reglab/statecodes huggingface dataset:
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.18 - Oxygen and Related Respiratory Equipment Services › Section 10.09.18.07 - Payment Procedures

Current through Register Vol. 51, No. 14, July 12, 2024
A. The
				  provider shall submit request for payment on the forms designated by the
				  Department, with attachments when applicable.
B. The Department reserves the right to
				  return to the provider, before payment, all invoices not properly signed and
				  completed and those submitted without required documentation.
C. The provider shall charge the Program the
				  provider's customary charge to the general public for similar items. If the
				  item 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 10.09.18 - Oxygen and Related Respiratory Equipment Services › Section 10.09.18.08 - Recovery and Reimbursement

Current through Register Vol. 51, No. 14, July 12, 2024
A.
				  If the recipient has insurance or other coverage, or if any other person is
				  obligated either legally or contractually to pay for or to reimburse the
				  recipient for any service 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 his 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 10.09.18 - Oxygen and Related Respiratory Equipment Services › Section 10.09.18.09 - 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, any agent or employee of a 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
				  Department;
(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 10.09.18 - Oxygen and Related Respiratory Equipment Services › Section 10.09.18.10 - 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 10.09.18 - Oxygen and Related Respiratory Equipment Services › Section 10.09.18.11 - 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 recipients 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 10.09.19 - Transportation Grants › Section 10.09.19.01 - Scope

Current through Register Vol. 51, No. 14, July 12, 2024
These regulations govern the administration of grants to
					 counties, municipal corporations, and nonprofit organizations for the provision
					 of safety-net transportation services to Medical Assistance Program recipients.
					 The grant funds are to be used by grantees to:
A. Screen requests for transportation by
				  recipients;
B. Arrange for
				  transportation;
C. Expand existing
				  and develop new transportation resources; and
D. Provide transportation services where no
				  other transportation is available to the recipient.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.19 - Transportation Grants › Section 10.09.19.02 - 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) "Ambulance" means a specially designed
				  vehicle used for transporting the sick or injured, which has necessary patient
				  care equipment including a stretcher, clean linens, first aid supplies, oxygen
				  equipment, and, in addition, other safety and lifesaving equipment which may be
				  required by State or local laws to classify the vehicle as an
				  ambulance.
(2) "Attendant" means an
				  individual needed to accompany a recipient who is unable to travel
				  alone.
(3) "Department" has the
				  meaning stated in COMAR
				  10.09.36.01A.
(4) "Emergency" means a situation
				  requiring prompt diagnosis and treatment of conditions having the potential of
				  causing imminent disability or death.
(5) "Emergency services" means services
				  provided in hospital emergency facilities after the onset of a medical
				  condition manifesting itself by symptoms of sufficient severity that the
				  absence of immediate medical attention could reasonably be expected by a
				  prudent layperson, possessing an average knowledge of health and medicine, to
				  result in:
(a) Placing health in
				  jeopardy;
(b) Serious impairment to
				  bodily functions;
(c) Serious
				  dysfunction of any bodily organ or part; or
(d) Development or continuance of severe
				  pain.
(6) "Grantee"
				  means a recipient of grant funds from the Department pursuant to this
				  chapter.
(7) "Medical Assistance
				  Program" means a program of comprehensive medical and other health-related care
				  for indigent and medically indigent individuals.
(8) "Medicare" has the meaning stated in
				  COMAR 10.09.36.01A.
(9) "Necessary" has the meaning
				  stated in COMAR
				  10.09.36.01A.
(10) "Nonambulatory" means a
				  condition which renders a recipient physically unable to use a bus, taxicab, or
				  private automobile in going to or from a hospital to receive needed medical
				  treatment.
(11) "Program" has the
				  meaning stated in COMAR
				  10.09.36.01A.
(12) "Recipient" means an
				  individual who is certified as eligible for, and is receiving, Medical
				  Assistance benefits.
(13)
				  "Wheelchair van" means a van equipped with either a lift tailgate or side lift
				  which is used for loading patients who are nonambulatory but who do not require
				  the use of equipment found in an ambulance.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.19 - Transportation Grants › Section 10.09.19.03 - Procedure for Submission of Proposals

