Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 1 › Subtitle 02 - DIVISION OF REIMBURSEMENTS › Chapter 10.02.01 - Charges for Services Provided Through the Department of Health and Mental Hygiene › Section 10.02.01.03 - 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) "Charge" means the dollar amount set or
				  approved by the Secretary for each clinic visit, day of care, hour, procedure,
				  or other unit of service, as specified in the Schedule of Charges, which is the
				  single rate to be charged all recipients of service, estates, third-party
				  payers and insurers, or chargeable persons.
(2) "Chargeable person" means:
(a) Any responsible relative of a recipient
				  of services;
(b) Except for a
				  recipient of services, any other person who is legally responsible for the cost
				  of care of the individual; and
(c)
				  Any person who maintains a policy of health insurance under which a recipient
				  of services is insured
(3)
				  "CPT" means a Current Procedural Terminology listing descriptive terms and
				  identifying codes for reporting clinical services and procedures.
(4) "Daily per capita inpatient cost of care"
				  means the cost of providing a day of care at a State-operated inpatient
				  facility.
(5) "Department" means
				  the Department of Health and Mental Hygiene.
(6) "Division" means the Cost Accounting and
				  Reimbursement Division of the Department.
(7) Federal Indirect Cost.
(a) "Federal indirect cost" means the cost
				  the federal government recognizes as the costs of operating an inpatient
				  facility that are not directly attributable to the operation of the inpatient
				  facility.
(b) "Federal indirect
				  cost" includes costs which benefit the Department as a whole and the inpatient
				  facility indirectly, but cannot be readily identified with the inpatient
				  facility without disproportionate effort.
(8) "Fee" means the charge or that part of the charge
				  after an ability-to-pay determination or the elimination of disallowed costs by
				  any third-party payer or insurer.
(9) "Health service" means any service for which a charge is
				  established that is provided to any person, client, or resident in or by a unit
				  of the Department, political subdivision, or grantee which is deemed
				  appropriate by that unit to the care and treatment of an individual under its
				  care or enrolled in its program.
(10) "Local health department" means a
				  governmental agency that:
(a) Is funded
				  wholly or partly by the Department;
(b) Assumes legal and financial
				  responsibility and accountability both for funds awarded by the Department and
				  for the provision of health services; and
(c) Operates under the general direction of a
				  health officer who is duly appointed by and reports to the Secretary pursuant
				  to Health-General Article, Title 3, Subtitle 3, Annotated Code of
				  Maryland.
(11) "Medical
				  Assistance " means the Maryland Medical Assistance Program, which is
				  administered by the State and pays the medical bills of certain needy and
				  low-income individuals pursuant to Health-General Article, Title 15, Subtitle
				  1, Annotated Code of Maryland, and 42 U.S.C. Chapter 7, Subchapter
				  XIX.
(12) "Non-inpatient related
				  costs" means costs at a State-operated facility which do not relate to the
				  delivery of inpatient care.
(13)
				  "Out-of-network services" means health services that are provided to a
				  recipient of services which are not subject to payment at a negotiated rate
				  under an agreement between the provider and a public or private third-party
				  payer or insurer for the recipient of services.
(14) "Private provider" means:
(a) All private or non-local health
				  department alcohol and drug abuse service providers funded by the Behavioral
				  Health Administration;
(b) Adult
				  day care service providers funded by the Office of Health Services;
				  and
(c) Family planning service
				  providers funded by the Prevention and Health Promotion
				  Administration.
(15)
				  "Provider" means a facility operated by:
(a)
				  The Department;
(b) A local health
				  department; or
(c) A private
				  provider
(16) Recipient
				  of Services.
(a) "Recipient of services" means
				  an individual who receives care, maintenance, treatment, or support from a
				  facility, clinic, local health department, program, or other entity that is
				  operated or funded wholly or partly by the Department.
(b) "Recipient of services" includes, but is
				  not limited to an individual:
(i) In a public
				  facility under Health-General Article, Title 10, Annotated Code of
				  Maryland;
(ii) In a facility or
				  Veterans' Administration hospital for comprehensive evaluation under
				  Health-General Article, Title 7, Annotated Code of Maryland;
(iii) In a residential public facility or a
				  facility from which this State obtains residential care under Health-General
				  Article, Title 7, Annotated Code of Maryland; and
(iv) To whom juvenile screening or treatment
				  services are provided under Human Services Article, §
													9-227(b)(1)(ii),
				  Annotated Code of Maryland.
(17) "Responsible relative" means one or more of the
				  following who are legally responsible for the cost of care of a recipient of
				  services:
(a) The spouse of the recipient of
				  services;
(b) A parent of the
				  recipient of services who is a minor; and
(c) An adult child of the recipient of
				  services.
(18) "Schedule
				  of charges" means a list of charges for health services as determined pursuant
				  to instructions provided by the Division and this chapter, and set or approved
				  by the Secretary.
(19) "Secretary"
				  means the Secretary of Health and Mental Hygiene.
(20) "Shared costs" means costs arising out
				  of shared functions between two State-operated inpatient facilities.
(21) Statewide and Departmental Overhead.
(a) "Statewide and departmental overhead"
				  means those costs incurred by the State and allocated to the facility which
				  benefit the State-operated inpatient facility's operation as a whole, but are
				  not related to the delivery of direct patient care.
(b) "Statewide and departmental overhead"
				  includes costs that are usually incurred for a common purpose benefiting the
				  State-operated inpatient facility which are not readily identified with the
				  State-operated inpatient facility without disproportionate effort, such as
				  Statewide accounting, purchasing, and personnel functions.
(22) "Third-party payer disallowance" means
				  the difference between the charge and the payment amount authorized by an
				  agreement between a provider and a public or private third-party payer or
				  insurer