Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.54 - Home and Community-Based Options Waiver › Section 10.09.54.04 - Conditions for Provider Participation - General Requirements

Current through Register Vol. 51, No. 14, July 12, 2024
A. To
				  participate as a provider of a service covered under this chapter, a provider
				  shall:
(1) Meet all of the conditions for
				  participation as a Maryland Medical Assistance Program provider as set forth in
				  COMAR 10.09.36, except as otherwise specified in this chapter;
(2) Verify the qualifications of all
				  individuals who render services on the provider's behalf, and provide a copy of
				  the current license or credentials upon request;
(3) Implement the reporting and follow-up of
				  incidents and complaints in accordance with the Department's established
				  reportable events policy;
(4) Agree
				  to cooperate with required inspections, reviews, and audits by authorized
				  governmental representatives;
(5)
				  Agree to provide services, and to subsequently bill the Department in
				  accordance with the reimbursement methodology specified in this chapter for
				  only those services covered under this chapter which have been:
(a) Pre-approved in the participant's plan of
				  service;
(b) Provided in a manner
				  consistent with the participant's plan of service; and
(c) Identified in the provider agreement as
				  within the scope of the provider's Medicaid participation;
(6) Agree to maintain and have available
				  written documentation of services, including dates and hours of services
				  provided to participants, for a period of 6 years, in a manner approved by the
				  Department;
(7) Agree not to
				  suspend, terminate, increase, or reduce services for an individual without
				  authorization from the Department and with consultation and agreement by the
				  participant or a participant's representative when applicable;
(8) Submit a transition plan to the case
				  manager and participant or participant's representative when applicable when
				  suspending or terminating services;
(9) Verify Medicaid eligibility at the
				  beginning of each month that services will be rendered;
(10) Not be a Medicaid provider or principal
				  of a Medicaid provider that has overpayments that remain due to the
				  Department;
(11) Notify the
				  Department in writing at least 45 days in advance of any:
(a) Voluntary closure;
(b) Change of ownership;
(c) Change of location;
(d) Sale of the business;
(e) Change in the name under which the
				  provider is doing business; or
(f)
				  Change in provider tax identification number;
(12) Include in the notice to the Department
				  regarding any change of status under §A(11) of this regulation, the method
				  for informing waiver participants and representatives of its intent to close,
				  change ownership, change location, or sell its business;
(13) Apply for a new license if applicable,
				  whenever ownership is to be transferred from the person or organization named
				  on the license to another person or organization in time to assure continuity
				  of waiver services;
(14) Submit a
				  Medicaid provider application to the Department if the new owner chooses to
				  participate in the waiver program;
(15) Render services in person, except as
				  expressly authorized by the Department in the regulation governing that service
				  type; and
(16) If rendering
				  services via telehealth, comply with COMAR 10.09.49 and any subregulatory
				  guidance issued by the Department.