reglab/statecodes huggingface dataset:
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.35 - Hospice Care › Section 10.09.35.10 - 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 10.09.35 - Hospice Care › Section 10.09.35.11 - Appeal Procedures

Current through Register Vol. 51, No. 14, July 12, 2024
Appeal procedures for providers 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 10.09.35 - Hospice Care › Section 10.09.35.12 - 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 10.09.36 - General Medical Assistance Provider Participation Criteria › Section 10.09.36.02 - License Requirements

Current through Register Vol. 51, No. 14, July 12, 2024
Medical Assistance Program providers shall, to the extent
					 required by law, be licensed, certified, or otherwise legally authorized to
					 practice or deliver services 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 10.09.36 - General Medical Assistance Provider Participation Criteria › Section 10.09.36.03-1 - Conditions for Participation - Home and Community-Based Settings

Current through Register Vol. 51, No. 14, July 12, 2024
A. Providers of
				  services under COMAR 10.09.84 shall comply with the provisions of §§D
				  - F of this regulation and 42 CFR
				  441.301(c)(4).
B. Effective January 1, 2018, to be enrolled
				  as a provider of services authorized under §§ 1915(c) or 1915(i) of
				  the Social Security Act, the provider shall comply with the provisions of
				  §§D - F of this regulation and
				  42 CFR
				  441.301(c)(4).
C. Providers of services authorized under
				  §§ 1915(c) or 1915(i) of the Social Security Act that are enrolled
				  Maryland Medicaid providers before January 1, 2018, shall comply with the
				  provisions of §§D - F of this regulation on or before March 17,
				  2022.
D. The setting in which
				  services are provided shall:
(1) Be integrated
				  in and support full access to the greater community for individuals receiving
				  Medicaid home and community-based services to the same degree of access as
				  individuals not receiving Medicaid home and community-based services;
(2) Be selected by the individual from among
				  setting options, including nondisability specific settings;
(3) Be identified and documented in the
				  person-centered service plan and is based on the individual's needs and
				  preferences;
(4) Ensure an
				  individual's rights of:
(a) Privacy;
(b) Dignity and respect; and
(c) Freedom from coercion and
				  restraint;
(5) Optimize,
				  but not regiment, individual initiative, autonomy, and independence in making
				  life choices, including but not limited to:
(a) Daily activities;
(b) Physical environment; and
(c) With whom to interact; and
(6) Facilitate individual choice
				  regarding services and supports, and who provides them.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.36 - General Medical Assistance Provider Participation Criteria › Section 10.09.36.03-2 - Conditions for Participation - Data Management Systems and Electronic Visit Verification

Current through Register Vol. 51, No. 14, July 12, 2024
A. This
				  regulation establishes standards for providers using Data Management
				  systems.
B. Definitions.
(1) In this regulation, the following terms
				  have the meanings indicated.
(2)
				  Terms Defined.
(a) "Data management system"
				  means a health information technology solution used by the Maryland Department
				  of Health (Department), its agents, providers, and Program participants that
				  stores provider or participant protected health information (PHI) or personally
				  identifiable information (PII) and related business processes.
(b) "Electronic visit verification (EVV)"
				  means an electronic service entry method used to record service details,
				  including but not limited to service type, provider and participant
				  information, date of service, service delivery location, and beginning and
				  ending times of service that meets the requirements of the 21st Century Cures
				  Act, codified at 42 U.S.C.
				  §
													1396b(l) and other
				  State or federal guidelines.
(c)
				  Electronic visit verification (EVV) services means services that are:
(i) Covered Medicaid services, according to
				  the respective authority, including but not limited to the Medicaid State Plan,
				  a Medicaid waiver program, or regulations; and
(ii) Required to be electronically recorded
				  in the Department's EVV system pursuant to
				  42 U.S.C. §
														1396b(l) and other State and
				  federal laws, regulations, or guidance.
(d) "Preauthorized" means approved by the
				  Department or its designee before services are rendered.
(e) "Worker" means:
(i) An individual who is employed by or
				  contracts with a provider; and
(ii)
				  For self-directed services, an individual who is paid by the program to provide
				  direct care services to a participant.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.36 - General Medical Assistance Provider Participation Criteria › Section 10.09.36.04 - Payment Procedures