Current through Register Vol. 51, No. 14, July 12, 2024
A. The Secretary shall request proposals for
				  the award of transportation grants.
B. An applicant shall include in the
				  applicant's proposal a description of how the applicant intends to carry out
				  the duties required by these regulations. At a minimum, the applicant shall
				  include the following items in the proposal:
(1) The criteria which the applicant will use
				  to determine the recipient's need for transportation services;
(2) A discussion of how the applicant will
				  arrange and provide transportation;
(3) If applicable, a description of how
				  volunteers will be recruited and reimbursed;
(4) The reporting methodology that will be
				  used by the grantee; and
(5) An
				  itemized budget for administrative costs, including:
(a) A staffing plan;
(b) Descriptions of individual job
				  responsibilities and salaries;
(c)
				  A budget form; and
(d) Other
				  pertinent material.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.19 - Transportation Grants › Section 10.09.19.04 - Services to Recipients

Current through Register Vol. 51, No. 14, July 12, 2024
A. A
				  grantee is responsible for arranging or providing nonemergency transportation
				  to and from medically necessary covered services to Medical Assistance
				  recipients and, when necessary, their attendants, who have no other means of
				  transportation available. In carrying out this duty, a grantee:
(1) Shall screen recipients' requests for
				  transportation in order to identify whether transportation is available to the
				  recipients from other sources;
(2)
				  When determining the appropriate means of transport for a recipient who appears
				  to have a mental or physical disability which would prevent the recipient from
				  using public transportation, shall request documentation prepared by the
				  recipient's physician which indicates that the recipient's medical condition
				  makes it medically contraindicated for the recipient to use public
				  transportation;
(3) Shall refer
				  recipients to organizations and programs which might be able to provide
				  transportation and otherwise arrange for transportation when
				  appropriate;
(4) Shall encourage
				  the development and expansion of transportation resources such as churches and
				  other community organizations;
(5)
				  Shall provide transportation to recipients for whom there is no other
				  transportation resource available, in the most efficient and cost-effective
				  manner possible, including the use of volunteers and charitable organizations
				  whenever possible; and
(6) May
				  refuse to pay for transportation services if the recipient requests
				  transportation less than 24 hours before the time the transportation is to be
				  provided.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.19 - Transportation Grants › Section 10.09.19.05 - Limitations

Current through Register Vol. 51, No. 14, July 12, 2024
Monies from a grant provided under these regulations may
					 not be used to pay for the following:
A. Emergency transportation
				  services;
B. Medicare ambulance
				  services;
C. Transportation to or
				  from Veterans Administration hospitals unless it is to receive treatment for a
				  non-military-related condition;
D.
				  Transportation to or from any correctional institutions;
E. Transportation of recipients committed by
				  the courts to mental institutions;
F. Transportation between a nursing facility
				  and a hospital, for routine diagnostic tests, nursing services, or physical
				  therapy which can be performed at the nursing facility;
G. Transportation services from a facility
				  for treatment when the treatment is provided by the facility in which the
				  recipient is located;
H.
				  Transportation to receive nonmedical services;
I. Gratuities of any kind;
J. Transportation between a medical day care
				  facility and the recipient's home;
K. Transportation to or from a State facility
				  while the patient is a resident of that facility;
L. Transportation of non-Medical Assistance
				  recipients;
M. Trips for purposes
				  related to education, recreational activities, or employment;
N. Transportation of anyone other than the
				  recipient, except for an attendant accompanying a minor or when an attendant is
				  medically necessary;
O. Wheelchair
				  van service for ambulatory recipients;
P. Ambulance service for a recipient who does
				  not need to be transported in a prone position;
Q. Transportation between a community
				  rehabilitation program (CRP) and the recipient's home;
R. Transportation between a day habilitation
				  program and the recipient's home;
S. Transportation to or from services that
				  are not medically necessary.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.19 - Transportation Grants › Section 10.09.19.06 - Notices to Recipients

