reglab/statecodes huggingface dataset:
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.84 - Community First Choice › Section 10.09.84.15 - Covered Services - Supports Planning

Current through Register Vol. 51, No. 14, July 12, 2024
A. Supports planning services shall:
(1) Address the individualized needs of the
				  participant;
(2) Be sensitive to
				  the educational background, culture, and general environment of the
				  participant;
(3) Support the
				  participant to self-direct services and exercise as much control as desired to
				  select, train, supervise, schedule, determine duties, and dismiss the personal
				  assistance worker; and
(4) Ensure
				  freedom of choice among any willing provider for all services.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.84 - Community First Choice › Section 10.09.84.16 - Covered Services - Consumer Training

Current through Register Vol. 51, No. 14, July 12, 2024
A. Consumer training includes instruction and
				  skill building in such areas including, but not limited to, acquisition,
				  maintenance, and enhancement of skills necessary for the participant to
				  accomplish ADLs and IADLs.
B. The
				  topics covered by consumer training shall be:
(1) Targeted to the individualized needs of
				  the participant receiving the training; and
(2) Sensitive of the educational background,
				  culture, and general environment of the participant receiving the
				  training.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.84 - Community First Choice › Section 10.09.84.17 - Covered Services - Personal Emergency Response Systems

Current through Register Vol. 51, No. 14, July 12, 2024
A. The Program
				  covers the following related to a device, system, or piece of equipment
				  described under §B of this regulation:
(1) Purchase and installation;
(2) Monthly cost of a covered system or
				  rented device or equipment, including monitoring, maintenance, and
				  repair.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.84 - Community First Choice › Section 10.09.84.18 - Covered Services - Items or Services that Substitute for Human Assistance

Current through Register Vol. 51, No. 14, July 12, 2024
A. The
				  program covers items or services that increase a participant's independence or
				  substitute for human assistance, to the extent that expenditures would
				  otherwise be made for the human assistance.
B. Each item or service shall:
(1) Be preauthorized in the participant's
				  plan of service as necessary to:
(a) Prevent
				  the participant's institutionalization; and
(b) Ensure the participant's health, safety,
				  and independence;
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.84 - Community First Choice › Section 10.09.84.19 - Covered Services - Environmental Assessments and Adaptations

Current through Register Vol. 51, No. 14, July 12, 2024
A. The Program
				  covers an on-site environmental assessment and adaptations of a home or
				  residence where the participant lives or will live as a participant.
B. An environmental assessment or adaptation
				  may not be provided before the effective date of the participant's enrollment
				  in services.
C. The environmental
				  assessment may be recommended by a multidisciplinary team in the plan of
				  service for a participant when an environmental assessment is considered
				  necessary to:
(1) Ensure the health and
				  safety of a participant with special environmental needs; and
(2) Obtain additional professional advice
				  from an occupational therapist about the:
(a)
				  Physical structure of a participant's home or residence; and
(b) Functional or mental limitations or
				  disabilities of a participant as they relate to the environment.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.84 - Community First Choice › Section 10.09.84.20 - Covered Services - Nurse Monitoring

Current through Register Vol. 51, No. 14, July 12, 2024
A. The program covers the following services
				  when provided by a nurse monitor:
(1) Being
				  available to give instruction and to answer questions;
(2) Complying with the Department's
				  reportable events policy; and
(3)
				  Maintaining an up-to-date client profile in an electronic database designated
				  by the Department.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.84 - Community First Choice › Section 10.09.84.21 - Covered Services Section Transition Services

Current through Register Vol. 51, No. 14, July 12, 2024
A. Definition. "Transition service" means a
				  service that is:
(1) Not otherwise available
				  under the Program;
(2) Approved in
				  the plan of service; and
(3)
				  Rendered to assist the participant in transitioning from an institution or a
				  provider-owned residence to a home or community-based residence.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.84 - Community First Choice › Section 10.09.84.22 - Conditions for Reimbursement

Current through Register Vol. 51, No. 14, July 12, 2024
The Program shall reimburse for the services specified in
					 Regulations .14-.21 of this chapter, if provided in accordance with the
					 requirements of this chapter and if the service:
A. Is recommended on the participant's plan
				  of service as necessary in order to:
(1)
				  Prevent the applicant's or participant's admission to an institution;
(2) Safely transition the applicant or
				  participant from an institution, such as a nursing facility, into the
				  community; or
(3) Assure the health
				  and safety of an applicant or participant in the community;
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.84 - Community First Choice › Section 10.09.84.23 - Limitations