Current through Register Vol. 51, No. 14, July 12, 2024
A. The
				  provider shall submit the request for payment of services rendered according to
				  procedures established by the Department and in the form designated by the
				  Department.
B. The Department
				  reserves the right to return to the provider, before payment, all invoices not
				  properly signed, completed, and accompanied by properly completed forms
				  required by the Department.
C.
				  Payment advances are not made routinely.
D. The Program will make no direct payment to
				  recipients.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.36 - General Medical Assistance Provider Participation Criteria › Section 10.09.36.05 - Cost Reporting

Current through Register Vol. 51, No. 14, July 12, 2024
A.
				  Providers who are reimbursed on the basis of cost reports shall submit to the
				  Department or its designee, in the form prescribed, financial and statistical
				  data within 3 months after the end of the provider's fiscal year unless the
				  Department grants the provider an extension or the provider discontinues
				  participation in the Program.
B. If
				  a provider discontinues participation, financial and statistical data shall be
				  submitted to the Department within 45 days after the effective date of
				  termination.
C. An extension shall
				  be granted upon written request by the provider, setting forth the specific
				  reasons for the request, if the Department determines, taking into
				  consideration the totality of the circumstances, that the request is
				  reasonable.
D. Availability of
				  Records.
(1) The provider shall keep all
				  records available for inspection or audit by the Department or the Department's
				  designee at any reasonable time during normal business hours.
(2) Documentation of Costs.
(a) Upon request by the Department or the
				  Department's designee, the provider shall make documentation of costs available
				  during the course of verification.
(b) The provider shall have 30 days from the
				  date of the request to provide this documentation.
(c) Costs for which documentation is not
				  provided within the 30 days shall be considered not allowable.
(3) Upon written demonstration by
				  the provider of good cause, the Department may grant, in writing, an extension
				  of time to provide the requested documentation.
(4) Records shall be retained for 6 years
				  after the month in which the cost report to which the materials apply is filed
				  with the Department or the Department's designee.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.36 - General Medical Assistance Provider Participation Criteria › Section 10.09.36.06 - Billing Time Limitations

Current through Register Vol. 51, No. 14, July 12, 2024
A.
				  Definition.
(1) In this regulation, the
				  following term has the meaning indicated.
(2) Term Defined. "Received" means:
(a) The Program taking delivery of a claim
				  after the Program signs a certified mail, return receipt requested parcel from
				  the United States Postal Service; or
(b) The claim is reported on the provider's
				  remittance advice.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.36 - General Medical Assistance Provider Participation Criteria › Section 10.09.36.07 - Recovery and Reimbursement

Current through Register Vol. 51, No. 14, July 12, 2024
A. If the
				  participant has insurance or other coverage, or if any other person is
				  obligated, either legally or contractually, to pay for, or to reimburse the
				  participant for, covered services, 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 Program shall pay the difference between what was
				  paid by the insurance carrier and the Program's maximum fees. Total payment
				  cannot exceed the Program's maximum fee. The provider shall submit a copy of
				  the insurance carrier's notice or remittance advice with the 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.
C. The Department may conduct provider audits
				  as authorized by State and federal law to ensure compliance with Program
				  requirements.
D. For audits
				  commencing on or after July 1, 2004, if the provider fails to reimburse the
				  Department in accordance with §§A and B of this regulation, the
				  provider shall be responsible for reimbursing the Department for the amount of
				  the overpayment and any audit costs incurred by the Department in seeking
				  recovery of the overpayment.
E. An
				  audit is considered to have commenced upon the initial written notification by
				  the Department or the Department's agent to the provider.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.36 - General Medical Assistance Provider Participation Criteria › Section 10.09.36.08 - 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 the provider,
				  or any person with an ownership interest in the provider or related party of
				  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 Program;
(3)
				  Recovery of an overpayment;
(4)
				  Removal from the Program; and
(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 10.09.36 - General Medical Assistance Provider Participation Criteria › Section 10.09.36.09 - Filing Appeal

