reglab/statecodes huggingface dataset:
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 5 › Subtitle 65 - BOARD OF MASSAGE THERAPY EXAMINERS › Chapter 10.65.10 - Telehealth › Section 10.65.10.01 - Scope

Current through Register Vol. 51, No. 14, July 12, 2024
A. This chapter
				  governs the practice of massage therapy using telehealth as an adjunct to, or
				  replacement for, in-person client visits.
B. Nothing in this chapter restricts or
				  limits reimbursement requirements pursuant to Health-General Article and
				  Insurance Article, Annotated Code of Maryland.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 5 › Subtitle 65 - BOARD OF MASSAGE THERAPY EXAMINERS › Chapter 10.65.10 - Telehealth › Section 10.65.10.02 - 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) "Asynchronous" means not occurring in
				  real time.
(2) "Board" means the
				  Maryland Board of Massage Therapy Examiners.
(3) Health Care Services.
(a) "Health care services" means to provide
				  client instruction through telehealth using:
(i) Techniques that include, but are not
				  limited to, stretching, movement, breathing, and self-massage; and
(ii) Applications, such as nonlegend topicals
				  and hot and cold packs or pads.
(b) "Health care services" does not include:
(i) Mental health counseling; or
(ii) Nutritional counseling.
(4) "In-person" means
				  within the physical presence of the client.
(5) "Synchronous" means occurring in real
				  time.
(6) "Telehealth" has the
				  meaning stated in Health Occupations Article, §
											1-1001, Annotated
				  Code of Maryland.
(7) "Telehealth
				  practitioner" means a Maryland licensed massage therapist or a registered
				  massage practitioner performing telehealth services within their respective
				  scope of practice as defined under Health Occupations Article, §
											6-101, Annotated
				  Code of Maryland.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 5 › Subtitle 65 - BOARD OF MASSAGE THERAPY EXAMINERS › Chapter 10.65.10 - Telehealth › Section 10.65.10.03 - Licensure and Registration

Current through Register Vol. 51, No. 14, July 12, 2024
Subject to the provisions of Health Occupations Article,
					 Title 6, Annotated Code of Maryland, a telehealth practitioner shall be
					 licensed or registered in Maryland when providing telehealth services to a
					 client located in the State.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 5 › Subtitle 65 - BOARD OF MASSAGE THERAPY EXAMINERS › Chapter 10.65.10 - Telehealth › Section 10.65.10.04 - Standards of Practice for Telehealth

Current through Register Vol. 51, No. 14, July 12, 2024
A. Before
				  performing telehealth services, a telehealth practitioner shall develop and
				  follow a procedure to:
(1) Verify the
				  identification of the client receiving telehealth services within a reasonable
				  degree of certainty through use of:
(a) A
				  government-issued photograph identification;
(b) Documentation of the client's:
(i) Date of birth; and
(ii) Home address; or
(c) Except for registered massage therapists,
				  an insurance, Medicaid, or Medicare card;
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 5 › Subtitle 65 - BOARD OF MASSAGE THERAPY EXAMINERS › Chapter 10.65.10 - Telehealth › Section 10.65.10.05 - Client Evaluation

Current through Register Vol. 51, No. 14, July 12, 2024
A. A telehealth
				  practitioner shall:
(1) Perform a synchronous
				  or asynchronous clinical client evaluation that is appropriate for the client
				  and the condition with which the client presents before providing health care
				  services through telehealth; and
(2) If clinically appropriate for the client,
				  provide or refer a client to:
(a) In-person
				  treatment; or
(b) Another type of
				  telehealth service.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 5 › Subtitle 65 - BOARD OF MASSAGE THERAPY EXAMINERS › Chapter 10.65.10 - Telehealth › Section 10.65.10.06 - Telehealth Practitioner Discipline

Current through Register Vol. 51, No. 14, July 12, 2024
A. The Board
				  shall use the same standards of evaluating and investigating a complaint about
				  and in disciplining a telehealth practitioner who practices telehealth as it
				  would use for a licensee or registrant who does not use telehealth technology
				  in the licensee's or registrant's practice.
B. The failure of a telehealth practitioner
				  to comply with this chapter shall constitute unprofessional conduct and may be
				  subject to disciplinary action by the Board.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 5 › Subtitle 65 - BOARD OF MASSAGE THERAPY EXAMINERS › Chapter 10.65.11 - Curriculum Approval › Section 10.65.11.02 - Approval of Curriculum Accredited by a Board-Recognized Massage Therapy Accreditation Agency

Current through Register Vol. 51, No. 14, July 12, 2024
A. The Board
				  shall approve any massage therapy education curriculum in Maryland whose
				  program has been granted accreditation by a BRMTA, provided the curriculum
				  meets all requirements of this chapter.
B. A program that has been accredited by a
				  BRMTA shall submit to the Board within 30 days of that accreditation:
(1) Evidence of current accreditation and
				  endorsement status;
(2)
				  Accreditation reports; and
(3) Any
				  correspondence related to the status of the curriculum's accreditation and
				  endorsement.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 5 › Subtitle 65 - BOARD OF MASSAGE THERAPY EXAMINERS › Chapter 10.65.11 - Curriculum Approval › Section 10.65.11.03 - Massage Therapy Faculty and Clinical Massage Therapy Faculty