Current through Register Vol. 51, No. 14, July 12, 2024
Whenever a grantee determines that the grantee will not
					 arrange or provide transportation for a recipient who has requested
					 transportation at least 24 hours in advance, even though the recipient has no
					 available transportation resource, the grantee shall send the recipient a
					 notice on a form, approved by the Department, that states the recipient has a
					 right to a fair hearing pursuant to COMAR
					 10.09.24.13A.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.19 - Transportation Grants › Section 10.09.19.07 - Documentation

Current through Register Vol. 51, No. 14, July 12, 2024
A grantee shall document the following items and make the
					 documentation available to the Department upon request:
A. Whether the recipient had other
				  transportation available or could reschedule the appointment to a time when
				  transportation would be available;
B. That any transportation paid for out of
				  grant funds was to or from a medically necessary service for a recipient;
				  and
C. Which recipients the grantee
				  denied transportation and the reason or reasons why.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.19 - Transportation Grants › Section 10.09.19.08 - Accountability

Current through Register Vol. 51, No. 14, July 12, 2024
The Department shall:
A. Follow all applicable policies required by
				  COMAR 10.04.04 when approving grants; and
B. Reconcile each grant on a yearly
				  basis.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.19 - Transportation Grants › Section 10.09.19.09 - Responsibility to Recipients

Current through Register Vol. 51, No. 14, July 12, 2024
A grantee is expected to meet the transportation needs of
					 recipients in a grantee's county out of grant funds. In those circumstances
					 when the grant funds are insufficient, the grantee shall contact the Program's
					 staff specialist for transportation services, who shall evaluate and assist in
					 resolving transportation requests. A grantee may not refuse services or
					 assistance to a recipient who requests transportation on the basis that the
					 grantee's grant funds have been exhausted.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.19 - Transportation Grants › Section 10.09.19.10 - Interpretive Regulation

Current through Register Vol. 51, No. 14, July 12, 2024
These 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 10.09.20 - Community Personal Assistance Services › Section 10.09.20.01 - 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) "Activities of daily living" means tasks
				  or activities that include, but are not limited to:
(a) Bathing and completing personal hygiene
				  routines;
(b) Dressing and changing
				  clothes;
(c) Eating;
(d) Mobility, including:
(i) Transferring from a bed, chair, or other
				  structure;
(ii) Moving, turning,
				  and positioning the body while in bed or in a wheelchair; and
(iii) Moving about indoors or outdoors;
				  and
(e) Toileting,
				  including:
(i) Bladder and bowel
				  requirements;
(ii) Routines
				  associated with the achievement or maintenance of continence; and
(iii) Incontinence care.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.20 - Community Personal Assistance Services › Section 10.09.20.02 - Requirements for Provider Licensing or Certification

Current through Register Vol. 51, No. 14, July 12, 2024
The following health professionals providing services under
					 this chapter shall be licensed to practice in the jurisdiction in which
					 services are rendered:
A. Registered
				  nurses;
B. Licensed practical
				  nurses;
C. Certified medication
				  technicians; and
D. Certified
				  nursing assistants.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.20 - Community Personal Assistance Services › Section 10.09.20.03 - Participant Eligibility

Current through Register Vol. 51, No. 14, July 12, 2024
A. To
				  participate in the Program, the participant shall:
(1) Be determined by the Department to need
				  assistance with one or more activities of daily living;
(2) Be eligible for Medicaid under an
				  eligibility coverage group described in COMAR 10.09.24, except for Regulations
				  .03C, .03-1-.03-3, and .05-2; and
(3) Reside at home.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.20 - Community Personal Assistance Services › Section 10.09.20.04 - Conditions for Provider Participation - General Requirements