Current through Register Vol. 51, No. 14, July 12, 2024
A. Source of
				  Appeals.
(1) A provider may file an appeal
				  from a proposed Program action to:
(a)
				  Suspend the provider from the Program;
(b) Withhold payment by the
				  Program;
(c) Recover an
				  overpayment;
(d) Remove the provider
				  from the Program;
(e) Disqualify
				  the provider from future participation in the Program, either as a provider or
				  as a person providing services for which Program payment will be claimed;
				  or
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.36 - General Medical Assistance Provider Participation Criteria › Section 10.09.36.10 - 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 to
					 Program participants 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 10.09.36 - General Medical Assistance Provider Participation Criteria › Section 10.09.36.11 - Provider Rights

Current through Register Vol. 51, No. 14, July 12, 2024
Providers participating in the Program shall have the right
					 to:
A. Be treated professionally with
				  courtesy, dignity, and respect regardless of the individual's:
(1) Race;
(2) Color;
(3) Religion;
(4) Gender;
(5) Sexual orientation;
(6) National origin;
(7) Political affiliation;
(8) Disability;
(9) Marital status;
(10) Age; or
(11) Union affiliation;
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.37 - Family Planning Program Eligibility › Section 10.09.37.01 - Purpose and Scope

Current through Register Vol. 51, No. 14, July 12, 2024
This chapter governs the determination of eligibility for
					 the Family Planning Program.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.37 - Family Planning Program Eligibility › Section 10.09.37.02 - 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) Applicant.
(a) "Applicant" means an individual whose
				  written, signed application for the Family Planning Program has been submitted
				  to the Department but has not received final action.
(b) "Applicant" includes a non-pregnant
				  individual whose application is submitted through an authorized
				  representative.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.37 - Family Planning Program Eligibility › Section 10.09.37.03 - Eligibility for Family Planning Program Coverage

Current through Register Vol. 51, No. 14, July 12, 2024
A. In order to be determined eligible for
				  benefits under the Family Planning Program, an applicant:
(1) Shall:
(a) Have a household income that does not
				  exceed 250 percent of the federal poverty level; and
(b) Meet the following requirements:
(i) Citizenship requirements in COMAR
				  10.09.24.05B;
(ii) Identity requirements in COMAR
				  10.09.24.05B -1(a)-(e) and
				  (g); and
(iii) Residency requirements in COMAR
				  10.09.24.05-3.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.37 - Family Planning Program Eligibility › Section 10.09.37.03-1 - Family Planning Program Presumptive Eligibility

Current through Register Vol. 51, No. 14, July 12, 2024
A. Definitions.
(1) In this regulation, the following terms
				  have the meanings indicated.
(2)
				  Terms Defined.
(a) "Applicant" means an
				  individual who has applied for presumptive eligibility at a participating
				  family planning clinic.
(b)
				  "Application" means the presumptive eligibility application.
(c) "Authorized representative" has the
				  meaning stated in COMAR 10.01.04.01.
(d) "Determination" means a decision
				  regarding an applicant's presumptive eligibility.
(e) "Family planning clinic" means an entity
				  that:
(i) Provides family planning services
				  under a written agreement with the Maryland Department of Health, Prevention
				  and Health Promotion Administration; and
(ii) Is approved to perform family planning
				  presumptive eligibility determinations.
(f) "Formerfoster care" means an individual
				  who:
(i) Is younger than 26 years
				  old;
(ii) Is not eligible and
				  enrolled for coverage under a mandatory Medical Assistance group other than
				  childless adult; and
(iii) Was
				  formerly in a Maryland out-of-home placement, including categorical Medical
				  Assistance, upon attaining age 18 and leaving out-of-home placement or upon
				  attaining age 19-21 during extended out-of-home placement under COMAR
				  07.02.11.04B.
(g) "Income" means
				  property or a service received by an individual in cash or in-kind, which can
				  be applied directly, or by sale or conversion, to meet basic needs for food,
				  shelter, and medical expenses.
(h)
				  "Maryland Family Planning Program Delegate Service Site" means an entity that
				  provides family planning services under a written agreement with the
				  Department.
(i) "Medical
				  Assistance" means the program administered by the State under Title XTK of the
				  Social Security Act, which provides comprehensive medical and other
				  health-related care for eligible individuals.
(j) "Presumptive eligibility" means temporary
				  eligibility for Family Planning Program services as determined by family
				  planning clinics in accordance with this regulation.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.37 - Family Planning Program Eligibility › Section 10.09.37.04 - Application