Current through Register Vol. 51, No. 14, July 12, 2024
A.
				  Qualifications of Massage Therapy Faculty.
(1) Unless otherwise provided in this
				  chapter, massage therapy faculty shall:
(a)
				  Be currently licensed or registered to practice massage therapy in
				  Maryland;
(b) Be academically and
				  professionally qualified;
(c)
				  Maintain expertise appropriate to their teaching responsibilities;
(d) Have a minimum of 5 years of clinical
				  experience as a licensed massage therapist or registered massage practitioner;
				  and
(e) Have an unencumbered
				  license or registration for the past 5 years.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 5 › Subtitle 65 - BOARD OF MASSAGE THERAPY EXAMINERS › Chapter 10.65.11 - Curriculum Approval › Section 10.65.11.04 - Resources, Facilities, and Services

Current through Register Vol. 51, No. 14, July 12, 2024
A. All
				  facilities used for clinical learning experiences shall comply with all
				  applicable federal, state, and local requirements.
B. Cooperating clinical entities shall have:
(1) Clinical massage therapy faculty on-site
				  and physically available for consultation with massage therapy student;
				  and
(2) A dedicated student area
				  for training demonstrations.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 5 › Subtitle 65 - BOARD OF MASSAGE THERAPY EXAMINERS › Chapter 10.65.11 - Curriculum Approval › Section 10.65.11.05 - Curriculum

Current through Register Vol. 51, No. 14, July 12, 2024
A. The
				  curriculum shall meet criteria as stated under COMAR 10.65.01.07.
B. Changes in course offerings that will
				  alter the curriculum, objectives, outcomes, competencies, or conceptual
				  framework of the program shall:
(1) Be
				  reported to the Board in the annual report; and
(2) Include the following information:
(a) The rationale for changes; and
(b) The methods of evaluation to be used to
				  determine the effect of the change.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 5 › Subtitle 65 - BOARD OF MASSAGE THERAPY EXAMINERS › Chapter 10.65.11 - Curriculum Approval › Section 10.65.11.06 - Curriculum Evaluation

Current through Register Vol. 51, No. 14, July 12, 2024
A. The program
				  shall develop and implement a Board-approved evaluation plan for evaluating the
				  total massage therapy education program not less than every 5 years for
				  curricula that are accredited by a BRMTA.
B. The evaluation plan shall include:
(1) All components of the
				  curriculum;
(2) Evaluation time
				  intervals;
(3) Student, graduate,
				  faculty, cooperating clinical entities, and administration
				  participation;
(4) Instruments or
				  methods used; and
(5) Evidence that
				  prior recommendations from the Board have been acted upon.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 5 › Subtitle 65 - BOARD OF MASSAGE THERAPY EXAMINERS › Chapter 10.65.11 - Curriculum Approval › Section 10.65.11.07 - Annual Review

Current through Register Vol. 51, No. 14, July 12, 2024
A. A program
				  shall submit the following to the Board no later than July 1 of each year:
(1) An annual report detailing the
				  program;
(2) A program
				  catalog;
(3) Any annual reports to
				  the BRMTA;
(4) Any correspondence
				  related to the status of the program's accreditation;
(5) A summary of practices followed in
				  safeguarding the health and well-being of students;
(6) Accurate and complete data including, but
				  not limited to, number of enrollments, admissions, graduates, and faculty;
				  and
(7) A report detailing:
(a) Annual pass rates for first-time
				  candidates who have taken the MBLEx exam; and
(b) Student retention and program completion
				  rates.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 5 › Subtitle 65 - BOARD OF MASSAGE THERAPY EXAMINERS › Chapter 10.65.11 - Curriculum Approval › Section 10.65.11.08 - Withdrawal of Curriculum Approval

Current through Register Vol. 51, No. 14, July 12, 2024
A. At least 30
				  days before issuing a formal notice of violation of regulations to a program,
				  the Board shall notify the chief administrator of:
(1) The controlling institution, if
				  applicable; and
(2) The massage
				  therapy education program that the Board is considering issuing a formal notice
				  of violation.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 5 › Subtitle 65 - BOARD OF MASSAGE THERAPY EXAMINERS › Chapter 10.65.11 - Curriculum Approval › Section 10.65.11.09 - New Programs and Continuing Approval Requirements

Current through Register Vol. 51, No. 14, July 12, 2024
A. New Program
				  Requirements. The Board shall cooperate with MHEC when approving and reviewing
				  curricula.
B. Approval.
(1) Upon review of an application for
				  curriculum approval, the Board may:
(a) Grant
				  approval;
(b) Place the curriculum
				  on provisional approval;
(c)
				  Request revisions of the curriculum to align with the Board's statute and
				  regulations; or
(d) Deny the
				  application.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 5 › Subtitle 65 - BOARD OF MASSAGE THERAPY EXAMINERS › Chapter 10.65.11 - Curriculum Approval › Section 10.65.11.10 - Closure of Programs

Current through Register Vol. 51, No. 14, July 12, 2024
A. Upon
				  request, the Board shall provide consultation concerning closing of a
				  program.
B. Upon the decision by a
				  program to close, and at least 90 days before closing, the program shall notify
				  the Board of its intent, giving the following information:
(1) Date and reason for closing;
(2) Plans for phasing out the program,
				  including a teach-out program;
(3)
				  Disposition of the records of students, graduates, and faculty; and
(4) Title of the position of the individual
				  to be responsible for the records and the name of the agency in which the
				  records will be located.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 5 › Subtitle 66 - OFFICE OF THE INSPECTOR GENERAL › Chapter 10.66.01 - Civil Money Remedy › Section 10.66.01.01 - Scope

