Health Centers (SBHC) › Section 10.09.76.07 - Payment Procedures

Current through Register Vol. 51, No. 14, July 12, 2024
A. The
				  provider shall submit a completed request for payment in the format designated
				  by the Department or HealthChoice MCO, including required
				  documentation.
B. The dental
				  provider shall submit a request for payment in the format designated by the
				  Department and in accordance with COMAR 10.09.05.07.
C. The Program reserves the right to return
				  to the provider, before payment, all invoices not properly completed.
D. Unless the service is free to individuals
				  not covered by Medicaid, a provider shall bill the Program the provider's
				  customary charge to the general public for similar services.
E. The Department shall authorize payment on
				  Medicare crossover claims only if:
(1) The
				  provider accepts Medicare assignments;
(2) Medicare makes a direct payment to the
				  provider;
(3) Medicare determines
				  the services are medically necessary;
(4) The services are covered by the Program;
				  and
(5) Initial billing is made
				  directly to Medicare according to Medicare guidelines.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.76 - School-Based Health Centers (SBHC) › Section 10.09.76.08 - 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 10.09.76 - School-Based Health Centers (SBHC) › Section 10.09.76.09 - 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 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 10.09.76 - School-Based Health Centers (SBHC) › Section 10.09.76.10 - 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 10.09.76 - School-Based Health Centers (SBHC) › Section 10.09.76.11 - Interpretive Regulation

Current through Register Vol. 51, No. 14, July 12, 2024
State regulations shall be interpreted in conformity with
					 COMAR 10.09.36.10.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.77 - Urgent Care Centers › Section 10.09.77.02 - License Requirements

Current through Register Vol. 51, No. 14, July 12, 2024
A. License
				  requirements under this chapter are found in COMAR
				  10.09.36.02D.
B. The provider shall ensure that
				  all X-ray and other radiological equipment is maintained and inspected in
				  compliance with the requirements of Environment Article, Title 8, Subtitle 3,
				  Annotated Code of Maryland.
C.
				  Urgent care services may be performed only by health care practitioners who are
				  licensed to perform these procedures within the state in which the center is
				  located.
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 the
				  requirements of Health-General Article, Title 17, Subtitles 2 and 3, Annotated
				  Code of Maryland, and COMAR
				  10.09.09.02 a and
				  10.10.01.02 a, as applicable;
				  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 10.09.77 - Urgent Care Centers › Section 10.09.77.03 - Conditions for Participation

Current through Register Vol. 51, No. 14, July 12, 2024
A.
				  The 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 10.09.77 - Urgent Care Centers › Section 10.09.77.04 - Covered Services

Current through Register Vol. 51, No. 14, July 12, 2024
The Program covers the following medically necessary
					 services rendered to participants in a free-standing urgent care center:
A. Acute illnesses with a sudden
				  onset;
B. Minor trauma;
C. Diagnostic, preventive, curative,
				  palliative, rehabilitative, or ameliorative services, when clearly related to
				  the participant's individual needs;
D. Urgent care services, when the services
				  are performed by a physician or one of the following acting within the scope of
				  their practice:
(1) licensed physician
				  assistant;
(2) A licensed
				  registered nurse; or
(3) A
				  certified nurse practitioner [provided that the individual performing the
				  service is in the physician's employ and performs the services within the scope
				  of the individual's license or certification]; and
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 10.09.77.05 - Limitations

Current through Register Vol. 51, No. 14, July 12, 2024
The Program does not cover the following:
A. Services not medically
				  necessary;
B. Investigational and
				  experimental drugs and procedures;
C. Services denied by Medicare as not
				  medically necessary;
D. Services
				  rendered via telehealth that do not comply with the telehealth requirements
				  established in COMAR 10.09.49 and any other subregulatory guidance issued by
				  the Department;
E. Laboratory or
				  x-ray services performed by another facility;
F. Immunizations;
G. Visits only to accomplish one or more of
				  the following:
(1) Collection of specimens for
				  laboratory procedures;
(2)
				  Interpretation of laboratory tests or panels;
(3) Ascertaining the patient's weight;
				  and
(4) Measurement of blood
				  pressure;