reglab/statecodes huggingface dataset:
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.29 - Residential Treatment Center Services › Section 10.09.29.13 - Interim Rates

Current through Register Vol. 51, No. 14, July 12, 2024
A. A provider
				  shall have its interim rate updated annually.
B. A provider's interim rate shall be
				  adjusted at the beginning of each fiscal year, by applying the Centers for
				  Medicare and Medicaid Services' published federal fiscal year market basket
				  index relating to hospitals excluded from the prospective payment system,
				  subject to the limitations in Regulation .07A of this chapter, to the
				  provider's interim rate in effect on the last day of the preceding fiscal
				  year.
C. The rate established in
				  §B of this regulation is in effect until such time as a new rate can be
				  calculated as specified in §§D-F of this regulation.
D. The provider shall submit annually, with
				  the cost report described in Regulation .12 of this chapter, schedules
				  detailing projected increases/decreases from the year just ended to the current
				  year.
E. The provider shall submit
				  a calculation reflecting the rate being requested for the current
				  year.
F. The Department or its
				  designee shall use the submitted cost report, schedules, calculations, and
				  other information as appropriate to calculate an updated interim rate for the
				  current year.
G. The rate
				  established in accordance with §F of this regulation shall be implemented
				  for the remainder of the fiscal year with no retroactive supplemental billing
				  or payment for differences in rates.
H. Providers may request an interim rate
				  revision:
(1) If the revised interim rate
				  exceeds the current rate by 7 percent; and
(2) Not more than two times during a fiscal
				  year.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.29 - Residential Treatment Center Services › Section 10.09.29.14 - Field Verification

Current through Register Vol. 51, No. 14, July 12, 2024
A. The
				  Department or its designee shall:
(1) Conduct
				  a field verification, at least every 3 years, of the reported costs of each
				  facility participating in the Program, if the amount of the facility's
				  reimbursement would justify the expense of a field verification;
(2) Desk review the reported costs of the
				  facility in those years when a field verification is not conducted;
(3) Notify each provider participating in the
				  Program of the results of the field verification or desk review; and
(4) Calculate final settlements by comparing
				  the verified allowable reimbursement to the interim reimbursement.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.29 - Residential Treatment Center Services › Section 10.09.29.15 - Change of Ownership

Current through Register Vol. 51, No. 14, July 12, 2024
A. The
				  current owner of a residential treatment center shall:
(1) Notify the Program of the contemplated
				  sale of a facility or controlling interest in it not less than 30 days before
				  the date of the change of ownership; and
(2) Before the date of the change of
				  ownership, post an indemnity bond or standby letter of credit, or provide some
				  assurance satisfactory to the Program that the purchaser will assume and be
				  responsible for all financial obligations of the current owner.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.30 - Statewide Evaluation and Planning Services › Section 10.09.30.01 - Purpose

Current through Register Vol. 51, No. 14, July 12, 2024
The purpose of this chapter is to codify policy regarding
					 comprehensive evaluations performed for the purpose of determining eligibility
					 for services or informing individuals of available services or as required for
					 Geriatric Evaluation Services (GES) or Preadmission Screening and Resident
					 Review (PASRR).
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.30 - Statewide Evaluation and Planning Services › Section 10.09.30.02 - Definitions

Current through Register Vol. 51, No. 14, July 12, 2024
A. The
				  following terms have the meanings indicated.
B. Terms Defined.
(1) "Comprehensive evaluation" means the assessment
				  performed by a nurse or social worker, or both, using the tools designated by
				  the Department, of a participant's medical, social, and functional status by:
(a) Direct observation of the
				  participant;
(b) Contact, as
				  appropriate, with the participant's representative; and
(c) Financial eligibility
				  screening.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.30 - Statewide Evaluation and Planning Services › Section 10.09.30.03 - Licensing Requirements

Current through Register Vol. 51, No. 14, July 12, 2024
The following health professionals providing services under
					 this regulation shall be licensed to practice in the jurisdiction in which
					 services are rendered:
(1)
				  Nurses;
(2) Nurse
				  practitioners;
(3)
				  Psychiatrists;
(4) Psychologists;
				  and
(5) Social workers.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.30 - Statewide Evaluation and Planning Services › Section 10.09.30.04 - Conditions for Participation