Current through Register Vol. 51, No. 14, July 12, 2024
This chapter establishes standards for civil money remedies
					 against any provider of health care services or health care supplies or
					 equipment if the Office of the Inspector General finds there are grounds under
					 Health General Article, §2-504.1, Annotated Code of Maryland, to impose a
					 civil money remedy.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 5 › Subtitle 66 - OFFICE OF THE INSPECTOR GENERAL › Chapter 10.66.01 - Civil Money Remedy › Section 10.66.01.02 - Definitions

Current through Register Vol. 51, No. 14, July 12, 2024
A. The following
				  terms have the meaning indicated.
B. Terms Defined.
(1) "Civil money remedy" means a monetary
				  remedy authorized by Health-General Article, §2-504.1, Annotated Code of
				  Maryland, and imposed for a violation of statute or regulation governing the
				  conditions of payment for any service or item for which the provider submitted
				  a claim for payment and received payment.
(2) "Department" means the Department of
				  Health and Mental Hygiene.
(3)
				  "Hearing" means a contested case hearing as defined by the Administrative
				  Procedure Act, State Government Article, Title 10, Subtitle 2, Annotated Code
				  of Maryland.
(4) "Identified
				  recovery" means the total dollar amount of claims identified by the OIG as paid
				  to the provider for a service or item not provided in accordance with
				  applicable statute and regulations.
(5) "Inspector General" means the Inspector
				  General, or the designated Assistant Inspector General, within the Department
				  of Health and Mental Hygiene.
(6)
				  "Office of Administrative Hearings (OAH)" means the independent unit in the
				  Executive Branch of State government authorized to conduct hearings in
				  contested cases, pursuant to the Administrative Procedure Act and this
				  chapter.
(7) "OIG" means the Office
				  of the Inspector General within the Department of Health and Mental
				  Hygiene.
(8) "Violation " means the
				  provision of a service that does not comply with applicable statutes or
				  regulations or both.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 5 › Subtitle 66 - OFFICE OF THE INSPECTOR GENERAL › Chapter 10.66.01 - Civil Money Remedy › Section 10.66.01.03 - Civil Money Remedy - Imposition

Current through Register Vol. 51, No. 14, July 12, 2024
A.
				  A civil money remedy may be imposed against a provider for violation of a State
				  or federal law governing the conditions of payment for any service or item for
				  which the provider submitted a claim for payment and received
				  payment.
B. It is within the sole
				  discretion of the Inspector General as to whether a civil money remedy is
				  imposed.
C. A civil money remedy
				  may not be imposed if otherwise prohibited by State or federal law.
D. A civil money remedy imposed under this
				  chapter:
(1) Is in lieu of full payment or
				  full adjustment of the paid claim and not in addition to repayment of the
				  claim;
(2) May not be less than the
				  federal financial participation share of the identified improper claim amount
				  unless good cause is shown;
(3)
				  May not exceed the amount of reimbursement that the provider received for the
				  paid claim;
(4) Is only available
				  if the provider has not been subjected to a:
(a) Repayment penalty or fine;
(b) Criminal action; or
(c) Civil false claims action under either
				  federal or State law for the same claim; and
(5) May not be imposed if the claim was
				  included in the universe of claims under an extrapolation
				  calculation.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 5 › Subtitle 66 - OFFICE OF THE INSPECTOR GENERAL › Chapter 10.66.01 - Civil Money Remedy › Section 10.66.01.04 - Civil Money Remedy - Appeal

Current through Register Vol. 51, No. 14, July 12, 2024
A. A
				  provider aggrieved by the imposition of a civil money remedy may appeal the
				  action by filing a request for a hearing in accordance with State Government
				  Article, Title 10, Subtitle2, Annotated Code of Maryland.
B. The Inspector General has the burden of
				  proof with respect to the basis for the imposition of the civil money
				  remedy.
C. The Office of
				  Administrative Hearings shall render a final decision within 30 days of the
				  hearing.
D. An order that imposes a
				  civil money remedy is final when the provider has exhausted all opportunities
				  to contest the civil money remedy in accordance with State Government Article,
				  Title 10, Subtitle 2, Annotated Code of Maryland.
E. After exhaustion of all appeals, a
				  provider shall pay a civil money remedy to the Department within 10 days after
				  the provider receives a final order that affirms the imposition of the civil
				  money remedy unless the Inspector General negotiates and approves a repayment
				  schedule.
F. If a provider does not
				  pay the civil money remedy to the Department after receiving the final order or
				  according to a negotiated repayment schedule, the State may deduct the amount
				  of the civil money remedy from any sum that is then or later owed by the State
				  to the provider, pursuant to State Finance and Procurement Article, §
										7-222,
				  Annotated Code of Maryland.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 5 › Subtitle 67 - MARYLAND HEALTHCHOICE PROGRAM › Chapter 10.67.02 - Maryland Medicaid Managed Care Program: Eligibility and Enrollment › Section 10.67.02.01 - Eligibility