Current through Register Vol. 51, No. 14, July 12, 2024
A. Reimbursement
				  for Personal Emergency Response System is limited to participants who:
(1) Live alone; or
(2) Have no regular caregiver for extended
				  parts of the day and would otherwise require extensive routine supervision to
				  ensure the participant's health and safety.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.84 - Community First Choice › Section 10.09.84.24 - Payment Procedures

Current through Register Vol. 51, No. 14, July 12, 2024
A. Request
				  for Payment - Personal Assistance. To receive payment as a personal assistance
				  provider agency under Regulation .14 of this chapter, a provider and its
				  workers shall use the telephonic timekeeping system approved by the Department
				  to:
(1) Document time; and
(2) Submit claims.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.84 - Community First Choice › Section 10.09.84.25 - Recovery and Reimbursement

Current through Register Vol. 51, No. 14, July 12, 2024
Recovery and reimbursement are as set forth in COMAR
					 10.09.36.07.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.84 - Community First Choice › Section 10.09.84.26 - 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 10.09.36.08.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.84 - Community First Choice › Section 10.09.84.27 - Appeal Procedures - Providers

Current through Register Vol. 51, No. 14, July 12, 2024
Appeal procedures shall be as set forth in:
A. COMAR
				  10.09.36.09; and
B. COMAR 10.01.03.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.84 - Community First Choice › Section 10.09.84.28 - Appeal Procedures - Applicants and Participants

Current through Register Vol. 51, No. 14, July 12, 2024
Appeal procedures for applicants and participants are those
					 set forth in:
A. COMAR
				  10.09.24.13; and
B. COMAR 10.01.04.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.84 - Community First Choice › Section 10.09.84.29 - 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 10.09.85 - Free-Standing Birth Centers › Section 10.09.85.01 - Definitions

Current through Register Vol. 51, No. 14, July 12, 2024
A. The following
				  terms have the meanings indicated.
B. Terms Defined.
(1) "Certified nurse midwife (CNM)" means a
				  registered nurse who is certified by the American College of Nurse-Midwives,
				  and is licensed in the state in which the service is provided.
(2) "Commission for the Accreditation of
				  Birth Centers (CABC)" means the independent authority that accredits developing
				  and existing birth centers in the United States of America, according to
				  established national standards.
(3)
				  "Department" means the Department of Health and Mental Hygiene.
(4) "Free-standing Birth Center" means a
				  free-standing facility not associated with a hospital that provides physician
				  or certified nurse midwifery services.
(5) "Medical Assistance Program" means the
				  program, financed by federal, state, and local funds, for the comprehensive
				  medical care for persons of all ages within certain income limits.
(6) "Medically necessary" means the service
				  or benefit is:
(a) Directly related to
				  diagnostic, preventive, curative, palliative, rehabilitative, or ameliorative
				  treatment of an illness, injury, disability, or health condition;
(b) Consistent with current accepted
				  standards of good medical practice;
(c) The most cost efficient service that can
				  be provided without sacrificing effectiveness or access to care; and
(d) Not primarily for the convenience of the
				  consumer, family, or provider.
(7) "Newborn" means an infant who is not more
				  than 48 hours old.
(8)
				  "Participant" means an individual who is eligible for Program
				  benefits.
(9) "Physician" means an
				  individual legally licensed to practice medicine by the Board or in the state
				  in which the physician's practice is located.
(10) "Program" means the Maryland Medical
				  Assistance Program.
(11) "Provider"
				  means a free-standing birth center.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.85 - Free-Standing Birth Centers › Section 10.09.85.02 - License Requirements

Current through Register Vol. 51, No. 14, July 12, 2024
A. A
				  free-standing birth center shall be certified by the Commission for the
				  Accreditation of Birth Centers, and:
(1) Be
				  licensed to operate in Maryland pursuant to Health General Article 19, Subtitle
				  3b, Annotated Code of Maryland and in accordance with the requirements as set
				  forth in COMAR 10.05.02; or
(2) If
				  located out-of-State, comply with the regulations of the jurisdiction in which
				  the free-standing birth center is located.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.85 - Free-Standing Birth Centers › Section 10.09.85.03 - 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 free-standing birth center require that the
				  provider:
(1) Verify the licenses and
				  credentials of all clinical professionals employed by or under contract with
				  the free-standing birth center as set forth in COMAR 10.05.02.04.
(2) Maintain adequate documentation of each
				  participant's delivery service and newborn care as set forth in COMAR
				  10.05.02.11.
(3) Comply with
				  safety requirements as set forth in COMAR
				  10.05.02.09 and COMAR 10.05.02.10.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.85 - Free-Standing Birth Centers › Section 10.09.85.04 - Covered Services