Current through Register Vol. 51, No. 14, July 12, 2024
Specific requirements for participation in the Program are
					 that providers shall:
A. Ensure that
				  all individuals performing services under Regulation .05 of this chapter meet
				  the licensure requirements as provided in Regulation .03 of this
				  chapter;
B. Have existing policies
				  and procedures concerning the completion of comprehensive evaluations, and
				  expedition of those evaluations when necessary, that the provider has agreed to
				  perform;
C. Develop, as
				  appropriate, agreements in order to facilitate access to services and
				  coordinate with local public agencies and other providers;
D. If approved as a provider of comprehensive
				  evaluations, inform participants of the results of the comprehensive evaluation
				  and of available services; and
E.
				  Ensure completion, at least every other year, of training on the tools
				  designated by the Department for the purposes of the comprehensive evaluation,
				  by all nurses and social workers providing services under this
				  chapter.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.30 - Statewide Evaluation and Planning Services › Section 10.09.30.05 - Covered Services

Current through Register Vol. 51, No. 14, July 12, 2024
A. The Program
				  reimburses for completed comprehensive evaluations, which include assessment by
				  a nurse, social worker, or both.
B.
				  The comprehensive evaluation or designated form is to be completed within the
				  following time frames:
(1) 3 business days
				  for all Geriatric Evaluation Services (GES) and Preadmission Screening and
				  Resident Review (PASRR) for individuals transferring from a hospital to a
				  nursing facility;
(2) 5 business
				  days for all other PASRR; and
(3)
				  15 calendar days for all other purposes.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.30 - Statewide Evaluation and Planning Services › Section 10.09.30.06 - Limitations

Current through Register Vol. 51, No. 14, July 12, 2024
A. The
				  comprehensive evaluation is advisory in nature and is designed to assist
				  individuals in identifying and using appropriate long term care
				  services.
B. A restriction may not
				  be placed on the qualified recipient's option to receive the comprehensive
				  evaluation.
C. The comprehensive
				  evaluation does not restrict or otherwise affect:
(1) Eligibility for Title XIX benefits or
				  other available benefits or programs;
(2) The freedom of a recipient to select from
				  all available services, including nursing home care, for which the individual
				  is found to be eligible; or
(3) The
				  participant's free choice of qualified providers.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.30 - Statewide Evaluation and Planning Services › Section 10.09.30.07 - Payment Procedures

Current through Register Vol. 51, No. 14, July 12, 2024
A. Request for
				  Payment.
(1) Requests for payment of services
				  rendered shall be submitted according to procedures established by the
				  Department. Payment requests which are not properly prepared or submitted may
				  not be processed, but shall be returned unpaid to the provider.
(2) Requests for payment shall be submitted
				  on the form specified by the Department.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.30 - Statewide Evaluation and Planning Services › Section 10.09.30.08 - 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 10.09.30 - Statewide Evaluation and Planning Services › Section 10.09.30.09 - 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 10.09.30 - Statewide Evaluation and Planning Services › Section 10.09.30.10 - 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
					 10.09.36.09.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.30 - Statewide Evaluation and Planning Services › Section 10.09.30.11 - Interpretive Regulation

Current through Register Vol. 51, No. 14, July 12, 2024
Interpretive regulatory requirements are as set forth in
					 COMAR 10.09.36.10.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.31 - Emergency Service Transporters › Section 10.09.31.01 - Definitions

Current through Register Vol. 51, No. 14, July 12, 2024
A. In this
				  chapter, the following terms have the meanings indicated.
B. Terms Defined.
(1) "Department" has the meaning stated in
				  COMAR 10.09.36.
(2) "Emergency
				  medical services (EMS) provider" has the meaning stated in Education Article,
				  §
											13-516, Annotated Code of
				  Maryland.
(3) "Emergency service
				  transporter" means a public entity or volunteer fire, rescue, or emergency
				  medical service that provides emergency medical transportation
				  services.
(4) "EMS Board" means the
				  State Emergency Medical Services Board established by Education Article, §
											13-503, Annotated Code of
				  Maryland.
(5) "Facility" means a
				  hospital or nursing facility including an intermediate care facility, skilled
				  nursing facility, comprehensive care facility, or extended care
				  facility.
(6) "Free-standing urgent
				  care center" means a location, distinct from a hospital emergency room, a
				  physician's office, or a free-standing clinic, whose purpose is to diagnose and
				  treat illness or injury for unscheduled, ambulatory patients seeking immediate
				  medical attention.
(7) "Mobile
				  integrated health" means a community-based preventive, primary, chronic,
				  pre-admission, or post-admission health care service provided by an emergency
				  medical services provider to a participant.
(8) "Participant" has the meaning stated in
				  COMAR 10.09.36.
(9) "Program" has
				  the meaning stated in COMAR 10.09.36.
(10) "Provider" has the meaning stated in
				  COMAR 10.09.36.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.31 - Emergency Service Transporters › Section 10.09.31.02 - Licensing Requirements