Current through Register Vol. 51, No. 14, July 12, 2024
For individuals not described in .03B of this chapter,
					 application for Family Planning Program services will be conducted pursuant to
					 the provisions of COMAR 10.09.24.04.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.37 - Family Planning Program Eligibility › Section 10.09.37.05 - Consideration of Income

Current through Register Vol. 51, No. 14, July 12, 2024
Determination of an applicant's income for purposes of the
					 Family Planning Program shall be determined under the household provisions of
					 COMAR 10.09.24.06-1 and the income
					 provisions applicable to MAGI household units of COMAR 10.09.24.07.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.37 - Family Planning Program Eligibility › Section 10.09.37.06 - Determining Financial Eligibility

Current through Register Vol. 51, No. 14, July 12, 2024
An applicant is financially eligible for the Family
					 Planning Program if the applicant's MAGI household income as determined under
					 COMAR 10.09.24.06-1 and .07 does not
					 exceed 250 percent of the federal poverty level.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.37 - Family Planning Program Eligibility › Section 10.09.37.07 - Certification Periods

Current through Register Vol. 51, No. 14, July 12, 2024
A. For a
				  participant, certification for initial eligibility begins not sooner than the
				  first day of the month of application.
B. A participant's eligibility under
				  Regulation .03 of this chapter will end as of the:
(1) End of a 12 month certification
				  period;
(2) Date eligibility is
				  determined in another Medicaid coverage group;
(3) Date the participant ceases to qualify
				  under the requirements of Regulation . 03A of this chapter,
(4) Beginning of the month in which the participant is
				  enrolled in Medicare; or
(5) Date
				  a participant becomes an inmate in a public institution.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.37 - Family Planning Program Eligibility › Section 10.09.37.08 - Covered Services

Current through Register Vol. 51, No. 14, July 12, 2024
A Family Planning Program recipient shall be entitled to
					 services as stated in COMAR 10.09.58.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.37 - Family Planning Program Eligibility › Section 10.09.37.09 - Post-Eligibility Requirements

Current through Register Vol. 51, No. 14, July 12, 2024
Post-eligibility requirements for the Family Planning
					 Program are set forth at COMAR 10.09.24.12.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.37 - Family Planning Program Eligibility › Section 10.09.37.10 - Hearings

Current through Register Vol. 51, No. 14, July 12, 2024
The procedures for the Program granting a hearing to an
					 applicant or a recipient and the status of benefits pending a hearing are set
					 forth in COMAR 10.01.04.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.37 - Family Planning Program Eligibility › Section 10.09.37.11 - Fraud and Abuse

Current through Register Vol. 51, No. 14, July 12, 2024
The requirements relating to fraud and abuse under COMAR
					 10.09.24.14 and COMAR
					 10.09.24.14-1 shall apply to this
					 chapter.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.37 - Family Planning Program Eligibility › Section 10.09.37.12 - Adjustments and Recoveries

Current through Register Vol. 51, No. 14, July 12, 2024
The requirements relating to adjustments and recoveries
					 under COMAR
					 10.09.24.15, excluding COMAR
					 10.09.24.15A(2)-(3)
					 and COMAR 10.09.24.15A(3),
					 shall apply to this chapter.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.37 - Family Planning Program Eligibility › Section 10.09.37.13 - Interpretive Regulation

Current through Register Vol. 51, No. 14, July 12, 2024
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 10.09.38 - Healthy Start Program › Section 10.09.38.02 - Licensing Requirements