Current through Register Vol. 51, No. 14, July 12, 2024
A. Criteria.
				  Except as provided in §B of this regulation, a Program recipient shall be
				  enrolled in the Maryland Medicaid Managed Care Program, described in this
				  chapter, if the recipient is eligible for receipt of Medical Assistance
				  benefits by qualifying:
(1) As categorically
				  needy or medically needy under COMAR 10.09.24, unless the participant is:
(a) 65 years old or older;
(b) Newly eligible and 64 1/2 years old or
				  older;
(c) Eligible to receive
				  Medicare benefits,
(d) Determined
				  medically needy under a spend down, or
(e) Otherwise certified for a period of less
				  than 9 months;
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 5 › Subtitle 67 - MARYLAND HEALTHCHOICE PROGRAM › Chapter 10.67.02 - Maryland Medicaid Managed Care Program: Eligibility and Enrollment › Section 10.67.02.02 - Enrollment

Current through Register Vol. 51, No. 14, July 12, 2024
A. The Department
				  shall make available through its website and upon request provide a paper copy
				  of the following:
(1) Materials regarding
				  each MCO providing services in the eligible individual's county of residence
				  including, but not limited to:
(a)
				  Information about how to access the provider directory and drug formulary, with
				  instructions for how to request paper copies if needed;
(b) A schedule of the benefits offered,
				  including any benefits offered beyond the basic required package described in
				  COMAR 10.67.67;
(c) Which, if any,
				  benefits are provided directly by the Department;
(d) If applicable, a list of services that
				  the MCO does not provide, reimburse for, or provide coverage of, because of
				  moral or religious objections, and information about where and how to obtain
				  these services;
(e) The
				  requirements for each MCO to provide adequate access to covered services,
				  including the network adequacy standards established in COMAR 10.67.66;
				  and
(f) Quality and performance
				  indicators for each MCO, including enrollee satisfaction; and
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 5 › Subtitle 67 - MARYLAND HEALTHCHOICE PROGRAM › Chapter 10.67.02 - Maryland Medicaid Managed Care Program: Eligibility and Enrollment › Section 10.67.02.03 - Health Service Needs Information

Current through Register Vol. 51, No. 14, July 12, 2024
A. The Department, MCO, or agents of the
				  Department or MCO shall attempt to complete the health service needs
				  information at the time of enrollment.
B. The Department shall transmit any
				  information obtained from health service needs information to the enrollee's
				  MCO within 5 business days.
C. Upon
				  its receipt and review of the health service needs information, an MCO shall
				  take appropriate action to ensure that a new enrollee, who needs special or
				  immediate health care services, as identified by the health service needs
				  information, receives them in a timely manner.
D. If the Department does not transmit health
				  services needs information for an enrollee to the MCO within 10 days of
				  enrollment, the MCO shall make at least two attempts to conduct an initial
				  screening of the enrollee's needs, within 90 days of the effective date of
				  enrollment. At least one of these attempts shall be during non-working
				  hours.
E. The Department shall inform an enrollee identified
				  in connection with the health service needs information as having a behavioral
				  health problem that the individual may self-refer to the behavioral health ASO
				  for services as described in COMAR 10.67.59 and 10.67.80.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 5 › Subtitle 67 - MARYLAND HEALTHCHOICE PROGRAM › Chapter 10.67.02 - Maryland Medicaid Managed Care Program: Eligibility and Enrollment › Section 10.67.02.04 - Assignment to Primary Care Provider (PCP)

Current through Register Vol. 51, No. 14, July 12, 2024
A. Within 10 days of the notification of
				  enrollment of a new enrollee or within 10 days of any event that requires a
				  change in an existing enrollee's PCP, an MCO shall notify the enrollee of the
				  enrollee's PCP assignment.
B. A
				  Program recipient with no previous affiliation with any of the providers on the
				  MCO's primary care provider panel who:
(1)
				  Indicates a preference for a participating PCP during the enrollment process
				  shall be assigned to that PCP unless the MCO documents in writing, for good
				  cause, its inability to assign the enrollee to that PCP; or
(2) Fails to make known any preference for a
				  PCP shall be assigned to a PCP whose location satisfies the access standards
				  specified in COMAR 10.67.66.06E.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 5 › Subtitle 67 - MARYLAND HEALTHCHOICE PROGRAM › Chapter 10.67.02 - Maryland Medicaid Managed Care Program: Eligibility and Enrollment › Section 10.67.02.05 - Reassignment

Current through Register Vol. 51, No. 14, July 12, 2024
A. Once every 12
				  months, a Program recipient may elect to:
(1)
				  Maintain enrollment with the recipient's current MCO;
(2) Enroll in another MCO in the recipient's
				  local access area; or
(3) Enroll in
				  an MCO outside the recipient's local access area, upon the approval of the
				  Department and the MCO.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 5 › Subtitle 67 - MARYLAND HEALTHCHOICE PROGRAM › Chapter 10.67.03 - Maryland Medicaid Managed Care Program: MCO Application › Section 10.67.03.02 - Application