Current through Register Vol. 51, No. 14, July 12, 2024
A provider shall meet all licensing requirements:
A. Set forth in COMAR 10.09.36; and
B. In the jurisdiction where the service is
				  provided.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.31 - Emergency Service Transporters › Section 10.09.31.03 - Conditions for Participation

Current through Register Vol. 51, No. 14, July 12, 2024
To participate in the Program, the provider shall:
A. Comply with the conditions for
				  participation set forth in COMAR 10.09.36;
B. Certify that all third-party payers are
				  routinely billed for services;
C.
				  Retain all documentation, including but not limited to run sheets, for 6 years;
				  and
D. When delivering mobile
				  integrated health, render services in accordance with the MIH services medical
				  protocols adopted by the EMS Board.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.31 - Emergency Service Transporters › Section 10.09.31.04 - Covered Services

Current through Register Vol. 51, No. 14, July 12, 2024
A. Emergency
				  Medical Transportation Services. The Program covers the following services when
				  provided by an enrolled emergency service transporter to an eligible
				  participant in response to a 911 call:
(1)
				  Medical services delivered at the scene of a 911 response consistent with EMS
				  Board protocols, with or without subsequent transportation;
(2) Medical services provided while
				  transporting the participant to a facility, free-standing urgent care center,
				  or other Department-approved destination; and
(3) Transportation to a facility,
				  free-standing urgent care center, or other Department-approved
				  destination.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.31 - Emergency Service Transporters › Section 10.09.31.05 - Limitations

Current through Register Vol. 51, No. 14, July 12, 2024
Under this chapter, the Program does not cover:
A. Services not rendered in response to a 911
				  call unless delivered as part of a mobile integrated health visit;
B. Services performed or billed by an
				  emergency services transporter that is not enrolled in the Program;
C. Services rendered by an emergency services
				  transporter in response to a 911 call when the participant refuses medical
				  services and transport of the participant does not occur;
D. Services rendered to anyone other than an
				  eligible participant;
E. Services
				  for which proper documentation, including but not limited to run sheets, cannot
				  be provided on request of the Department or its designee;
F. Services not indicated by the medical
				  protocols adopted by the EMS Board;
G. Mobile integrated health services
				  delivered to participants younger than 18 years old; and
H. Services delivered in any setting other
				  than the eligible participant's home or any community-based site permitted
				  under the medical protocols adopted by the EMS Board.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.31 - Emergency Service Transporters › Section 10.09.31.06 - Payment Procedures

Current through Register Vol. 51, No. 14, July 12, 2024
A. Payment
				  procedures for this chapter are set forth in COMAR 10.09.36.
B. Emergency Medical Transportation Services
				  Reimbursement.
(1) Payment for covered
				  services provided in response to each 911 call incident is the lesser of:
(a) The amount billed; or
(b) Effective July 1, 2022, $150.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.31 - Emergency Service Transporters › Section 10.09.31.07 - Recovery and Reimbursement

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 10.09.31 - Emergency Service Transporters › Section 10.09.31.08 - 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
					 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 10.09.31 - Emergency Service Transporters › Section 10.09.31.09 - Appeal Procedures

Current through Register Vol. 51, No. 14, July 12, 2024
Appeal procedures 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 10.09.32 - Targeted Case Management for HIV-Infected Individuals › Section 10.09.32.02 - Licensing Requirements

Current through Register Vol. 51, No. 14, July 12, 2024
A.
				  Registered nurses participating in targeted case management for HIV-infected
				  individuals shall be licensed pursuant to Health Occupations Article, Title 7,
				  Annotated Code of Maryland, or pursuant to comparable licensing requirements of
				  the jurisdiction in which services are rendered.
B. Social workers participating in targeted
				  case management for HIV-infected individuals shall be licensed pursuant to
				  Health Occupations Article, Title 18, Annotated Code of Maryland.
C. Physicians participating in targeted case
				  management for HIV-infected individuals shall be licensed to practice medicine
				  in the jurisdiction in which services are rendered.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.32 - Targeted Case Management for HIV-Infected Individuals › Section 10.09.32.03 - Conditions for Participation