Current through Register Vol. 51, No. 14, July 12, 2024
A. To participate
				  as a provider of a service covered under this chapter, a provider:
(1) Shall meet all of the conditions for
				  participation as a Medicaid provider as set forth in COMAR 10.09.36, except as
				  otherwise specified in this chapter;
(2) Shall verify the qualifications of all
				  individuals who render services on the provider's behalf and provide a copy of
				  the current license or credentials on request;
(3) Shall implement the reporting and
				  follow-up of incidents and complaints in accordance with the Department's
				  established policy by:
(a) Reporting
				  incidents and complaints within 24 hours of knowledge of the event;
(b) Submitting a written report within 7
				  calendar days on a form designated by the Department; and
(c) Notifying the local department of social
				  services immediately if the provider has a reason to believe that the
				  participant has been subjected to abuse, neglect, self-neglect, or
				  exploitation, in accordance with COMAR 07.02.16;
(4) Shall agree to cooperate with required
				  inspections, reviews, and audits by authorized governmental agents;
(5) Shall agree to provide services, and to
				  subsequently bill the Department in accordance with the reimbursement
				  methodology specified in this chapter, for only those services covered under
				  this chapter which have been:
(a)
				  Preauthorized in the participant's plan of service;
(b) Provided in a manner consistent with the
				  participant's plan of service; and
(c) Identified in the provider agreement as
				  within the scope of the provider's Medicaid participation;
(6) Shall agree to maintain and have
				  available written documentation of services, including dates and hours of
				  services provided to participants, for a period of 6 years from the date of
				  service, in a manner approved by the Department;
(7) Shall agree not to suspend, terminate,
				  increase, or reduce services for an individual without authorization from the
				  Department and only after consultation and input from the participant or, when
				  applicable, the participant's representative;
(8) Shall submit a transition plan to the
				  case manager or supports planner and participant or, when applicable, the
				  participant's representative when suspending or terminating services;
(9) Shall verify Medicaid eligibility at the
				  beginning of each month that services will be rendered;
(10) May not be a Medicaid provider or
				  principal of a Medicaid provider that has overpayments that remain due to the
				  Department; and
(11) Shall be free
				  from conflicts of interest.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.20 - Community Personal Assistance Services › Section 10.09.20.06 - Specific Conditions for Provider Participation - Supports Planning

Current through Register Vol. 51, No. 14, July 12, 2024
To participate in the Program as a supports planning
					 provider under Regulation .10 of this chapter, a provider shall:
A. Agree to be monitored by the Department;
				  and
B. Be:
(1) Identified by the Department through a
				  solicitation process; or
(2) The
				  area agency on aging that is enrolled to provide case management services under
				  COMAR 10.09.54.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.20 - Community Personal Assistance Services › Section 10.09.20.07 - Specific Conditions for Provider Participation - Nurse Monitoring

Current through Register Vol. 51, No. 14, July 12, 2024
To participate in the Program as a nurse monitoring
					 provider under Regulation .11 of this chapter, a provider shall:
A. Be designated by the Department through a
				  process approved by the Centers for Medicare and Medicaid Services in
				  accordance with § 1915(b)(4) of the Social Security Act;
B. Employ or contract with registered nurses
				  who hold a current professional license to practice in Maryland;
C. Agree to accept all referrals from the
				  Department; and
D. Agree to be
				  monitored by the Department.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.20 - Community Personal Assistance Services › Section 10.09.20.08 - Covered Services - General

Current through Register Vol. 51, No. 14, July 12, 2024
The Program shall reimburse for the services specified in
					 Regulations .09-.11 of this chapter, when, pursuant to the requirements of this
					 chapter, these services have been preauthorized by the Department in the
					 participant's plan of service, billed in accordance with the payment procedures
					 in Regulation .14 of this chapter, and documented as necessary to prevent
					 institutionalization.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.20 - Community Personal Assistance Services › Section 10.09.20.09 - Covered Services - Personal Assistance