Current through Register Vol. 51, No. 14, July 12, 2024
A. When applying
				  for participation in the Maryland Medicaid Managed Care Program as an MCO, an
				  applicant shall submit an application to the Secretary in the form that the
				  Secretary requires.
B. An applicant
				  may omit from its application any information or documents that it has
				  previously submitted to the Department, if:
(1) The information or documents are up to
				  date; and
(2) The applicant
				  identifies in its application the information and documents that it has
				  omitted.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 5 › Subtitle 67 - MARYLAND HEALTHCHOICE PROGRAM › Chapter 10.67.03 - Maryland Medicaid Managed Care Program: MCO Application › Section 10.67.03.03 - Organization, Operations, and Financing

Current through Register Vol. 51, No. 14, July 12, 2024
Except as provided in Regulation .02B of this chapter, an
					 MCO applicant shall include the following information or descriptions in its
					 application:
A. An indication whether
				  the applicant is an operating HMO with a certificate of authority from the
				  Maryland Insurance Administration;
B. A written legal history of the applicant,
				  specific as to dates and parties involved, that includes, but is not limited
				  to:
(1) Predecessor corporations,
(2) Mergers,
(3) Reorganizations, and
(4) Changes of ownership;
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 5 › Subtitle 67 - MARYLAND HEALTHCHOICE PROGRAM › Chapter 10.67.03 - Maryland Medicaid Managed Care Program: MCO Application › Section 10.67.03.04 - Financial Solvency

Current through Register Vol. 51, No. 14, July 12, 2024
An applicant that is not a Maryland certified HMO shall
					 include in its application the following information or descriptions:
A. A table labeled "Insurance Coverage",
				  specifying the applicant's coverage in insurance types including, but not
				  limited to, reinsurance, risk of insolvency, medical malpractice, general
				  liability, and fidelity bond, and detailing the:
(1) Carrier,
(2) Entity covered,
(3) Description of coverage including
				  deductibles, coinsurance, and minimum and maximum benefits,
(4) Premium in effect,
(5) Any additional policies to cover new
				  risks associated with anticipated MCO functions, and
(6) Any other pertinent
				  arrangements;
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 5 › Subtitle 67 - MARYLAND HEALTHCHOICE PROGRAM › Chapter 10.67.03 - Maryland Medicaid Managed Care Program: MCO Application › Section 10.67.03.06 - Access and Capacity: Benefits and Appointments

Current through Register Vol. 51, No. 14, July 12, 2024
An MCO applicant shall include in its application the
					 following information or descriptions:
A. Written evidence of the applicant's
				  preparedness to provide benefits equivalent to the benefit level mandated by
				  the Maryland Medical Assistance Program as described in COMAR
				  10.67.67;
B. A description of any
				  benefits the applicant proposes to provide in addition to those required by the
				  Maryland Medicaid Managed Care Program, including:
(1) Whether there are any limitations on
				  these services; and
(2) The name,
				  medical specialty, location, and employment status as enumerated in Regulation
				  .05F(5) of this chapter, of any providers rendering additional
				  services;
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 5 › Subtitle 67 - MARYLAND HEALTHCHOICE PROGRAM › Chapter 10.67.03 - Maryland Medicaid Managed Care Program: MCO Application › Section 10.67.03.07 - Access and Capacity: Contracts and Provider Applications

Current through Register Vol. 51, No. 14, July 12, 2024
An MCO applicant shall include in its application the
					 following information or descriptions:
A. A description of the applicant's hiring
				  and subcontracting policies, which shall correspond to the requirements of
				  Insurance Article, §
										15-112, Annotated Code of
				  Maryland;
B. A blank copy of the
				  provider application form;
C.
				  Documentary assurances that the applicant and its health care providers furnish
				  access on a nondiscriminatory basis, in accordance with State and federal law,
				  to all of their enrollees regardless of gender, race, age, religion, national
				  origin, physical or mental disability, or type of illness or
				  condition;
D. If the applicant is
				  an HMO that will require its panel providers to participate in the MCO,
				  documentation of the mechanism the MCO will use to make an equitable
				  distribution of enrollees among its panel providers so that no provider is
				  assigned a disproportionate number of enrollees;
E. Written evidence of the applicant's
				  organizational capacity to provide special programs adequate to meet the
				  individual needs of all enrollees, including:
(1) Outreach;
(2) Case management;
(3) Home visiting;
(4) Disease management;
(5) Prevention and wellness education;
				  and
(6) All Medicaid-covered
				  services required to comply with State statutes and regulations mandating
				  health and behavioral health services for children in State-supervised
				  care;
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 5 › Subtitle 67 - MARYLAND HEALTHCHOICE PROGRAM › Chapter 10.67.03 - Maryland Medicaid Managed Care Program: MCO Application › Section 10.67.03.08 - National Committee on Quality Assurance (NCQA) Accreditation

Current through Register Vol. 51, No. 14, July 12, 2024
Effective July 1, 2012 an MCO applicant shall be NCQA
					 accredited within 2 years of their effective date as an MCO.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 5 › Subtitle 67 - MARYLAND HEALTHCHOICE PROGRAM › Chapter 10.67.03 - Maryland Medicaid Managed Care Program: MCO Application › Section 10.67.03.10 - Special Needs Populations