Current through Register Vol. 51, No. 14, July 12, 2024
The Program covers the facility-related services provided
					 by the free-standing birth center for the care of the delivering mother and
					 newborn, and covers the cost of;
A.
				  Support staff;
B. The use of the
				  free-standing birth center; and
C.
				  Supplies, linens, and equipment.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.85 - Free-Standing Birth Centers › Section 10.09.85.05 - Limitations

Current through Register Vol. 51, No. 14, July 12, 2024
A. The Program does
				  not cover laboratory or x-ray services performed by another facility. The
				  facility performing these services shall bill the Program directly.
B. Professional services are to be billed
				  separately from the free-standing birth center facility fee.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.85 - Free-Standing Birth Centers › Section 10.09.85.06 - Payment Procedures

Current through Register Vol. 51, No. 14, July 12, 2024
A. The
				  Program will reimburse free-standing birth centers for:
(1) A facility fee of $2,000 for the care of
				  the delivering mother and delivery of the newborn, if the delivery takes place
				  at the facility; and
(2) A facility
				  fee of $500 for the care of the newborn.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.85 - Free-Standing Birth Centers › Section 10.09.85.07 - Recovery and Reimbursement

Current through Register Vol. 51, No. 14, July 12, 2024
A.
				  If the recipient has insurance or if any other person is obligated either
				  legally or contractually to pay for or to reimburse for any service covered by
				  this chapter, 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 Department.
				  The provider shall submit a copy of the insurance carrier's notice or
				  remittance advice with the claim. If payment is made by both the Program and by
				  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 by the insurance or other source, whichever is less.
B. The provider shall reimburse the
				  Department for any overpayment.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.85 - Free-Standing Birth Centers › Section 10.09.85.08 - Cause for Suspension or Removal and Imposition of Sanctions

Current through Register Vol. 51, No. 14, July 12, 2024
Causes for suspension or removal and imposition of
					 sanctions shall be as set forth in COMAR
					 10.09.36.08
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.85 - Free-Standing Birth Centers › Section 10.09.85.09 - Appeals Procedures

Current through Register Vol. 51, No. 14, July 12, 2024
Appeal procedures are as set forth in COMAR 10.09.36.09.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.85 - Free-Standing Birth Centers › Section 10.09.85.10 - Interpretive Regulation

Current through Register Vol. 51, No. 14, July 12, 2024
General policies governing the interpretive regulations
					 that are applicable to all providers are 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 10.09.86 - Maryland Medicaid Managed Care Program: Independent Review Organization (IRO) (Recodified to be COMAR 10.67.13) › Section 10.09.86.01 - Scope and Purpose (Recodified)

Current through Register Vol. 51, No. 14, July 12, 2024
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.86 - Maryland Medicaid Managed Care Program: Independent Review Organization (IRO) (Recodified to be COMAR 10.67.13) › Section 10.09.86.02 - Definitions (Recodified)

Current through Register Vol. 51, No. 14, July 12, 2024
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.86 - Maryland Medicaid Managed Care Program: Independent Review Organization (IRO) (Recodified to be COMAR 10.67.13) › Section 10.09.86.03 - Use of Independent Review Organizations (Recodified)

Current through Register Vol. 51, No. 14, July 12, 2024
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.86 - Maryland Medicaid Managed Care Program: Independent Review Organization (IRO) (Recodified to be COMAR 10.67.13) › Section 10.09.86.04 - Conflicts of Interest Standards for Independent Review Organizations and Expert Reviewers (Recodified)

Current through Register Vol. 51, No. 14, July 12, 2024
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.86 - Maryland Medicaid Managed Care Program: Independent Review Organization (IRO) (Recodified to be COMAR 10.67.13) › Section 10.09.86.05 - Assignment of an Expert Reviewer (Recodified)

Current through Register Vol. 51, No. 14, July 12, 2024
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.86 - Maryland Medicaid Managed Care Program: Independent Review Organization (IRO) (Recodified to be COMAR 10.67.13) › Section 10.09.86.06 - Independent Review (Recodified)