Current through Register Vol. 51, No. 14, July 12, 2024
A. The Program covers personal assistance
				  services that are approved in the plan of service and rendered to a participant
				  by a qualified provider in the participant's home or a community
				  setting.
B. The Program covers the
				  following services when provided by a personal assistance provider:
(1) Assistance with activities of daily
				  living;
(2) Delegated nursing
				  functions if this assistance is:
(a) Specified
				  in the participant's plan of service; and
(b) Rendered in accordance with the Maryland
				  Nurse Practice Act, COMAR 10.27.11, and other requirements of the Maryland
				  Board of Nursing;
(3)
				  Assistance with tasks requiring judgment to protect a participant from harm or
				  neglect;
(4) Assistance with or
				  completion of instrumental activities of daily living, provided in conjunction
				  with the services covered under §B(1)-(3) of this regulation;
				  and
(5) Assistance with the
				  participant's self-administration of medications, or administration of
				  medications or other remedies, when ordered by a physician.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.20 - Community Personal Assistance Services › Section 10.09.20.10 - Covered Services - Supports Planning

Current through Register Vol. 51, No. 14, July 12, 2024
A. Supports planning services shall:
(1) Address the individualized needs of the
				  participant;
(2) Be sensitive to
				  the educational background, culture, and general environment of the
				  participant;
(3) Support the
				  participant to self-direct services and exercise as much control as desired to
				  select, train, supervise, schedule, determine duties of, and dismiss the
				  personal assistance provider; and
(4) Ensure freedom of choice among any
				  willing provider for all services.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.20 - Community Personal Assistance Services › Section 10.09.20.11 - Covered Services - Nurse Monitoring

Current through Register Vol. 51, No. 14, July 12, 2024
A. The Program covers the following services
				  when provided by a nurse monitor:
(1) Being
				  available to give instruction and to answer questions;
(2) Complying with the Department's
				  reportable events policy; and
(3)
				  Maintaining an up-to-date client profile in an electronic database designated
				  by the Department.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.20 - Community Personal Assistance Services › Section 10.09.20.12 - Conditions for Reimbursement

Current through Register Vol. 51, No. 14, July 12, 2024
The Program shall reimburse for the services specified in
					 Regulations .09-.11 of this chapter, if provided in accordance with the
					 requirements of this chapter, and if the service:
A. Is recommended on the participant's plan
				  of service as necessary to assure the health and safety of an applicant or
				  participant in the community;
B.
				  Has been preauthorized by the Department in the participant's plan of
				  service;
C. Is provided to an
				  enrolled participant;
D. Is
				  medically necessary; and
E. Is
				  provided by a Medicaid provider who meets the conditions for participation
				  under this chapter.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.20 - Community Personal Assistance Services › Section 10.09.20.13 - Limitations

Current through Register Vol. 51, No. 14, July 12, 2024
A. The Department
				  shall establish a budget for personal assistance services that may be included
				  in the participant's plan of service, based on each participant's assessed
				  need.
B. The Program does not cover
				  the following services:
(1) Service primarily
				  for the purpose of housekeeping unrelated to the participant's activities of
				  daily living, such as:
(a) Cleaning of the
				  floor and furniture in areas not occupied by the participant;
(b) Laundry other than that incidental to the
				  care of the participant; and
(c)
				  Shopping for groceries or household items unless in the company of the
				  participant;
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.20 - Community Personal Assistance Services › Section 10.09.20.14 - Payment Procedures

Current through Register Vol. 51, No. 14, July 12, 2024
A. Request
				  for Payment - Personal Assistance. To receive payment as a personal assistance
				  provider agency under Regulation .09 of this chapter, a provider and its
				  workers shall use the telephonic time-keeping system approved by the Department
				  to:
(1) Document time; and
(2) Submit claims.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.20 - Community Personal Assistance Services › Section 10.09.20.15 - Recovery and Reimbursement

Current through Register Vol. 51, No. 14, July 12, 2024
Recovery and reimbursement procedures shall be as set forth
					 in COMAR 10.09.3607.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.20 - Community Personal Assistance Services › Section 10.09.20.16 - 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
					 shall be 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 10.09.20 - Community Personal Assistance Services › Section 10.09.20.17 - Appeal Procedures - Providers

