Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.08 - Freestanding Clinics › Section 10.09.08.01 - 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) "All-inclusive cost-per-visit rate" means
				  the rate that is established for Federally Qualified Health Centers (FQHCs)
				  which includes all services that are rendered to a participant on a given date
				  of service.
(2) "Clinic services"
				  means preventive, diagnostic, therapeutic, rehabilitative, or palliative items
				  or services furnished by or under the direction of a licensed physician or
				  dentist either in a freestanding clinic, or outside the clinic if the:
(a) Participant does not reside in a
				  permanent dwelling or have a fixed home or mailing address; and
(b) Service is provided by clinic
				  personnel.
(3) "Dental
				  services" means emergency, preventive, or therapeutic services for oral
				  diseases which are administered by or under the general supervision of a
				  dentist in the practice of the profession.
(4) "Department" means the Department of
				  Health and Mental Hygiene, the State agency designated to administer the
				  Maryland Medical Assistance Program under Title XIX of the Social Security Act,
				  42 U.S.C. §
												1396 et seq.
(5) "Direct supervision" means that a
				  physician is:
(a) Physically present in the
				  same area of a facility as a nonphysician providing the services required in
				  the physician's plan of care unless standing orders and protocols are provided
				  for physician extenders such as nurse practitioners, nurse midwives, and
				  physician assistants; and
(b)
				  Readily available for consultation.
(6) "Early and periodic screening, diagnosis
				  and treatment (EPSDT)" means the provision of preventive health care, including
				  medical and dental services under
				  42 CFR §
												441.50 et seq. (1981), and COMAR 10.09.23 for
				  assessing growth and development and for detecting and treating health problems
				  in Medical Assistance enrollees younger than 21 years old.
(7) "Extraordinary one-time circumstance"
				  means a highly unusual event beyond the control of a federally qualified health
				  center (FQHC), such as an earthquake or flood, which results in an increase in
				  the FQHC's operating costs.
(8)
				  Freestanding Clinic.
(a) "Freestanding
				  clinic" means a health care facility that is not licensed as a hospital, part
				  of a hospital, or nursing home and is not administratively part of a
				  physician's, dentist's, or osteopath's office, but which has a separate staff
				  functioning under the direction of a clinic administrator or health officer and
				  is organized and operated to provide ambulatory health services.
(b) "Freestanding clinic" does not include a
				  clinic or clinic site located in a participant's home.
(9) Home.
(a) "Home" means the house, apartment,
				  trailer, licensed health care facility, or other dwelling in which a
				  participant resides.
(b) "Home"
				  does not include dedicated commercial space in a high-rise apartment
				  building.
(10) "Hospital"
				  means an institution which:
(a) Falls within
				  the jurisdiction of Health-General Article, Title 19, Subtitle 3, Annotated
				  Code of Maryland; and
(b) Is
				  licensed under COMAR 10.07.01 or is licensed by the state in which the service
				  is provided.
(11)
				  "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.
(12) "Mental health services" means those
				  services described in COMAR
				  10.67.08.02 that are rendered to
				  treat an individual for a diagnosis as set forth in COMAR
				  10.67.08.02M and
				  N.
(13) "Out-stationed eligibility
				  worker" means an employee of a federally qualified health center who is
				  responsible for the receipt and initial processing of applications for Medical
				  Assistance for pregnant women, and children born after September 30, 1983, who
				  are younger than 19 years old in accordance with
				  42 CFR
				  435.904.
(14) "Participant" means an individual who is
				  certified as eligible for, and is receiving, Medical Assistance
				  benefits.
(15) "Patient care
				  policies" means written policies and protocols, describing patient care
				  practices and procedures:
(a) Established for
				  the clinic's operation by a group of professional personnel, including one or
				  more physicians affiliated with the freestanding clinic; and
(b) Approved by the signature of the clinic's
				  medical director.
(16)
				  "Plan of care" means a written plan for the evaluation, treatment, and
				  follow-up of each patient, maintained in the individual's medical record and
				  containing, at a minimum, the following information where applicable:
(a) Patient identification data, dates of
				  service, and medical history;
(b)
				  Chief complaint, physical findings, and presumptive diagnosis;
(c) Plan of treatment;
(d) Results of all laboratory tests and
				  diagnostic radiology procedures ordered and performed;
(e) Referral to consultant specialist and
				  consultants report;
(f) Medications
				  administered and prescribed, with notations indicating quantity, strength,
				  dosage, and refill instructions; and
(g) Final diagnoses, other therapy ordered,
				  and follow-up plan.
(17)
				  "Preauthorization" means the approval required from the Department or its
				  designee before services can be rendered.
(18) "Primary care services" means those
				  medical care services which address a patient's general health needs, including
				  the coordination of the individual's health care with the responsibility for
				  the:
(a) Prevention of disease;
(b) Promotion and maintenance of health;
(c) Treatment of illness; and
(d) When appropriate, referral to
				  other specialists for more intensive care.
(19) "Program" means the Maryland Medical
				  Assistance Program.
(20) "Provider"
				  means a freestanding clinic which, through appropriate agreement with the
				  Department, has been identified as a Program provider by the issuance of a
				  provider number.
(21) "Qualified
				  provider" means an individual that meets the definition of a qualified provider
				  under Health-General Article, §§20-103(a) and 20-207, Annotated Code
				  of Maryland.
(22) "Rural health
				  clinic" means a facility that meets the definition of a rural health clinic as
				  contained in 42 CFR §
												491.2(f).
(23) "Scope of services change" means a
				  permanent and substantial change in the services or practices of a FQHC that
				  results from one or more of the following:
(a) The addition or deletion of a
				  Medicaid-covered FQHC service as described in §1905(a)(2)(B) and (C) of
				  the federal Social Security Act;
(b) The addition, elimination, expansion, or
				  reduction of a Health Resources and Service Administration (HRSA) approved FQHC
				  practice location; or
(c) A change
				  in costs for out-stationed eligibility worker services.