Current through Register Vol. 51, No. 14, July 12, 2024
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.86 - Maryland Medicaid Managed Care Program: Independent Review Organization (IRO) (Recodified to be COMAR 10.67.13) › Section 10.09.86.07 - Payment of Fees and Sanctions (Recodified)

Current through Register Vol. 51, No. 14, July 12, 2024
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.86 - Maryland Medicaid Managed Care Program: Independent Review Organization (IRO) (Recodified to be COMAR 10.67.13) › Section 10.09.86.08 - Appeal (Recodified)

Current through Register Vol. 51, No. 14, July 12, 2024
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.87 - Free-Standing Independent Diagnostic Testing Facilities › Section 10.09.87.01 - Definitions

Current through Register Vol. 51, No. 14, July 12, 2024
A. In this chapter,
				  the following terms have the meanings indicated.
B. Terms Defined.
(1) "CMS" means Centers for Medicare and
				  Medicaid Services.
(2) "Department"
				  means The Department of Health and Mental Hygiene.
(3) "Independent Diagnostic Testing Facility
				  (IDTF)" means a fixed location or mobile entity independent of a hospital or
				  physician's office where diagnostic services are performed by licensed
				  certified non-physician personnel under appropriate physician
				  supervision.
(4) "Major medical
				  equipment" means:
(a) All cardiac
				  catheterization equipment necessary to perform heart catheterization;
(b) A computerized tomography (CT)
				  scanner;
(c) A
				  lithotriptor;
(d) Radiation therapy
				  equipment, including a linear accelerator; and
(e) A Magnetic Resonance Imager
				  (MRI).
(5) "Mammography"
				  means the radiographic examination of the soft tissues of the breast.
(6) "Medically necessary" means medically
				  necessary as defined in COMAR 10.09.36.01.
(7) "Medicare" means the insurance program
				  administered by the federal government under Title XVIII of the Social Security
				  Act, 42 U.S.C. §
												1395 et seq.
(8) "NPI" means National Provider
				  Identifier.
(9) "Program" means the
				  Maryland Medical Assistance Program.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.87 - Free-Standing Independent Diagnostic Testing Facilities › Section 10.09.87.02 - License Requirements

Current through Register Vol. 51, No. 14, July 12, 2024
A. The
				  provider shall meet all license requirements as set forth in COMAR 10.09.36.02.
B. A facility or mobile unit that
				  is operating radiological equipment shall be licensed or certified and
				  registered by the Department of the Environment in accordance with COMAR
				  26.12.01 through COMAR 26.12.03.
C.
				  A facility that performs mammography services shall be certified by the Food
				  and Drug Administration (FDA).
D. A
				  facility operating major medical equipment shall meet all the general licensing
				  requirements for a facility as provided in COMAR 10.05.03.02.
E. The driver of the Mobile IDTF unit:
(1) Shall possess a valid operator's license
				  appropriate for the type of vehicle that is driven; and
(2) May not have:
(a) Violations related to the operation of a
				  motor vehicle in the last 3 years; and
(b) Any violations involving alcohol or other
				  illegal substances related to the operation of a motor vehicle in the last 10
				  years.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.87 - Free-Standing Independent Diagnostic Testing Facilities › Section 10.09.87.03 - 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. Requirements for participation
				  in the Program as an IDTF provider/mobile IDTF provider require that the
				  provider:
(1) Be approved by Medicare to
				  furnish diagnostic services in an IDTF;
(2) Meets the licensure requirements in
				  accordance with Regulation .02 of this chapter; and
(3) Meets performance standards in accordance
				  with 42 CFR §
												410.33(g).
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.87 - Free-Standing Independent Diagnostic Testing Facilities › Section 10.09.87.04 - Covered Services

Current through Register Vol. 51, No. 14, July 12, 2024
A. The
				  Program covers medically necessary radiology services rendered to a recipient
				  in an IDTF when the services are:
(1)
				  Rendered in a CMS certified IDTF or an IDTF Mobile Unit;
(2) Provided according to the laws and
				  regulations of the state and locality in which they are rendered;
(3) Rendered by a physician or supervised
				  technician;
(4) Ordered in writing
				  by the treating physician or non-physician practitioner, in accordance with
				  State law, who is enrolled as a provider in the Program with an active status
				  on the date of service; and
(5)
				  Adequately documented in the recipient's medical record.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.87 - Free-Standing Independent Diagnostic Testing Facilities › Section 10.09.87.05 - Limitations