Current through Register Vol. 51, No. 14, July 12, 2024
Appeal procedures shall be as set forth in:
A. COMAR
				  10.09.36.09; and
B. COMAR 10.01.03.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.20 - Community Personal Assistance Services › Section 10.09.20.18 - Appeal Procedures - Applicants and Participants

Current through Register Vol. 51, No. 14, July 12, 2024
Appeal procedures for applicants and participants are those
					 set forth in:
A. COMAR
				  10.09.24.13; and
B. COMAR 10.01.04.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.20 - Community Personal Assistance Services › Section 10.09.20.19 - Interpretive Regulation

Current through Register Vol. 51, No. 14, July 12, 2024
Interpretive regulatory requirements shall be as set forth
					 in COMAR 10.09.3610.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.21 - Pharmacists › Section 10.09.21.01 - Purpose and Scope

Current through Register Vol. 51, No. 14, July 12, 2024
This chapter establishes requirements for individual
					 pharmacists who enroll in the Program.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.21 - Pharmacists › Section 10.09.21.02 - 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) "Board" means the Maryland Board of
				  Pharmacy.
(2) "Contraceptives"
				  means contraceptive medications and self-administered contraceptive devices
				  approved by the U.S. Food and Drug Administration.
(3) "Injectable medication for treatment of a
				  sexually transmitted infection" means a medication that:
(a) Is administered by injection other than
				  intravenously;
(b) Treats a
				  sexually transmitted infection; and
(c) Is not a vaccine.
(4) "Maintenance injectable medication" has
				  the meaning stated in COMAR 10.34.41.02.
(5) "Maryland Medical Assistance Program"
				  means the program of comprehensive medical and other health-related care for
				  indigent and medically indigent individuals.
(6) "Participant" means an individual who is
				  certified as eligible for, and is receiving, Medical Assistance
				  benefits.
(7) "Pharmacist" means an
				  individual licensed in good standing to practice pharmacy in the state where
				  the service is provided.
(8)
				  "Pharmacy" means an establishment or institution licensed in good standing that
				  is required to obtain a permit in accordance with Health Occupations Article,
				  Title 12, Annotated Code of Maryland.
(9) "Primary care practitioner" means a
				  licensed health care practitioner who provides an individual's primary care
				  services and is the primary coordinator of health care services for the
				  individual.
(10) "Program" means
				  the Maryland Medical Assistance Program.
(11) "Reproductive health care practitioner"
				  means a licensed health care practitioner who is authorized to provide
				  reproductive health services.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.21 - Pharmacists › Section 10.09.21.03 - Provider Qualifications and Conditions for Participation

Current through Register Vol. 51, No. 14, July 12, 2024
A. The
				  pharmacist shall meet:
(1) Licensure
				  requirements set forth in COMAR
				  10.09.36.02; and
(2) Conditions for participation set forth in
				  COMAR 10.09.36.03.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.21 - Pharmacists › Section 10.09.21.04 - Covered Services

Current through Register Vol. 51, No. 14, July 12, 2024
The following services are covered under this
					 chapter:
A. Contraceptive services, as
				  follows:
(1) A patient assessment performed
				  at the pharmacist's practice location in order to determine:
(a) Whether to prescribe contraceptives;
				  and
(b) Which contraceptive options
				  to prescribe; and
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.21 - Pharmacists › Section 10.09.21.05 - Limitations

Current through Register Vol. 51, No. 14, July 12, 2024
A pharmacist may not prescribe contraceptives before
					 January 1, 2019.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.21 - Pharmacists › Section 10.09.21.06 - Payment Procedures