Current through Register Vol. 51, No. 14, July 12, 2024
An MCO applicant shall include in its application the
					 following information or descriptions:
A. A narrative description of the clinical
				  expertise and experience of the MCO's network for special needs populations in
				  a format specified by the Department;
B. Written evidence of the applicant's
				  ability to comply with specific quality access, data, and performance
				  measurements to satisfy the general requirements for all special needs
				  populations specified in COMAR 10.67.65.04C;
C. Written evidence, including treatment
				  protocols, of the applicant's ability to provide the range of clinical and
				  support services specified in COMAR 10.67.65.05-.10 and .13, to ensure
				  appropriate and coordinated services to the following special populations:
(1) Children with special health care
				  needs,
(2) Individuals with a
				  physical disability,
(3)
				  Individuals with a developmental disability,
(4) Pregnant and postpartum women,
(5) Individuals who are homeless,
(6) Individuals with HIV/AIDS, and
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 5 › Subtitle 67 - MARYLAND HEALTHCHOICE PROGRAM › Chapter 10.67.03 - Maryland Medicaid Managed Care Program: MCO Application › Section 10.67.03.11 - Management Information System and Data Reporting

Current through Register Vol. 51, No. 14, July 12, 2024
An MCO applicant shall include in its application the
					 following information or descriptions:
A. A description of the applicant's
				  management information system, including, but not limited to:
(1) Capacities, including:
(a) The ability to generate and transmit
				  electronic claims data consistent with the Medicaid Statistical Information
				  System (MSIS) requirements or successor systems;
(b) The ability to collect and report data on
				  enrollee and provider characteristics and on all services furnished to
				  enrollees through an encounter data system;
(c) The ability to screen the data collected
				  for completeness, logic, and consistency; and
(d) The ability to collect and report data
				  from providers in standardized formats using secure information exchanges and
				  technologies utilized for Medicaid quality improvement and care coordination
				  efforts;
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 5 › Subtitle 67 - MARYLAND HEALTHCHOICE PROGRAM › Chapter 10.67.04 - Maryland Medicaid Managed Care Program: Managed Care Organizations › Section 10.67.04.03 - Quality Assessment and Improvement

Current through Register Vol. 51, No. 14, July 12, 2024
A. An MCO shall have a continuous, systematic
				  program designed to monitor, measure, evaluate, and improve the quality of
				  health care services delivered to enrollees including individuals with special
				  health care needs. At a minimum, the MCO shall:
(1) Comply with all applicable federal and
				  State laws and regulations;
(2)
				  Comply with all access and quality standards and levels of performance
				  established by the Department including all standards for individuals with
				  special health care needs in Regulations .04-.10 of this chapter; and
(3) Be able to provide the Department with
				  timely accurate information in areas including but not limited to:
(a) Provider networks;
(b) Utilization of services; and
(c) Identification and management of
				  individuals with special health care needs, including but not limited to:
(i) Enrollees with HIV;
(ii) Pregnant women;
(iii) Enrollees with disabilities;
(iv) Adult enrollees with diabetes;
(v) Pediatric enrollees with asthma;
				  and
(vi) Children with special
				  health care needs.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 5 › Subtitle 67 - MARYLAND HEALTHCHOICE PROGRAM › Chapter 10.67.04 - Maryland Medicaid Managed Care Program: Managed Care Organizations › Section 10.67.04.03-1 - HealthChoice Health Equity Incentive Program

Current through Register Vol. 51, No. 14, July 12, 2024
A. The
				  Department shall award a defined amount of funding annually to MCOs based on
				  the county of residence of their members and the socioeconomic disadvantage
				  index described in this regulation.
B. Socioeconomic Disadvantage Index.
(1) The Department shall calculate a ranking
				  for each service area in Maryland in accordance with the following domains:
(a) Community safety;
(b) Food security;
(c) Housing security; and
(d) Transportation access.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 5 › Subtitle 67 - MARYLAND HEALTHCHOICE PROGRAM › Chapter 10.67.04 - Maryland Medicaid Managed Care Program: Managed Care Organizations › Section 10.67.04.03-2 - HealthChoice Population Health Incentive Program (PHIP)

Current through Register Vol. 51, No. 14, July 12, 2024
A. Effective
				  January 1, 2022, the Department shall establish the HealthChoice Population
				  Health Incentive Program (PHIP).
B.
				  An MCO may be eligible for an incentive payment for the following performance
				  measures:
(1) Ambulatory care visits for
				  Supplemental Security Income (SSI) adults;
(2) Ambulatory care visits for Supplemental
				  Security Income (SSI) children;
(3)
				  HEDIS asthma medication ratio;
(4)
				  Hemoglobin A1c control for patients with diabetes - poor control
				  (>9.0%);
(5) Lead screening
				  measures:
(a) Lead screening measure for
				  children 12-23 months old; and
(b)
				  HEDIS lead screening in children;
(6) HEDIS postpartum care;
(7) HEDIS risk of continued opioid
				  use->=31 days covered; and
(8)
				  HEDIS timeliness of prenatal care.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 5 › Subtitle 67 - MARYLAND HEALTHCHOICE PROGRAM › Chapter 10.67.04 - Maryland Medicaid Managed Care Program: Managed Care Organizations › Section 10.67.04.04 - Special Needs Populations

