Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.12 - Disposable Medical Supplies and Durable Medical Equipment › Section 10.09.12.01 - 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) "Customary charge" means the uniform
				  amount that the provider charges in the majority of cases for a specific supply
				  or piece of equipment, excluding token charges for charity patients and
				  substandard charges for welfare and other low income patients.
(2) "Customized equipment" means durable
				  medical equipment which is uniquely constructed or substantially modified by
				  the provider from the standard product:
(a)
				  For a specific recipient according to the description and orders of a
				  physician; and
(b) In such a way
				  that the equipment can only be used by the specific recipient.
(3) "Department" means Department
				  as defined in COMAR
				  10.09.36.01A.
(4) "Disposable medical supplies"
				  means consumable or disposable items with minimal or no potential for reuse
				  which are used to serve a medically necessary purpose and, with the exception
				  of disposable gloves and incontinence supplies, have no practical use in the
				  absence of illness, injury, disability, or health condition.
(5) "Durable medical equipment" means
				  equipment which satisfies all of the following requirements:
(a) It can withstand repeated use;
(b) It is used to serve a medically necessary
				  purpose; and
(c) It has no
				  practical use in the absence of illness, injury, disability, or health
				  condition.
(6) "Home"
				  means that place of residence occupied by the recipient, including an assisted
				  living facility, but other than a hospital, nursing facility, or other medical
				  institution.
(7) "Hospital" means
				  an institution which falls within the jurisdiction of Health-General Article,
				  Title 19, Subtitle 3, Annotated Code of Maryland, and is licensed pursuant to
				  COMAR 10.07.01 or other applicable standards established by the state in which
				  the service is provided.
(8)
				  "Incontinence" means the inability to refrain from yielding to the urge to
				  urinate or defecate for persons previously having bowel or bladder control or
				  individuals who are lacking bowel or bladder control due to congenital
				  anomalies or postnatal insult.
(9)
				  "Invoice" means a form designated by the Department for use by providers in
				  submitting bills for payment.
(10)
				  "Maximum allowable reimbursement" means the payment limitation established by
				  the Department.
(11) "Medical
				  Assistance Program" means the Medical Assistance Program as defined in COMAR
				  10.09.36.01A.
(12) "Medically necessary" means
				  that 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.
(13) "Medicare" means Medicare as defined in
				  COMAR 10.09.36.01A.
(14) "Nursing facility" means a
				  facility licensed as a comprehensive care or extended care facility pursuant to
				  COMAR 10.07.02.
(15) "Physical
				  therapy program" means an established program that outlines the prescribed
				  equipment and treatment, along with frequency, duration, and goals or expected
				  outcome of the recipient.
(16)
				  "Prepayment authorization" means the approval required from the Department or
				  its designee before services can be reimbursed.
(17) "Prescriber" means a physician, dentist,
				  podiatrist, physician's assistant, clinical nurse specialist, or nurse
				  practitioner licensed in the state in which the prescriber's practice is
				  maintained who has examined the recipient.
(18) "Prescriber order" means a document on
				  the prescriber's letterhead or prescription form which details the:
(a) Patient name and Medical Assistance
				  number;
(b) Item needed including
				  the accessories, adaptions, modifications, and attachments considered medically
				  necessary and medically appropriate by the prescriber;
(c) Estimated quantity of the item;
(d) Length of time of need;
(e) Date of face-to-face encounter and how
				  the health status of the recipient at the time of the face-to-face encounter is
				  related to the items prescribed; and
(f) Prescriber's signature.
(19) "Prescription" means a
				  written order for medical supplies or equipment, signed by the
				  prescriber.
(20) "Program" means
				  program as defined in COMAR
				  10.09.36.01A.
(21) "Provider" means provider as
				  defined in COMAR
				  10.09.36.01A.
(22) "Recipient" means recipient
				  as defined in COMAR
				  10.09.36.01A.
(23) Wholesale cost.
(a) "Wholesale cost" means the price paid by
				  the provider to the manufacturer or any other supplier for disposable medical
				  supplies or durable medical equipment after consideration of both primary
				  discounts and secondary volume and prompt payment discounts applicable at the
				  time the manufacturer's invoice is paid.
(b) "Wholesale cost" includes, but is not
				  limited to:
(i) Shipping;
(ii) Handling; and
(iii) Insurance costs.
(c) "Wholesale cost" does not include
				  associated costs such as:
(i)
				  Evaluation;
(ii) Assembly by the
				  provider;
(iii) Fitting and
				  adjustment; and
(iv) Delivery to
				  the recipient.