Current through Register Vol. 51, No. 14, July 12, 2024
A.
				  General requirements for participation in the Medical Assistance Program are
				  that providers shall meet all the conditions for participation as set forth in
				  COMAR 10.09.36.03A.
B. Specific requirements for
				  participation in the Program as a provider of services covered under this
				  chapter are that the provider shall maintain a record on each participant which
				  meets the Program's requirements and which includes:
(1) Verification of the participant's
				  HIV-infected status;
(2)
				  Verification of the participant's eligibility for services;
(3) A signed consent form by the participant
				  to participate in HIV ongoing case management;
(4) The completed bio-psychosocial
				  assessment;
(5) The completed plan
				  of care signed by all members of the multidisciplinary team;
(6) Documentation for each contact made by
				  the case manager including:
(a) Date and
				  subject of contact;
(b) Person
				  contacted;
(c) Person making the
				  contact;
(d) Nature, extent, and
				  unit or units of service provided; and
(e) Place of service; and
(7) A signed case closure form
				  when HIV ongoing case management services are ended.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.32 - Targeted Case Management for HIV-Infected Individuals › Section 10.09.32.04 - Covered Services

Current through Register Vol. 51, No. 14, July 12, 2024
The Program covers the following services when they have
					 been documented as medically necessary:
A. HIV Diagnostic Evaluation Services.
(1) These services shall include, as a unit
				  of service, performance of a bio-psychosocial assessment and development or
				  revision of a recommended plan of care, as well as all other necessary covered
				  services described in §A(2) of this regulation.
(2) A bio-psychosocial assessment shall be
				  completed within 6 weeks of the participant's referral for case management
				  services. The assessment shall be performed by the HIV diagnostic evaluation
				  services provider representative on the multidisciplinary team and include:
(a) A review of relevant medical and other
				  records, with the participant's or legal representative's written
				  consent;
(b) A consult with the
				  participant's attending physician and current providers of medical, social, or
				  other support services, as appropriate;
(c) A face-to-face assessment of the
				  participant, preferably at the participant's residence, to determine:
(i) Medical, psychiatric, and substance abuse
				  history, including current medications;
(ii) Nutritional status;
(iii) Emotional and behavioral
				  status;
(iv) Health care
				  coverage;
(v) Living
				  situation;
(vi) Personal support
				  systems;
(vii) Employment and
				  income status;
(viii) Health
				  education;
(ix) Social support;
				  and
(x) Any additional service
				  needs;
(d) A consult, as
				  appropriate, with the participant or the participant's legally authorized
				  representative or representatives; and
(e) All areas listed on the Department's
				  approved sample bio-psychosocial assessment form.
(3) Documentation of the results of the
				  assessment shall be kept in the participant's record.
(4) The multidisciplinary team will develop a
				  written, individualized plan of care which reflects both the needed and
				  available services being recommended for delivery.
(5) The plan of care shall:
(a) Be participant-centered and
				  goal-oriented;
(b) Be developed and
				  written in collaboration with the participant and other members of the
				  multidisciplinary team;
(c)
				  Incorporate findings from the bio-psychosocial assessment;
(d) Incorporate findings and recommendations
				  from the multidisciplinary team;
(e) Establish a plan for after-hours crises,
				  including medical and social crises, and other emergency situations;
(f) Document the proposed frequency of
				  contact with a minimum of 1 face-to-face meeting every 6 months; and
(g) Address all areas listed on the
				  Department's approved sample plan of care form.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.32 - Targeted Case Management for HIV-Infected Individuals › Section 10.09.32.05 - Limitations

Current through Register Vol. 51, No. 14, July 12, 2024
A. HIV-targeted
				  case management shall be advisory in nature.
B. A restriction may not be placed on
				  qualified recipients' option to receive HIV case management services.
C. HIV-targeted case management does not
				  restrict or otherwise affect:
(1) Eligibility
				  for Title XIX benefits or other available benefits or programs;
(2) The freedom of a recipient to select from
				  all available services for which the individual is found to be eligible;
				  or
(3) The participant's free
				  choice of qualified providers.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.32 - Targeted Case Management for HIV-Infected Individuals › Section 10.09.32.06 - Payment Procedures