Current through Register Vol. 51, No. 14, July 12, 2024
A. The provider
				  shall adhere to general provider payment procedures established in COMAR
				  10.09.36.04.
B. The provider shall
				  be reimbursed in accordance with COMAR
				  10.09.02.07D.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.21 - Pharmacists › Section 10.09.21.07 - 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 10.09.21 - Pharmacists › Section 10.09.21.08 - Cause for Suspension of 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 10.09.22 - Free-Standing Dialysis Facility Services › Section 10.09.22.02 - 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
				  10.09.36.02B.
B. A physician providing services
				  in a free-standing dialysis facility shall be licensed and legally authorized
				  to practice medicine in the state in which the service is provided.
C. 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, and meets the standards established by COMAR 26.12.01 and COMAR
				  26.12.02, 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 either COMAR 10.10.01 or COMAR 10.10.06, 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 10.09.22 - Free-Standing Dialysis Facility Services › Section 10.09.22.03 - Conditions for Participation

Current through Register Vol. 51, No. 14, July 12, 2024
A.
				  General requirements for participation in the Program are that a provider shall
				  meet all conditions for participation as set forth in COMAR 10.09.36.03.
B. Specific requirements for
				  participation in the Program as a freestanding dialysis facility include all of
				  the following:
(1) Be approved by Medicare to
				  furnish dialysis service to kidney disease patients and maintain documentation
				  of certification by the Division of Survey and Certification of CMS.
(2) Verify the licenses and credentials of
				  all professionals employed by, or under contract with, the free-standing
				  dialysis facility to provide services.
(3) Meet the requirements of COMAR
				  10.30.01.05C, for
				  a dialysis facility, home dialysis unit, or self-care dialysis facility, or all
				  of the above.
(4) Have clearly
				  defined, written, patient care policies.
(5) Maintain adequate documentation of each
				  participant visit, as part of the plan of care, which, at a minimum, shall
				  include:
(a) Date of service;
(b) Participant's reason for visit;
(c) A brief description of service
				  provided;
(d) A legible signature
				  and printed or typed name of professional providing care, with the appropriate
				  title.
(6) Have written,
				  effective procedures for infection control which are known to all levels of
				  staff as specified in COMAR 10.06.01.
(7) Maintain adequate administrative and
				  medical records which are defined as having documentation sufficient in
				  quantity, scope, and detail to confirm that the free-standing dialysis facility
				  services are provided in accordance with this regulation.
(8) Not employ or contract with a person,
				  partnership, or corporation which the Program has disqualified from providing
				  or supplying services to Medical Assistance participants.
(9) Be approved by the Medical Assistance
				  Program 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 10.09.22 - Free-Standing Dialysis Facility Services › Section 10.09.22.04 - Covered Services

Current through Register Vol. 51, No. 14, July 12, 2024
A. The
				  Program covers medically necessary services described in §B of this
				  regulation, rendered to participants in a freestanding dialysis facility, when
				  these services are:
(1) Performed by a
				  physician or by one of the following:
(a) A
				  physician assistant;
(b) A nurse
				  practitioner;
(c) An RN;
(d) An LPN;
(e) A social worker; or
(f) A dietitian-nutritionist;
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.22 - Free-Standing Dialysis Facility Services › Section 10.09.22.05 - 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. Drugs and supplies which are acquired at
				  no cost;
E. Injections and visits
				  solely for the administration of injections, unless both the participant's
				  inability to take oral medications and medical necessity for the injections are
				  documented in the participant's medical record;
F. Travel expenses;
G. Specimen collection, except by
				  venipuncture and capillary or arterial puncture, as a separate
				  service;
H. Laboratory or X-ray
				  services performed by another facility;
I. Completion of forms and reports;
J. Broken or missed appointments;
				  and
K. Professional services
				  rendered by mail or telephone.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.22 - Free-Standing Dialysis Facility Services › Section 10.09.22.06 - Payment Procedures

Current through Register Vol. 51, No. 14, July 12, 2024
A.
				  Reimbursement Principles.
(1) Reimbursement
				  by the Program is for services described in Regulation .04B of this chapter
				  provided at a free-standing dialysis facility which has been approved for
				  Medicare by the Division of Survey and Certification of CMS.
(2) Reimbursement shall be consistent with
				  the rates established by the Program for those services which are approved by
				  Medicare.
(3) Physician services
				  are not reimbursed under this regulation. Reimbursement for physician services
				  are in accordance with COMAR 10.09.02.07.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.22 - Free-Standing Dialysis Facility Services › Section 10.09.22.07 - Recovery and Reimbursement