Current through Register Vol. 51, No. 14, July 12, 2024
A.
				  An MCO shall provide health care services to enrollees who are members of
				  special needs populations.
B.
				  Special needs populations consist of the following non-mutually exclusive
				  populations:
(1) Children with special health
				  care needs;
(2) Individuals with a
				  physical disability;
(3)
				  Individuals with a developmental disability;
(4) Pregnant and postpartum women;
(5) Individuals who are homeless;
(6) Individuals with HIV/AIDS; and
(7) Individuals with a need for substance
				  abuse treatment; and
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 5 › Subtitle 67 - MARYLAND HEALTHCHOICE PROGRAM › Chapter 10.67.04 - Maryland Medicaid Managed Care Program: Managed Care Organizations › Section 10.67.04.05 - Special Needs Populations - Children with Special Health Care Needs

Current through Register Vol. 51, No. 14, July 12, 2024
A. An MCO shall
				  meet the standards set forth in this regulation for treating children with
				  special health care needs.
B. The
				  Department shall maintain a record of the complaints received through the
				  Department's enrollee and provider hotlines which involve the denial of care
				  for children and review these complaint logs as part of its quality assurance
				  system.
C. An MCO shall demonstrate
				  that its therapies provider network is adequate by demonstrating its:
(1) Providers' pediatric
				  specialties;
(2) Collaboration with
				  schools that provide IEP or IFSP services to its enrollees, where available;
				  and
(3) Provision of family-focused
				  services and development of family-focused plans of care.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 5 › Subtitle 67 - MARYLAND HEALTHCHOICE PROGRAM › Chapter 10.67.04 - Maryland Medicaid Managed Care Program: Managed Care Organizations › Section 10.67.04.06 - Special Needs Populations - Individuals with a Physical Disability

Current through Register Vol. 51, No. 14, July 12, 2024
A. An MCO shall
				  meet the standards set forth in this regulation for treating an individual with
				  a physical disability.
B. An MCO
				  shall demonstrate that its providers for durable medical equipment and
				  assistive technology provide the appropriate services and are clinically
				  qualified to provide these services to the individual with a physical
				  disability.
C. Before placement of
				  an individual with a physical disability into an intermediate or long-term care
				  facility, an MCO shall:
(1) Recommend that an
				  individual with a physical disability be transferred to an intermediate or
				  long-term care facility only after assessing the needs of the individual and
				  the ability of the MCO to meet these needs in the community as supplemented by
				  other Medicaid services;
(2)
				  Conduct a second opinion review of the case, performed by the MCO's medical
				  director, before a transfer to an intermediate care facility or a long-term
				  care facility is implemented; and
(3) If the MCO's medical director determines
				  that the transfer to an intermediate or long- term care facility is medically
				  necessary and that the expected stay will be greater than 30 days, obtain
				  approval from the Department before making the transfer.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 5 › Subtitle 67 - MARYLAND HEALTHCHOICE PROGRAM › Chapter 10.67.04 - Maryland Medicaid Managed Care Program: Managed Care Organizations › Section 10.67.04.07 - Special Needs Populations - Individuals with a Developmental Disability

Current through Register Vol. 51, No. 14, July 12, 2024
A. An MCO shall
				  meet the standards set forth in this regulation for treating an individual with
				  a developmental disability.
B. An
				  MCO shall ensure that its case managers have experience or training related to
				  developmental disabilities.
C. An
				  MCO shall utilize individuals with expertise in disabilities to review its
				  marketing and informational forms and publications, which shall be provided in
				  alternative formats with reasonable accommodation to people with developmental
				  disabilities.
D. An MCO shall
				  provide education for the MCO's member services staff, triage staff, and case
				  managers on special communications requirements for individuals with
				  developmental disabilities.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 5 › Subtitle 67 - MARYLAND HEALTHCHOICE PROGRAM › Chapter 10.67.04 - Maryland Medicaid Managed Care Program: Managed Care Organizations › Section 10.67.04.08 - Special Needs Populations - Pregnant and Postpartum Women

Current through Register Vol. 51, No. 14, July 12, 2024
A. An MCO shall
				  meet the standards set forth in this regulation for treating pregnant and
				  postpartum women.
B. An MCO shall
				  ensure access to prenatal care for pregnant women and postpartum care for
				  postpartum women by:
(1) Scheduling an
				  appointment for the first prenatal visit and seeing the woman within 10 days of
				  request;
(2) Scheduling an
				  appointment for a postpartum woman and seeing the woman within 10 days of
				  request:
(3) Arranging for an
				  adequate network of providers including obstetricians, gynecologists,
				  perinatologists, neonatologists, anesthesiologists, and advanced practice
				  nurses who are capable of addressing complex maternal and infant health issues;
				  and
(4) Linking a pregnant woman
				  with a pediatric provider before delivery.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 5 › Subtitle 67 - MARYLAND HEALTHCHOICE PROGRAM › Chapter 10.67.04 - Maryland Medicaid Managed Care Program: Managed Care Organizations › Section 10.67.04.09 - Special Needs Populations - Homeless Individuals

Current through Register Vol. 51, No. 14, July 12, 2024
An MCO's initial health screen shall attempt to identify
					 homeless individuals and link them to the appropriate provider of
					 services.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 5 › Subtitle 67 - MARYLAND HEALTHCHOICE PROGRAM › Chapter 10.67.04 - Maryland Medicaid Managed Care Program: Managed Care Organizations › Section 10.67.04.10 - Special Needs Populations - Individuals with HIV/AIDS