Current through Register Vol. 51, No. 14, July 12, 2024
A. Request
				  for Payment.
(1) Requests for payment of
				  HIV-targeted case management services rendered shall be submitted by an
				  approved provider according to procedures as set forth in COMAR
				  10.09.36.04A.
(2) Requests for payment shall be
				  submitted on the invoice form specified by the Department. The completed form
				  shall indicate the:
(a) Date or dates of
				  service;
(b) Participant's name and
				  Medical Assistance number;
(c)
				  Provider's name, identification number, and location; and
(d) Nature, procedure code or codes, and unit
				  or units of covered service provided.
(3) Providers shall bill the Program for the
				  appropriate fee specified in §C of this regulation.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.32 - Targeted Case Management for HIV-Infected Individuals › Section 10.09.32.07 - Recovery and Reimbursement

Current through Register Vol. 51, No. 14, July 12, 2024
Recovery and reimbursement shall be as set forth in COMAR
					 10.09.36.07A.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.32 - Targeted Case Management for HIV-Infected Individuals › Section 10.09.32.08 - 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
					 10.09.36.08A.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.32 - Targeted Case Management for HIV-Infected Individuals › Section 10.09.32.09 - Appeal Procedures

Current through Register Vol. 51, No. 14, July 12, 2024
Appeal procedures shall be as set forth in COMAR
					 10.09.36.09A.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.32 - Targeted Case Management for HIV-Infected Individuals › Section 10.09.32.10 - Interpretive Regulation

Current through Register Vol. 51, No. 14, July 12, 2024
State regulations shall be interpreted as set forth in
					 COMAR 10.09.36.10A.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.33 - Health Homes › Section 10.09.33.02 - Licensing Requirements

Current through Register Vol. 51, No. 14, July 12, 2024
A. A PRP
				  serving adults and participating as a health home shall be approved pursuant to
				  COMAR 10.63.03.09.
B. A PRP
				  serving minors and participating as a health home shall be approved pursuant to
				  COMAR 10.63.03.10.
C. An MTS
				  program participating as a health home shall be approved pursuant to COMAR
				  10.63.03.04.
D. An OTP
				  participating as a health home shall be approved to provide opioid maintenance
				  therapy pursuant to COMAR 10.63.03.19.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.33 - Health Homes › Section 10.09.33.03 - Participant Eligibility

Current through Register Vol. 51, No. 14, July 12, 2024
A. An
				  individual is eligible for health home services if the individual:
(1) Is a recipient of Maryland Medical
				  Assistance; and
(2) Meets the
				  following criteria:
(a) Receives outpatient
				  mental health rehabilitation or treatment services with a PRP or MTS program
				  for a serious and persistent mental illness or serious emotional disturbance,
				  and is not currently receiving:
(i) 1915(i)
				  waiver services; or
(ii) Mental
				  health case management; or
(b) Receives treatment with an OTP for an
				  opioid substance use disorder and is at risk for additional chronic conditions
				  based on:
(i) Current alcohol use, tobacco
				  use, or other non-opioid use; or
(ii) A history of alcohol, tobacco, or other
				  non-opioid substance dependence.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.33 - Health Homes › Section 10.09.33.04 - Conditions for Health Home Provider Participation

Current through Register Vol. 51, No. 14, July 12, 2024
To be eligible as a health home, a provider shall:
A. Meet the conditions for provider
				  participation in the Medical Assistance Program, as set forth in COMAR
				  10.09.36.03;
B. Meet the approval requirements set forth
				  in Regulation .02 of this chapter;
C. Be accredited by, or demonstrate evidence
				  of having started the accreditation process from, an approved accrediting body
				  as a health home;
D. For PRP and
				  MTS health homes serving minors, demonstrate a minimum of 3 years of experience
				  serving minors, which may be achieved as an independent practice or as a member
				  of a broader agency, with exceptions designated by the Department;
E. At the time of enrollment as a health
				  home, be registered or be able to provide documentation of starting the process
				  of registration with CRISP in order to receive hospital encounter
				  alerts;
F. At the time of
				  enrollment as a health home, be registered or be able to provide documentation
				  of starting the process of registration with one of the following organizations
				  in order to receive access to real-time pharmacy data for participants:
(1) CRISP; or
(2) The State's ASO;
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.33 - Health Homes › Section 10.09.33.05 - Health Home Provider Staff

Current through Register Vol. 51, No. 14, July 12, 2024
A.
				  Health Home Staffing Requirements.
(1) Health
				  Home Care Manager.
(a) At minimum, the health
				  home shall maintain health home care manager staff at a ratio of .5 FTE per 125
				  participants.
(b) Up to a staffing
				  level of 1 FTE, the health home care manager shall be a:
(i) Nurse practitioner meeting the conditions
				  of COMAR 10.27.07; or
(ii)
				  Registered nurse licensed pursuant to COMAR 10.27.01 and meeting the conditions
				  of COMAR 10.27.09.
(c) A
				  health home employing more than 1 FTE health home care manager may employ a
				  physician's assistant licensed pursuant to COMAR
				  10.32.03.04 to fulfill the
				  additional care manager roles.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.33 - Health Homes › Section 10.09.33.06 - Covered Services