Current through Register Vol. 51, No. 14, July 12, 2024
The Program does not cover the following:
A. Services for which the IDTF provider
				  cannot supply a properly completed order identifying the authorized ordering
				  practitioner by National Provider Identifier (NPI);
B. IDTF services ordered by an:
(1) Individual who is not enrolled as a
				  provider in the Program with an active status on the date of service;
				  and
(2) Entity, facility, or
				  another provider that is not an individual.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.87 - Free-Standing Independent Diagnostic Testing Facilities › Section 10.09.87.07 - Payment Procedures

Current through Register Vol. 51, No. 14, July 12, 2024
A. General
				  policies for payment that are applicable to all providers are set forth in
				  COMAR 10.09.36.04.
B. IDTF
				  providers shall identify the individual who ordered the diagnostic services by
				  either:
(1) Recording the National Provider
				  Identifier (NPI) number for the individual provider on the claim; or
(2) Recording the name and NPI of the
				  authorized ordering provider on the invoice and attaching to the invoice a copy
				  of the properly completed order that identifies the authorized ordering
				  provider.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.87 - Free-Standing Independent Diagnostic Testing Facilities › Section 10.09.87.08 - Recovery and Reimbursement

Current through Register Vol. 51, No. 14, July 12, 2024
General policies governing recovery and reimbursement
					 procedures that are applicable to all providers 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 10.09.87 - Free-Standing Independent Diagnostic Testing Facilities › Section 10.09.87.09 - Cause for Suspension or Removal and Imposition of Sanctions

Current through Register Vol. 51, No. 14, July 12, 2024
General policies governing the cause for suspension and
					 removal and imposition of sanctions procedures that are applicable to all
					 providers 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 10.09.87 - Free-Standing Independent Diagnostic Testing Facilities › Section 10.09.87.10 - Appeal Procedures

Current through Register Vol. 51, No. 14, July 12, 2024
General policies governing appeal procedures that are
					 applicable to all providers are set forth in COMAR 10.09.36.09.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.88 - Portable X-ray Providers › Section 10.09.88.01 - Definitions

Current through Register Vol. 51, No. 14, July 12, 2024
A. In this chapter,
				  the following terms have the meanings indicated.
B. Terms Defined.
(1) "CMS" means Centers for Medicare and
				  Medicaid Services.
(2) "Department"
				  means the Maryland Department of Health and Mental Hygiene.
(3) "Mammography" means the radiographic
				  examination of the soft tissues of the breast.
(4) "Medical Assistance Program" means the
				  program of comprehensive medical and other health-related care for indigent and
				  medically indigent persons.
(5)
				  "Medically necessary" means medically necessary as defined in COMAR
				  10.09.36.01.
(6) "Medicare" means
				  the insurance program administered by the federal government under Title XVIII
				  of the Social Security Act, 42 U.S.C. §
												1395 et
				  seq.
(7) "NPI" means National
				  Provider Identifier.
(8) "Program"
				  means the Medical Assistance Program.
(9) "Portable X-ray provider" means an entity
				  that moves its portable X-ray equipment that is separate from and unattached to
				  the vehicle to a fixed location (e.g. a physician's office or nursing
				  home).
(10) "Provider" means:
(a) An individual, association, partnership,
				  corporation, unincorporated group, or any other person authorized, licensed, or
				  certified to provide services for Program recipients and who, through
				  appropriate agreement with the Department, has been identified as a Program
				  provider by the issuance of an individual account number;
(b) An agent, employee, or related party of a
				  person identified in §B(10)(a) of this regulation; or
(c) An individual or any other person with an
				  ownership interest in a person identified in §B(10)(a) of this
				  regulation.
(11)
				  "Recipient" means an individual who is certified as eligible for, and is
				  receiving, Medical Assistance benefits.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.88 - Portable X-ray Providers › Section 10.09.88.02 - License Requirements