Current through Register Vol. 51, No. 14, July 12, 2024
A. A
				  certified nurse midwife providing Healthy Start services shall be:
(1) Licensed as a registered nurse in the
				  state in which services are provided;
(2) Certified as a nurse midwife by the
				  American College of Nurse-Midwives; and
(3) In compliance with requirements to
				  practice nurse midwifery in the state in which services are provided.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.38 - Healthy Start Program › Section 10.09.38.03 - 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:
(1) Meet the licensure
				  requirements in Regulation .02 of this chapter, and verify the licenses and
				  credentials of all professionals employed by the provider;
(2) Apply for participation in the Program
				  using an application form designated by the Department;
(3) Be approved for participation by the
				  Department;
(4) Have a provider
				  agreement with the Department in effect;
(5) Be identified as a Program provider by
				  issuance of an individual provider number;
(6) Verify the eligibility of
				  recipients;
(7) Accept payment by
				  the Program as payment in full for services rendered and make no additional
				  charge to any person for the covered services specified in Regulation .04 of
				  this chapter;
(8) Provide services
				  without discrimination on the basis of race, color, sex, national origin,
				  marital status, physical or mental handicap;
(9) Maintain adequate records concerning
				  service provision for a minimum of 6 years and make them available, upon
				  request, to the Department or its designee;
(10) Not knowingly employ or contract with
				  any person, partnership, or corporation which has been disqualified from the
				  Program to provide or supply service to Medical Assistance recipients, unless
				  prior written approval has been received from the Department;
(11) Agree that claims rejected for payment
				  due to late billing may not be billed to the participant;
(12) Not place a restriction on the
				  recipient's right to choose the provider;
(13) Agree that if the Program denies payment
				  or requests repayment on the basis that an otherwise covered service was not
				  medically necessary or has not been preauthorized, the provider may not seek
				  payment for that service from the participant; and
(14) Be selected by the participant from
				  among qualified providers.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.38 - Healthy Start Program › Section 10.09.38.04 - Covered Services

Current through Register Vol. 51, No. 14, July 12, 2024
Effective July 1, 2006, the Program shall reimburse for the
					 following services:
A. Risk
				  Assessment-Plan of Care.
(1) One unit of
				  service is to be reimbursed for each pregnancy.
(2) A risk assessment is an appraisal of the
				  participant's medical history and current health, nutritional, psychological,
				  and social status, as specified in the Healthy Start Risk Assessment
				  Instrument. It results in the identification of problems having an impact on
				  the outcome of the pregnancy and the subsequent health care status of the
				  child. Based on the assessment, an appropriate plan of care is drafted and
				  appropriate referrals are made. A copy of the completed Healthy Start Risk
				  Assessment Instrument will be sent by the provider to the participant's local
				  health department within 10 working days of the risk assessment.
(3) A plan of care is a description of the
				  services and resources required to meet the participant's needs identified
				  through the risk assessment. An individual participant's plan of care:
(a) Includes a description of the specific
				  action steps necessary to address each identified need;
(b) Matches the risk status of the
				  participant to the appropriate intensity and breadth of care;
(c) Describes the elements of care, provider
				  or providers, and facilities to be utilized by the participant;
(d) Is subject to modification as new
				  information arises during the course of care, including information
				  communicated from the provider of home-visiting services;
(e) Is individualized and is developed in
				  consultation with the participant; and
(f) Encompasses the continuum of care from
				  the prenatal period through postpartum.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.38 - Healthy Start Program › Section 10.09.38.05 - Limitations

Current through Register Vol. 51, No. 14, July 12, 2024
The Healthy Start Program may not restrict or otherwise
					 affect:
A. Eligibility for benefits
				  under Title XIX of the Social Security Act or other available benefits or
				  programs; and
B. The provider's
				  right to bill the Program for other covered program services.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.38 - Healthy Start Program › Section 10.09.38.06 - Payment Procedures

Current through Register Vol. 51, No. 14, July 12, 2024
A. Request
				  for Payment.
(1) Requests for payment of
				  Healthy Start Program services rendered and completed shall be submitted by an
				  approved provider 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 invoice form specified by the Department. A separate invoice shall be
				  submitted for each participant. The completed form shall indicate the:
(a) Date or dates of service;
(b) Participant's name and Medical Assistance
				  number;
(c) Provider's name,
				  location, and provider number; and
(d) Nature, unit or units, and procedure code
				  or codes of covered services 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 10.09.38 - Healthy Start Program › Section 10.09.38.07 - Recovery and Reimbursement