Current through Register Vol. 51, No. 14, July 12, 2024
A. The
				  Department covers the services in §§B-G of this regulation when these
				  services have been documented, pursuant to the requirements in this chapter, as
				  necessary.
B. Comprehensive Care
				  Management. The health home shall collaborate to provide comprehensive care
				  management services including:
(1) An initial
				  assessment performed prior to the patient's enrollment, which includes:
(a) A comprehensive assessment of the
				  participant's physical health, mental health, chemical dependency, and social
				  service needs, signed off on by a physician or nurse practitioner, if no such
				  assessment has been performed in the preceding 6-month period; and
(b) Requesting records from the participant's
				  primary care physician and other providers;
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.33 - Health Homes › Section 10.09.33.07 - Health Home Participant Flow

Current through Register Vol. 51, No. 14, July 12, 2024
A. Enrollment.
(1) The health home shall enroll an
				  individual only after the individual has been enrolled in the health home
				  provider's applicable PRP, MTS, or OTP services.
(2) During enrollment, an OTP established as
				  a health home shall identify eligible individuals under the OTP's care and
				  report the diagnoses related to qualifying risk factors set forth in Regulation
				  .03A(2)(b) of this chapter in eMedicaid.
(3) The health home shall provide the
				  individual with a brief description of health home services, including:
(a) Explaining the data-sharing elements of
				  the program; and
(b) Describing how
				  the individual may opt out if desired.
(4) Following the provision of information in
				  accordance with §A(3) of this regulation, the health home shall obtain the
				  individual's consent to participate in the health home.
(5) Following consent to participate in
				  accordance with §A(4) of this regulation, the health home shall complete
				  the individual's online eMedicaid intake report thereby enrolling the
				  individual into the health home.
(6) The health home shall:
(a) Notify a participant's other treatment
				  providers about health home services; and
(b) Encourage other providers' participation
				  in care coordination efforts.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.33 - Health Homes › Section 10.09.33.08 - Limitations

Current through Register Vol. 51, No. 14, July 12, 2024
A. An eligible
				  individual may not receive services from a health home provider that is not the
				  individual's PRP, MTS, or OTP provider.
B. Health home services do not restrict or
				  otherwise affect:
(1) Eligibility for Title
				  XIX benefits or other available benefits or programs, except as limited by
				  §E of this regulation;
(2) The
				  freedom of a participant to select from all available services for which the
				  participant is found to be eligible; or
(3) A participant's free choice among
				  providers in the Medical Assistance Program.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.33 - Health Homes › Section 10.09.33.09 - Payment Procedures

Current through Register Vol. 51, No. 14, July 12, 2024
A. The
				  Department shall reimburse the health home for covered services according to
				  the requirements in this chapter and the rate established in §C of this
				  regulation.
B. Request for Payment.
(1) The health home provider is authorized to
				  bill for the intake and ongoing monthly rate for a participant when:
(a) The participant is receiving PRP, MTS, or
				  OTP services; and
(b) The intake
				  portion of the participant's eMedicaid file has been submitted and initial
				  services have been delivered.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.33 - Health Homes › Section 10.09.33.10 - Recovery and Reimbursement

Current through Register Vol. 51, No. 14, July 12, 2024
Recovery and reimbursement shall be 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 10.09.33 - Health Homes › Section 10.09.33.11 - Cause for Suspension or Removal and Imposition of Sanctions

Current through Register Vol. 51, No. 14, July 12, 2024
A. Cause for
				  suspension or removal from the Medical Assistance Program and imposition of
				  sanctions shall be as set forth in COMAR 10.09.36.08.
B. If the Department determines that a health
				  home provider has failed to comply with the provisions of this chapter, the
				  Department may initiate one or more of the following actions against the health
				  home provider:
(1) Recovery of overpayment
				  made by the Department;
(2)
				  Withholding of payment by the Department;
(3) Reduction in payment by the Department,
				  including a 10 percent reduction in reimbursement for services that are not
				  billed within the time frame required by Regulation .09B(2) of this
				  chapter;
(4) Suspension from being
				  a health home provider;
(5) Removal
				  from being a health home provider; or
(6) Disqualification from being a health home
				  provider at any future time.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.33 - Health Homes › Section 10.09.33.12 - Appeal Procedures