Current through Register Vol. 51, No. 14, July 12, 2024
A.
				  Providers of Medical Assistance Program services shall, to the extent required
				  by law, be licensed and legally authorized to practice or deliver services in
				  the state in which the service is provided.
B. The provider and the equipment personnel
				  shall be licensed or registered in accordance with applicable federal, State
				  and local laws in accordance with
				  42 CFR §
											486.100.
C. The portable X-ray provider shall be
				  certified and registered by the Department of Environment in accordance with
				  COMAR 26.12.01-.03
D. A portable
				  X-ray provider that performs mammography services shall be certified by the
				  Food and Drug Administration (FDA).
E. The driver that transports portable X-ray
				  equipment:
(1) Shall possess a valid
				  operator's license appropriate for the type of vehicle that is
				  driven;
(2) May not have violations
				  related to the operation of a motor vehicle in the last 3 years; and
(3) May not have any violations involving
				  alcohol or other illegal substances related to the operation of a motor vehicle
				  in the last 10 years.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.88 - Portable X-ray Providers › Section 10.09.88.03 - Conditions for Participation

Current through Register Vol. 51, No. 14, July 12, 2024
A.
				  A provider shall meet all conditions for participation as set forth in COMAR
				  10.09.36.03.
B. The provider shall
				  also:
(1) Be certified by CMS to furnish
				  portable X-ray services;
(2) Meet
				  the licensure requirements as provided in Regulation .02 of this
				  chapter;
(3) Meet performance
				  standards in accordance with 42 CFR §
												410.33(g);
(4) Ensure that portable X-ray services are
				  rendered under the supervision of a qualified physician in accordance with
				  42 CFR §
												486.102;
(5) Ensure that portable X-ray services are
				  rendered by a qualified technician in accordance with
				  42 CFR §
												486.104;
(6) Ensure that portable X-ray services
				  performed for Medical Assistance recipients are ordered by a doctor of medicine
				  or a doctor of osteopathy and records are properly preserved in accordance with
				  42 CFR §
												486.106;
(7) Ensure that inspections of all X-ray
				  equipment and shielding are made by qualified individuals at intervals not
				  greater than 24 months in accordance with
				  42 CFR §
												486.110; and
(8) Identify the ordering practitioner who
				  authorized the diagnostic services by either:
(a) Recording the National Provider
				  Identifier (NPI) number for the individual practitioner on the claim;
				  or
(b) Recording the name and NPI
				  of the authorized ordering practitioner on the invoice and attaching to the
				  invoice a copy of the properly completed order that identifies the authorized
				  ordering practitioner.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.88 - Portable X-ray Providers › Section 10.09.88.04 - Covered Services

Current through Register Vol. 51, No. 14, July 12, 2024
A. The
				  Program covers medically necessary services rendered to recipients, when the
				  services are:
(1) Provided according to the
				  laws and regulations of the State and locality in which they are rendered in
				  accordance with 42 CFR
				  §
												486.100;
(2) Rendered by a physician who meets the
				  qualification standards in accordance with
				  42 CFR §
												486.102 or qualified non-physician
				  (technician) who meets the qualification standards in accordance to
				  42 CFR §
												486.104; and
(3) Ordered in writing by the treating
				  physician or nurse practitioner who is enrolled as a provider in the Program
				  with an active status on the date of service in accordance with State
				  law.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.88 - Portable X-ray Providers › Section 10.09.88.05 - Limitations

Current through Register Vol. 51, No. 14, July 12, 2024
The Program does not cover the following:
A. Services for which the portable X-ray
				  provider cannot provide a properly completed order identifying the authorized
				  ordering physician or practitioner by National Provider Identifier
				  (NPI);
B. Services not adequately
				  documented in the recipient's medical record;
C. Services not medically
				  necessary;
D. Procedures that are
				  known by the provider as investigational or experimental in nature;
E. Services which are specifically included
				  as an integral part of another service;
F. Consultations;
G. Office visits;
H. Injections;
I. Surgeries; and
J. Therapeutic services.
K. X-ray services ordered by an:
(1) Individual who is not enrolled as a
				  provider in the Program with an active status on the date of service;
				  and
(2) Entity, facility, or
				  another provider that is not an individual.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.88 - Portable X-ray Providers › Section 10.09.88.07 - Payment Procedures

Current through Register Vol. 51, No. 14, July 12, 2024
A. General
				  policies for payment that are applicable to all providers are set forth in
				  COMAR 10.09.36.04.
B. The
				  Department shall allow a single transportation payment for each trip the
				  portable X-ray provider makes to a particular location.
C. The Department shall reimburse for covered
				  services at the lesser of:
(1) The provider's
				  customary charge unless the service is free to individuals not covered by
				  Medicaid, or
(2) The Department's
				  fee schedule.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.88 - Portable X-ray Providers › Section 10.09.88.08 - Recovery and Reimbursement