Current through Register Vol. 51, No. 14, July 12, 2024
A. If
				  the participant has insurance or if any other person is obligated either
				  legally or contractually to pay for, or to reimburse for, any service covered
				  by this chapter, the provider shall seek payment from that source. If payment
				  is made by both the Program and by the insurace or other source, the provider
				  shall refund the Department, within 60 days of receipt, the amount paid by the
				  Program, or by 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 10.09.22 - Free-Standing Dialysis Facility Services › Section 10.09.22.08 - 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, any agent or employee of a provider, or
				  any person with an ownership interest in the provider, has failed to comply
				  with all applicable federal or State laws or regulations, the Department may
				  initiate one or more of the following actions against the responsible party:
(1) Recovery of overpayments as specified in
				  Regulation .07 of this chapter;
(2)
				  Withholding part or all of the payment by the Program;
(3) Suspension from the Program;
(4) Permanent removal from the
				  Program;
(5) 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 10.09.22 - Free-Standing Dialysis Facility Services › Section 10.09.22.09 - 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
					 10.09.36.09.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.22 - Free-Standing Dialysis Facility Services › Section 10.09.22.10 - 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 which
					 are provided 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 10.09.23 - Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) Services › Section 10.09.23.01-1 - Incorporation by Reference

Current through Register Vol. 51, No. 14, July 12, 2024
The Audiology, Physical Therapy, and Early Periodic,
					 Screening, Diagnosis, and Treatment (EPSDT) Provider Manual (Maryland Medical
					 Assistance Program, Effective January 1, 2022) is incorporated by
					 reference.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.23 - Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) Services › Section 10.09.23.02 - Provider Qualifications

Current through Register Vol. 51, No. 14, July 12, 2024
A.
				  EPSDT screening and treatment providers shall meet all of the licensure and
				  certification requirements specified in this or any other applicable chapter of
				  COMAR, statute, or policy for the service that the provider renders.
B. In order for the Program to consider a
				  health care practitioner for certification by the Healthy Kids Program as an
				  EPSDT screening provider, the practitioner shall have a demonstrated history of
				  providing services to children younger than 21 years old and shall also:
(1) Be a doctor of medicine or osteopathy who
				  is:
(a) Licensed in good standing and legally
				  authorized to practice medicine and surgery in the jurisdiction in which the
				  service is provided; and
(b)
				  Board-certified in one of the following:
(i)
				  Pediatrics;
(ii) Family practice;
				  or
(iii) Internal medicine;
				  or
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.23 - Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) Services › Section 10.09.23.03 - Conditions for Participation

Current through Register Vol. 51, No. 14, July 12, 2024
A. In order to
				  receive payments as a Medicaid provider, providers shall meet the following
				  general requirements:
(1) All conditions for
				  participation set forth in COMAR 10.09.36;
(2) If delivering services via telehealth,
				  comply with COMAR 10.09.49 and any subregulatory guidance issued by the
				  Department;
(3) The licensure and
				  provider qualification requirements in Regulation .02 of this chapter;
				  and
(4) Verify the licenses and
				  credentials of all professionals employed or contracted by the provider, and
				  keep on file documentation of how that verification was
				  completed.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.23 - Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) Services › Section 10.09.23.04 - Covered Services

Current through Register Vol. 51, No. 14, July 12, 2024
A. The Program
				  covers all medically necessary care, including all health care services to
				  identify and correct physical and mental problems that are covered in the State
				  Plan, or that are allowable under the federal Medicaid program as described in
				  §1905(a) of the Social Security Act.
B. For a foster care child, the Program also
				  covers upon entry to or moving within the foster care system:
(1) A brief initial check-up; and
(2) A comprehensive EPSDT screen as described
				  in §C of this regulation.