Current through Register Vol. 51, No. 14, July 12, 2024
Appeal procedures shall be as set forth in COMAR
					 10.09.36.09.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.33 - Health Homes › Section 10.09.33.13 - Interpretive Regulation

Current through Register Vol. 51, No. 14, July 12, 2024
State regulations shall be interpreted as set forth in
					 COMAR 10.09.36.10.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.34 - Therapeutic Behavioral Services › Section 10.09.34.02 - Conditions for Provider Participation

Current through Register Vol. 51, No. 14, July 12, 2024
A. A therapeutic behavioral service provider
				  shall:
(1) Ensure that therapeutic behavioral
				  aides are trained and supervised in:
(a)
				  Principles of behavior change and childhood development;
(b) Clinically accepted techniques for
				  decreasing or eliminating maladaptive behaviors;
(c) Implementing a behavioral plan;
(d) Identifying the needs and characteristics
				  of the participant; and
(e)
				  Documenting interventions and outcomes;
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.34 - Therapeutic Behavioral Services › Section 10.09.34.03 - Covered Services

Current through Register Vol. 51, No. 14, July 12, 2024
A. The
				  Program covers the services listed in this chapter when the services are:
(1) Diagnosed, identified, and prescribed by
				  an EPSDT provider to be medically necessary;
(2) Preauthorized by the Department or its
				  designee; and
(3) Delivered in
				  accordance with the behavioral plan.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.34 - Therapeutic Behavioral Services › Section 10.09.34.04 - Limitations

Current through Register Vol. 51, No. 14, July 12, 2024
A. To be eligible
				  for therapeutic behavioral services the:
(1)
				  Participant shall be younger than 21 years old and enrolled in the
				  Program;
(2) Participant shall be
				  assessed as having behaviors or symptoms related to a mental health diagnosis
				  that places the individual's current living arrangement at risk and creates a
				  risk for a more restrictive placement, or prevents transition to a less
				  restrictive placement;
(3)
				  Participant's behaviors or symptoms shall be safely and effectively treated in
				  the community; and
(4)
				  Participant's parent, guardian, or individual who customarily provides care
				  shall be present during the provision of all therapeutic behavioral services to
				  participate in the behavioral plan, unless there are clinical goals
				  specifically addressed in the behavior plan that need to be achieved requiring
				  that the parent, guardian, or individual who customarily provides care not be
				  present.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.34 - Therapeutic Behavioral Services › Section 10.09.34.05 - Preauthorization

Current through Register Vol. 51, No. 14, July 12, 2024
A. The Department
				  or its designee shall require preauthorization for therapeutic behavioral
				  services.
B. The initial
				  authorization shall be given for not more than 60 calendar days.
C. Additional authorization beyond the
				  initial authorization shall be requested at a minimum, every 60 days and in
				  advance of the expiration of the previous authorization.
D. Authorization may only be given if the
				  therapeutic behavioral service continues to be effective and progress towards
				  the specified goals is documented.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.34 - Therapeutic Behavioral Services › Section 10.09.34.06 - Payment Procedures

Current through Register Vol. 51, No. 14, July 12, 2024
A. Request for
				  payment of services shall be submitted in accordance with COMAR
				  10.09.36.04A.
B. Billing time limitations for
				  claims submitted pursuant to this chapter as set forth in COMAR
				  10.09.36.06A.
C. Reimbursement for services
				  covered under this chapter is as follows:
(1)
				  For dates of service from November 1, 2021 through June 30, 2022:
(a) Initial therapeutic assessment and
				  reassessment at a rate of $136.12; and
(b) Therapeutic behavioral services at a rate
				  of:
(i) $29.50 for the first 30 minutes;
				  and
(ii) $14.75 for each additional
				  15 minutes.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.34 - Therapeutic Behavioral Services › Section 10.09.34.07 - Recovery and Reimbursement

Current through Register Vol. 51, No. 14, July 12, 2024
Recovery and reimbursement shall be as set forth in COMAR
					 10.09.36.07A.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.34 - Therapeutic Behavioral Services › Section 10.09.34.08 - Cause for Suspension or Removal and Imposition of Sanctions

Current through Register Vol. 51, No. 14, July 12, 2024
Causes for suspension or removal and imposition of
					 sanctions shall be as set forth in COMAR
					 10.09.36.08A.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.34 - Therapeutic Behavioral Services › Section 10.09.34.09 - Appeal Procedures