Current through Register Vol. 51, No. 14, July 12, 2024
General policies governing recovery and reimbursement
					 procedures that are applicable to all providers 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 10.09.88 - Portable X-ray Providers › Section 10.09.88.09 - Cause for Suspension or Removal and Imposition of Sanctions

Current through Register Vol. 51, No. 14, July 12, 2024
General policies governing the cause for suspension and
					 removal and imposition of sanctions procedures that are applicable to all
					 providers 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 10.09.88 - Portable X-ray Providers › Section 10.09.88.10 - Appeal Procedures

Current through Register Vol. 51, No. 14, July 12, 2024
General policies governing appeal procedures that are
					 applicable to all providers are set forth in COMAR 10.09.36.09.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.89 - 1915(i) Intensive Behavioral Health Services for Children, Youth, and Families › Section 10.09.89.01 - Scope

Current through Register Vol. 51, No. 14, July 12, 2024
The purpose of this chapter is to implement a home and
					 community-based services benefit for children and youth with serious emotional
					 disturbances (SED) and their families, authorized under a 1915(i) Medicaid
					 State Plan Amendment. Eligible participants are served by care coordination
					 organizations through a care coordination service delivery model that utilizes
					 child and family teams to create and implement individualized plans of care
					 that are driven by the strengths and needs of the participants and their
					 families.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.89 - 1915(i) Intensive Behavioral Health Services for Children, Youth, and Families › Section 10.09.89.03 - Participant Eligibility

Current through Register Vol. 51, No. 14, July 12, 2024
A. For an
				  applicant to be eligible for 1915(i) services, the applicant shall meet all of
				  the criteria in §§B-H of this regulation.
B. The applicant shall be younger than 18
				  years old at the time of enrollment.
C. The applicant shall reside in a home- and
				  community-based setting that is:
(1) Located
				  in the 1915(i) service area; and
(2) Not any of the following excluded
				  settings:
(a) Therapeutic Group Home (TGH)
				  licensed by the Behavioral Health Administration (BHA) under COMAR
				  10.21.07;
(b) Psychiatric Respite
				  Care facility located on the grounds of an institution for mental disease (IMD)
				  for the purpose of placement;
(c)
				  Residential program for adults with serious mental illness licensed under COMAR
				  10.63; or
(d) Group residential
				  facility licensed under COMAR 10.63.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.89 - 1915(i) Intensive Behavioral Health Services for Children, Youth, and Families › Section 10.09.89.04 - Termination of Participant Enrollment

Current through Register Vol. 51, No. 14, July 12, 2024
A. A participant shall be disenrolled from
				  the 1915(i), as of the date established by the Department, if the participant:
(1) No longer meets all of the criteria for
				  1915(i) eligibility specified in §§A-H of Regulation .03 of this
				  chapter;
(2) Voluntarily chooses to
				  disenroll from the benefit, if the participant is 18 years old, or the
				  participant's family or medical guardian chooses to do so on behalf of a
				  participant who is younger than 18 years old or in the custody of the State, or
				  both;
(3) Is hospitalized for
				  longer than 30 days;
(4) Moves out
				  of the service area and cannot reasonably access services and
				  supports;
(5) Is admitted to and
				  placed in an RTC for longer than 60 days;
(6) Is admitted to and placed in a
				  Therapeutic Group Home (TGH) licensed by BHA under COMAR 10.21.07 or an adult
				  residential program approved under COMAR 10.21.22;
(7) Is placed in a Psychiatric Respite Care
				  program, a non-medical group residential facility located on the grounds of an
				  IMD primarily for the purpose of placement;
(8) Loses eligibility for Maryland Medical
				  Assistance for more than 30 days;
(9) Turns 22 years old;
(10) Is detained, committed to a juvenile
				  justice or correctional facility, or incarcerated for longer than 60
				  days;
(11) Does not meet medical
				  re-certification criteria;
(12)
				  Does not participate in a Child and Family Team (CFT) meeting within 90
				  days;
(13) Is no longer actively
				  engaged in ongoing behavioral health treatment with a licensed mental health
				  professional; or
(14) Is placed in
				  a group residential facility licensed under COMAR 14.31.05-.07.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.89 - 1915(i) Intensive Behavioral Health Services for Children, Youth, and Families › Section 10.09.89.05 - 1915(i) Model