Current through Register Vol. 51, No. 14, July 12, 2024
Recovery and reimbursement are as set forth in COMAR
					 10.09.36.07A.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.38 - Healthy Start Program › Section 10.09.38.08 - 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
					 are 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 10.09.38 - Healthy Start Program › Section 10.09.38.09 - Appeal Procedures

Current through Register Vol. 51, No. 14, July 12, 2024
Appeal procedures are 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 10.09.38 - Healthy Start Program › Section 10.09.38.10 - Interpretive Regulation

Current through Register Vol. 51, No. 14, July 12, 2024
State regulations are 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 10.09.39 - Doula Services › Section 10.09.39.02 - Certification Requirements

Current through Register Vol. 51, No. 14, July 12, 2024
A provider shall be certified as described in the
					 Professional Services Provider Manual and Fee Schedule under COMAR
					 10.09.02.07D.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.39 - Doula Services › Section 10.09.39.03 - 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 certified doula provider require that the
				  provider:
(1) Maintain up-to-date
				  certification through a doula certification program as specified in Regulation
				  .02 of this chapter; and
(2) Shall
				  have adequate liability insurance.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.39 - Doula Services › Section 10.09.39.04 - Covered Services

Current through Register Vol. 51, No. 14, July 12, 2024
A.
				  Effective January 1, 2022, the Program covers doula services as defined in
				  Regulation .01 of this chapter when the services:
(1) Are medically necessary;
(2) Are rendered during a birthing parent's
				  prenatal period, labor and delivery, and postpartum period; and
(3) If rendered via telehealth, comply with
				  the requirements established in COMAR 10.09.49 and any other subregulatory
				  guidance.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.39 - Doula Services › Section 10.09.39.05 - Limitations

Current through Register Vol. 51, No. 14, July 12, 2024
Doula services covered under this chapter are subject to
					 the following limitations:
A. One of
				  the following providers shall be present while doula services are provided
				  during the delivery:
(1) An
				  obstetrician-gynecologist;
(2) A
				  family medicine practitioner; or
(3) A certified nurse midwife.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.39 - Doula Services › Section 10.09.39.06 - Payment Procedures

Current through Register Vol. 51, No. 14, July 12, 2024
A. The provider
				  shall submit the request for payment in the format designated by the
				  Program.
B. The Program reserves
				  the right to return to the provider, before payment, all invoices not properly
				  signed, completed, and accompanied by properly completed forms required by the
				  Program.
C. The provider shall
				  charge the Program the provider's customary charge to the general public. If
				  the service is free to individuals not covered by Medicaid:
(1) The provider:
(a) May charge the Program; and
(b) Shall be reimbursed in accordance with
				  §H of this regulation; and
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.39 - Doula Services › Section 10.09.39.07 - Recovery and Reimbursement

Current through Register Vol. 51, No. 14, July 12, 2024
Recovery and reimbursement regulations are 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 10.09.39 - Doula Services › Section 10.09.39.08 - 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
					 are 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 10.09.39 - Doula Services › Section 10.09.39.09 - 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 10.09.39 - Doula Services › Section 10.09.39.10 - Interpretive Regulation

Current through Register Vol. 51, No. 14, July 12, 2024
Interpretive regulatory requirements shall be 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 10.09.39 - Doula Services › Section 10.09.39.11 - Implementation Date

Current through Register Vol. 51, No. 14, July 12, 2024
This chapter shall be implemented on January 1,
					 2022.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.40 - Early Intervention Service Coordination › Section 10.09.40.03 - Conditions for Participation

Current through Register Vol. 51, No. 14, July 12, 2024
A. General
				  requirements for participation in the Program are that providers shall do the
				  following, either directly through staff or by agreement:
(1) Meet all conditions for participation as
				  set forth in COMAR
				  10.09.36.03K;
				  and
(2) Maintain a file on each
				  participant which meets the Program's requirements and which includes for each
				  contact made by the service coordinator:
(a)
				  Date and subject of contact,
(b)
				  Person contacted,
(c) Person making
				  the contact,
(d) Nature, content,
				  and unit or units of service provided;
(e) Place of service; and
(f) Signature and printed name of the service
				  coordinator.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.40 - Early Intervention Service Coordination › Section 10.09.40.04 - Covered Services

