Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.10 - Nursing Facility Services › Section 10.09.10.03 - Conditions for Participation

Current through Register Vol. 51, No. 14, July 12, 2024
To participate in the Program, the provider shall:
A. Be certified by the Department at its
				  total licensed nursing facility bed capacity as meeting the requirements of
				  Title XIX of the Social Security Act,
				  42 U.S.C. §
											1396 et seq., for participation as a nursing
				  facility;
B. Be in compliance with
				  preadmission screening and resident review requirements as described by 42 CFR
				  Part 483, Subpart C (1996);
C. Be
				  in compliance with the requirements of COMAR 10.09.36;
D. Be approved for participation by the
				  Department;
E. Have a provider
				  agreement in effect;
F. Employ an
				  organized medical staff or a medical director who is a licensed
				  physician;
G. Provide, according to
				  the needs of the recipient, those services listed in Regulation .04 of this
				  chapter;
H. Accept payment by the
				  Department as payment in full for covered services rendered and make no
				  additional charge to any person for covered services except as provided for in
				  Regulation .28 of this chapter;
I.
				  Maintain adequate records for a minimum of 6 years and make them available,
				  upon request, to the Department or its designee;
J. Provide services without regard to race,
				  color, age, sex, national origin, marital status, physical or mental
				  handicap;
K. Verify the recipient's
				  eligibility;
L. Place no
				  restriction on a recipient's right to select providers of his choice;
M. Have in effect a predischarge
				  plan;
N. Agree that if the Program
				  denies payment or requests repayment on the basis that an otherwise covered
				  service was not medically necessary or preauthorized in accordance with
				  Regulation .06 of this chapter, the provider may not seek payment for that
				  service from the recipient;
O.
				  Perform utilization control functions for all recipients designated eligible
				  for nursing facility services as described by 42 CFR §§ 346.370,
				  456.360,
				  456.371,
				  456.380, and
				  456.381 (1996), and as required by
				  the Utilization Control Plan for Selected Institutional Services Reimbursed by
				  the Maryland Medical Assistance Program;
P. Notify the Department or its designee of
				  patient activity or circumstance that affects placement, eligibility, or
				  reimbursement on such form and at such time as specified by the
				  Department;
Q. Before discharging
				  any Medical Assistance recipient certified as requiring nursing facility
				  services, place in the recipient's permanent medical record the following
				  information on a consent form designated by the Department, a copy of which
				  shall be submitted to the Department and to the Office on Aging:
(1) A certification that the recipient or
				  guardian has:
(a) Been informed of the
				  recipient's right to remain in the discharging facility and have the cost of
				  care paid by the Medical Assistance Program,
(b) Been informed that the Medical Assistance
				  Program will not pay for room and board in a setting outside of a nursing
				  facility and that the Program may pay for the cost of medical services received
				  outside of a nursing facility subject to medical and financial eligibility
				  determinations and covered services limitations,
(c) Been informed of the recipient's right as
				  a patient, as stated in the Health-General Article, §19-345, Annotated
				  Code of Maryland,
(d) Been informed
				  of the services provided by and the location of the alternative
				  placement,
(e) Voluntarily given
				  informed consent to the transfer;