Current through Register Vol. 51, No. 14, July 12, 2024
A. An MCO shall meet the standards set forth
				  in this regulation for treating individuals with HIV/AIDS.
B. HIV/AIDS Specialist.
(1) An MCO shall allow an enrollee with
				  HIV/AIDS to choose an HIV/AIDS specialist for treatment and coordination of
				  primary and specialty care.
(2) To
				  qualify as an HIV/AIDS specialist, a health care provider shall be board
				  certified in the field of infectious diseases by a member board of the American
				  Board of Medical Specialties or:
(a) Hold a
				  current, valid, unrevoked, and unsuspended Maryland license or certification as
				  a:
(i) Doctor of medicine;
(ii) Doctor of osteopathy;
(iii) Nurse practitioner; or
(iv) Physician's assistant being supervised
				  by a medical doctor;
(b)
				  Have provided direct, continuous, ongoing care for at least 20 patients with
				  HIV over the past 2 years; and
(c)
				  Have completed one of the following requirements:
(i) If a medical doctor, certified
				  physician's assistant being supervised by a medical doctor, or doctor of
				  osteopathy, at least 30 hours of HIV-related continuing medical education
				  category I credits over the past 2 years;
(ii) If a nurse practitioner, at least 30
				  hours of HIV-related continuing education units over the past 2
				  years;
(iii) If a medical doctor,
				  certified physician's assistant being supervised by a medical doctor, doctor of
				  osteopathy, or a nurse practitioner, an accredited training program over the
				  past year; or
(iv) If a medical
				  doctor, certified physician's assistant being supervised by a medical doctor,
				  doctor of osteopathy, or a nurse practitioner, has completed the American
				  Academy of HIV Medicine (AAHIVM) credentialing examination.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 5 › Subtitle 67 - MARYLAND HEALTHCHOICE PROGRAM › Chapter 10.67.04 - Maryland Medicaid Managed Care Program: Managed Care Organizations › Section 10.67.04.12 - Consumer Advisory Board

Current through Register Vol. 51, No. 14, July 12, 2024
A. An
				  MCO shall establish a consumer advisory board to facilitate the receipt of
				  input from enrollees.
B.The
				  consumer advisory board membership shall:
(1)
				  Consist of enrollees and enrollees' family members, guardians, or caregivers;
				  and
(2) Be comprised of no less
				  than one third representation from the MCO's special needs populations, or
				  their representatives and the MCO's special needs coordinator.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 5 › Subtitle 67 - MARYLAND HEALTHCHOICE PROGRAM › Chapter 10.67.04 - Maryland Medicaid Managed Care Program: Managed Care Organizations › Section 10.67.04.13 - Children in State-Supervised Care

Current through Register Vol. 51, No. 14, July 12, 2024
A. An MCO shall provide or arrange to provide
				  all Medicaid-covered services required to comply with State statutes and
				  regulations mandating health and mental health services for children in
				  State-supervised care.
B. An MCO
				  shall ensure the continuity and coordination of care, provided locally to the
				  extent the services are available, to an enrollee who is a child in
				  State-supervised care.
C. An
				  enrollee who is a child in State-supervised care who moves shall be disenrolled
				  from the recipient's MCO and enrolled in an alternative MCO if the recipient's
				  current MCO does not serve the geographic region to which the child has been
				  relocated.
D. An MCO shall expedite
				  a change of providers within its provider panel upon the move of an enrollee
				  who is a child in State-supervised care to a new geographic area served by the
				  MCO.
E. On request of the
				  responsible State or local agency, a child in State-supervised care may be
				  disenrolled from the current MCO and enrolled in an MCO serving the group
				  facility in which the child resides, members of the foster care family, or
				  other children in foster care placement with the child.
F. Enrollee Self-Referral. An MCO shall
				  permit the self-referral of a child in State-supervised care to an EPSDT
				  certified provider for an initial examination, including a mental health
				  screen, and shall pay for all portions of the examination except for the mental
				  health screen, which shall be paid for by the Specialty Mental Health
				  System.
G. Coordination with
				  Responsible Agency. An MCO shall appoint a liaison to coordinate services to a
				  child in State-supervised care with the responsible State or local
				  agencies.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 5 › Subtitle 67 - MARYLAND HEALTHCHOICE PROGRAM › Chapter 10.67.04 - Maryland Medicaid Managed Care Program: Managed Care Organizations › Section 10.67.04.14 - Referral to Behavioral Health ASO

Current through Register Vol. 51, No. 14, July 12, 2024
A. An MCO is responsible for providing
				  medically necessary primary behavioral health services to their
				  enrollees.
B. An enrollee may
				  self-refer to the behavioral health ASO for services described in COMAR
				  10.67.59 or 10.67.80.
C. If an
				  enrollee's primary care physician determines that primary behavioral health
				  services are not sufficient to meet the enrollee's needs, the primary care
				  physician shall refer the enrollee to the behavioral health ASO for services
				  described in COMAR 10.67.59 or 10.67.80.
D. If an MCO determines that primary
				  behavioral health services are not sufficient to meet the enrollee's needs, the
				  MCO shall refer the enrollee to the behavioral health ASO for services
				  described in COMAR 10.67.59 or 10.67.80.
E. An MCO shall cooperate with the behavioral
				  health ASO in developing referral procedures and protocols.