Current through Register Vol. 51, No. 14, July 12, 2024
A. The Program
				  shall reimburse for the services in §§B, C, and D of this regulation,
				  when they have been documented as necessary.
B. Initial Service Coordination.
(1) A unit of service is defined as a
				  completed initial Individualized Family Service Plan (IFSP) and at least one
				  contact with the participant or the participant's family, on the participant's
				  behalf.
(2) The covered services
				  include convening and conducting a multidisciplinary team to:
(a) Perform a multidisciplinary assessment;
				  and
(b) Develop an initial IFSP for
				  a participant that identifies the:
(i)
				  Participant's needs for early intervention, medical, mental and behavioral
				  health, social, educational, financial assistance, counseling, and other
				  support services;
(ii)
				  Responsibilities and rights of the participant and the family,
(iii) Provider's responsibilities,
				  and
(iv) Resources available to
				  provide the needed services.
(3) Administrative, supervisory, and
				  monitoring services associated with the initial service coordination are
				  included as a part of the service.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.40 - Early Intervention Service Coordination › Section 10.09.40.05 - Limitations

Current through Register Vol. 51, No. 14, July 12, 2024
A. Early
				  intervention service coordination is advisory in nature.
B. A restriction may not be placed on a
				  qualified participant's option to receive early intervention service
				  coordination.
C. Early intervention
				  service coordination does not restrict or otherwise affect:
(1) Eligibility for Title XIX benefits or
				  other available benefits or programs;
(2) The freedom of a participant's parent or
				  family to select from all available services for which the participant is found
				  to be eligible;
(3) A participant's
				  parent or family's free choice among qualified providers, in the participant's
				  behalf; or
(4) A provider's right
				  to bill the Program for other covered Program services.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.40 - Early Intervention Service Coordination › Section 10.09.40.06 - Payment Procedures

Current through Register Vol. 51, No. 14, July 12, 2024
A. Request for
				  Payment.
(1) Requests for payment of early
				  intervention service coordination shall be submitted by an approved provider
				  according to procedures established by the Department. The Department reserves
				  the right to return to the provider, before payment, all claims not properly
				  signed and completed.
(2) A
				  provider shall submit a request for payment on the claim form designated by the
				  Department. A separate claim shall be submitted for each participant.
(3) The completed claim form in §A(2)B
				  of this regulation shall indicate the:
(a)
				  Date or dates of service;
(b)
				  Participant's name and Medical Assistance number;
(c) Provider's name, location, and provider
				  number; and
(d) Nature, unit or
				  units, and procedure code or codes of covered services provided.
(4) Providers shall bill the
				  Program for the appropriate fee specified in §C of this
				  regulation.
(5) The Program may not
				  make direct payment to participants.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.40 - Early Intervention Service Coordination › Section 10.09.40.07 - Recovery and Reimbursement

Current through Register Vol. 51, No. 14, July 12, 2024
Recovery and reimbursement shall be as set forth in COMAR
					 10.09.36.07K.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.40 - Early Intervention Service Coordination › Section 10.09.40.08 - 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
					 10.09.36.08K.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.40 - Early Intervention Service Coordination › Section 10.09.40.09 - Appeal Procedures

Current through Register Vol. 51, No. 14, July 12, 2024
Appeal Procedures shall be as set forth in COMAR
					 10.09.36.09K.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.40 - Early Intervention Service Coordination › Section 10.09.40.10 - Interpretive Regulation

Current through Register Vol. 51, No. 14, July 12, 2024
State regulations shall be interpreted as set forth in
					 COMAR 10.09.36.10K.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.41 - Employed Individuals with Disabilities › Section 10.09.41.01 - Purpose