Current through Register Vol. 51, No. 14, July 12, 2024
A. The 1915(i)
				  shall provide community-based treatment to children with SED or co-occurring
				  diagnosis through the care coordination model.
B. Enrollment in 1915(i) services qualifies
				  and requires the participant to receive case management services through a CCO,
				  pursuant to COMAR 10.09.90.
C. Each
				  participant shall have an individualized POC that is managed by the CCO,
				  pursuant to COMAR 10.09.90:
D. In
				  partnership with the CFT, the CCO shall:
(1)
				  Reevaluate the POC at least every 45 days with re-administration of
				  BHA-approved assessments as appropriate, and more frequently in response to a
				  crisis;
(2) Determine the family
				  vision, which will guide the planning process;
(3) Identify strengths of the entire
				  team;
(4) Determine the needs that
				  the team will work on;
(5)
				  Determine outcome statements for meeting identified needs;
(6) Determine the specific services and
				  supports required in order to achieve the goals identified in the
				  POC;
(7) Create a mission statement
				  that the team generates and commits to following;
(8) Identify the individuals responsible for
				  each of the strategies in the POC;
(9) Review and update the crisis plan;
				  and
(10) Meet at least every 45
				  days or more frequently as clinically indicated to:
(a) Coordinate the implementation of the POC;
				  and
(b) Re-evaluate and update the
				  POC as necessary.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.89 - 1915(i) Intensive Behavioral Health Services for Children, Youth, and Families › Section 10.09.89.06 - Conditions for Provider Participation

Current through Register Vol. 51, No. 14, July 12, 2024
A. The Department shall grant approval to
				  providers to be eligible to receive Medicaid funds for 1915(i) services if the
				  provider meets the requirements set forth in this chapter.
B. Application. To provide 1915(i) services,
				  a provider applicant shall:
(1) Submit an
				  application to the Department on the form approved by the Department, with all
				  questions answered and all required documents attached; and
(2) Attest that the provider applicant is in
				  compliance with the general provider requirements and specific 1915(i) service
				  requirements set forth in this chapter and in COMAR 10.09.36.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.89 - 1915(i) Intensive Behavioral Health Services for Children, Youth, and Families › Section 10.09.89.07 - Denial, Emergency Suspension of Approval, and Disciplinary Action

Current through Register Vol. 51, No. 14, July 12, 2024
A. Denial of
				  Approval.
(1) If the Department proposes to
				  deny approval to an applicant under the provisions of this chapter, the
				  Department shall give written notice of the proposed denial to the:
(a) Provider applicant;
(b) Care coordination organization (CCO);
				  and
(c) Administrative service
				  organization (ASO).
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.89 - 1915(i) Intensive Behavioral Health Services for Children, Youth, and Families › Section 10.09.89.08 - General Conditions for 1915(i) Services Provider Participation

Current through Register Vol. 51, No. 14, July 12, 2024
A. A provider of
				  1915(i) services shall:
(1) Provide the
				  documentation required by the Department for initial approval and provider
				  recertification, or as requested by the Department;
(2) Be approved by the Department as meeting
				  the requirements of being able to provide the services set forth in this
				  chapter;
(3) Have a provider
				  agreement in effect, to include adherence to quality assurance, auditing, and
				  monitoring policies and procedures;
(4) Receive training and certification as
				  required and approved by the Department and determined to be appropriate for
				  the level and scope of services provided;
(5) Meet all the conditions for participation
				  in COMAR 10.09.36 except as otherwise specified in this chapter;
(6) Maintain general liability insurance, and
				  provide proof of this insurance:
(a) At the
				  time of initial application to be a provider of 1915(i) services;
(b) At recertification; and
(c) Upon request by the Department;
(7) Make available to the
				  Department and federal funding agents all records for inspection and copying,
				  including but not limited to:
(a) Personnel
				  files for each individual employed, regardless of method of
				  compensation;
(b) Financial
				  records;
(c) Treatment records;
				  and
(d) Service records;
(8) Comply with the following
				  prohibitions against utilization of staff:
(a) Unless waived by the Department in
				  accordance with §D of this regulation, prohibit from working with the
				  participant or the participant's family any staff, volunteers, students, or any
				  individual who is:
(i) Convicted of, received
				  probation before judgment, or entered a plea of nolo contendere to a felony or
				  a crime of moral turpitude or theft; or
(ii) Has an indicated finding of child abuse
				  or neglect; and
(9) Maintain administrative and medical
				  records documenting the date, time, duration, and substantive notes associated
				  with the services delivered, which shall be signed by the provider and
				  indicated by the participant's plan of care.