Current through Register Vol. 51, No. 14, July 12, 2024
Appeals procedures shall be as set forth in accordance with
					 COMAR 10.09.36.09A.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.34 - Therapeutic Behavioral Services › Section 10.09.34.10 - Interpretive Regulation

Current through Register Vol. 51, No. 14, July 12, 2024
This chapter shall be interpreted as set forth in COMAR
					 10.09.36.10A.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.35 - Hospice Care › Section 10.09.35.01 - 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) "Attending physician" means:
(a) A doctor of medicine or osteopathy
				  legally authorized to practice medicine and surgery by the State; or
(b) A nurse practitioner who meets the
				  qualifications set forth in COMAR 10.27.07.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.35 - Hospice Care › Section 10.09.35.02 - Licensing Requirements

Current through Register Vol. 51, No. 14, July 12, 2024
A. In
				  order to participate in the Program, a provider shall be licensed by the
				  Department pursuant to Health-General Article, Title 19, Subtitle 9, Annotated
				  Code of Maryland, or shall be legally authorized to provide hospice care in the
				  jurisdiction in which the services are provided, and shall obtain other
				  licenses as may be required by applicable State and local laws.
B. Employees of the provider who provide
				  hospice care services must be licensed, certified, or registered in accordance
				  with applicable federal, State, and local laws.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.35 - Hospice Care › Section 10.09.35.03 - Conditions of Participation

Current through Register Vol. 51, No. 14, July 12, 2024
A.
				  General requirements for participation in the Program are that providers shall:
(1) Meet all conditions for participation as
				  set forth in COMAR
				  10.09.36.03A,
				  except as otherwise specified in this regulation; and
(2) Ensure that the licensure requirements as
				  provided in Regulation .02 of this chapter are met.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.35 - Hospice Care › Section 10.09.35.04 - Duration of Hospice Care

Current through Register Vol. 51, No. 14, July 12, 2024
A. An
				  individual may elect to receive hospice care during one or more of the
				  following election periods:
(1) An initial
				  90-day period;
(2) A subsequent
				  90-day period; or
(3) An unlimited
				  number of subsequent 60-day periods.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.35 - Hospice Care › Section 10.09.35.06 - Covered Services

Current through Register Vol. 51, No. 14, July 12, 2024
A. Hospice
				  care includes the services listed in §B of this regulation when the
				  services are:
(1) Provided to an eligible
				  recipient who elects hospice care, in accordance with Regulation .05 of this
				  chapter;
(2) Reasonable and
				  necessary for the palliation or management of the participant's terminal
				  illness and related conditions;
(3)
				  Consistent with the plan of care established before the services are
				  provided;
(4) Provided by
				  appropriately qualified personnel;
(5) Administered according to accepted
				  standards of practice; and
(6)
				  Routinely provided directly by provider employees, when they are the core
				  services listed in §B(1)-(4) of this regulation, except that the provider
				  may contract for supplemental services during peak patient loads, under
				  extraordinary circumstances, or to obtain physician specialty
				  services.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.35 - Hospice Care › Section 10.09.35.07 - Limitations

Current through Register Vol. 51, No. 14, July 12, 2024
When a recipient is enrolled in Medicare Part A, Program
					 payment for hospice care shall be limited to payment of the recipient's
					 Medicare hospice care co-insurance amounts for drugs and biologicals and for
					 respite care and, where applicable, room and board for residents of a nursing
					 facility under Regulation .08E of this chapter.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.35 - Hospice Care › Section 10.09.35.08 - Payment Procedures

Current through Register Vol. 51, No. 14, July 12, 2024
A.
				  Reimbursement Principles.
(1) The Program
				  shall pay the provider at one of four rates for each day that the participant
				  is under the provider's care, subject to the conditions, limitations, and
				  exceptions set forth in this chapter.
(2) The payment rates for providers shall be
				  those established by the Health Care Financing Administration (HCFA) of the
				  U.S. Department of Health and Human Services for hospice care under a Medical
				  Assistance Program.
(3) The daily
				  rates are prospective rates, and there shall be no retroactive adjustment of
				  payment other than the limitation on payment for inpatient care set forth in
				  §C of this regulation.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.35 - Hospice Care › Section 10.09.35.09 - Recovery and Reimbursement

Current through Register Vol. 51, No. 14, July 12, 2024
Recovery and reimbursement shall be as set forth in COMAR
					 10.09.36.07A.