Current through Register Vol. 51, No. 14, July 12, 2024
The purpose of this chapter is to increase employment
					 opportunities by making Medical Assistance coverage available to employed
					 individuals with disabilities who meet:
A. The disability criteria under Title II or
				  XVI of the Social Security Act; and
B. The nonfinancial and financial eligibility
				  requirements established in this chapter.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.41 - Employed Individuals with Disabilities › Section 10.09.41.02 - Definitions

Current through Register Vol. 51, No. 14, July 12, 2024
A. Applicability of
				  COMAR 10.09.24.02D
				  efinitions.
(1) Except as provided in
				  §A(2) of this regulation, terms used in this chapter that are not defined
				  in §C of this regulation have the meanings stated for the same terms in
				  COMAR 10.09.24.02.
(2) If a term's
				  definition in COMAR
				  10.09.24.02 references a "local
				  department of social services" in the context of a determination of
				  eligibility, the words "local department of social services" in the COMAR
				  10.09.24.02 definition shall be
				  replaced, for purposes of the term's meaning in this chapter, with "the
				  Department".
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.41 - Employed Individuals with Disabilities › Section 10.09.41.03 - Nonfinancial Eligibility

Current through Register Vol. 51, No. 14, July 12, 2024
A. The
				  Department shall determine whether an applicant or recipient meets the
				  nonfinancial eligibility requirements for Medical Assistance benefits under
				  this regulation.
B. An applicant or
				  participant meets the nonfinancial eligibility requirements for Medical
				  Assistance benefits under this regulation if the applicant or participant:
(1) Is 16 years old or older, but younger
				  than 65 years old;
(2) Is employed,
				  except when an unemployment grace period described under Regulation .07 of this
				  chapter applies, and verifies employment and compliance with all applicable
				  requirements relating to FICA, income tax reporting, withholding, and payment
				  requirements, including, if self-employed, payment of estimated taxes, by
				  submitting documentation such as:
(a) Pay
				  stubs;
(b) A letter from the
				  employer verifying the applicant's or recipient's employment;
(c) Bank statements showing deposits of
				  earnings;
(d) Income tax
				  returns;
(e) Evidence of payment of
				  estimated taxes; or
(f) Business
				  ledgers;
(3) Except for
				  the consideration of substantial gainful activity, meets the definition of
				  disability in §1614(a)(3) of the Social Security Act, as determined by:
(a) The Department pursuant to a disability
				  determination process for applicants who have not had a disability
				  determination completed by the Social Security Administration within the time
				  period prescribed in §C(2) of this regulation; or
(b) The Social Security Administration, if
				  the applicant or recipient:
(i) Receives SSDI
				  benefits; or
(ii) Has lost
				  eligibility for SSDI or SSI for any reason other than medical
				  improvement;
(4) As specified in COMAR 10.09.24:
(a) Meets the eligibility requirements for
				  Medical Assistance as to:
(i) Citizenship;
				  and
(ii) Residency; and
(b) Is not:
(i) An institutionalized person;
(ii) An inmate of a public institution;
				  or
(iii) An inpatient in an
				  institution for mental disease; and
(5) Is not a current recipient of:
(a) Comprehensive Medical Assistance benefits
				  pursuant to COMAR 10.09.24; or
(b)
				  Benefits under the Maryland Children's Health Program pursuant to COMAR
				  10.09.11 or 10.09.43.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.41 - Employed Individuals with Disabilities › Section 10.09.41.04 - Financial Eligibility

Current through Register Vol. 51, No. 14, July 12, 2024
A. Assistance
				  Unit. An applicant's or recipient's assistance unit shall include the:
(1) Applicant or recipient; and
(2) Applicant's or recipient's spouse when
				  living in the same household, whether or not the spouse is eligible for the
				  same benefits under this chapter.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.41 - Employed Individuals with Disabilities › Section 10.09.41.05 - Application Requirements - Determination and Redetermination of Eligibility

Current through Register Vol. 51, No. 14, July 12, 2024
A. Application.
(1) To any individual requesting information,
				  the Department shall provide oral or written information about:
(a) EID eligibility requirements;
(b) The coverage, scope, and related services
				  of the Medical Assistance Program; and
(c) Applicants' and recipients' rights and
				  obligations under the Medical Assistance Program.