reglab/statecodes huggingface dataset:
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.49 - Telehealth Services › Section 10.09.49.04 - Provider Conditions for Participation

Current through Register Vol. 51, No. 14, July 12, 2024
A. To render or
				  bill for services delivered via telehealth, the provider shall meet the
				  requirements as set forth in:
(1) Except when
				  the originating site is not a Medicaid payable provider, be enrolled as a
				  Medical Assistance Program provider on the date of the service is
				  rendered;
(2) Except when the
				  originating site is not a Medicaid payable provider, meet the requirements for
				  participation in the Medical Assistance Program as set forth in:
(1) COMAR
				  10.09.36.02;
(2) COMAR
				  10.09.36.03; and
(3) The COMAR chapter defining the covered
				  service being rendered;
(3) The COMAR chapter defining the covered
				  service being rendered.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.49 - Telehealth Services › Section 10.09.49.05 - Technical Requirements

Current through Register Vol. 51, No. 14, July 12, 2024
A. A provider
				  of services delivered through telehealth shall adopt and implement technology
				  in a manner that supports the standard of care to deliver the required
				  service.
B. A service delivered
				  through synchronous audio-visual telehealth shall, at a minimum, meet the
				  following technology requirements:
(1)
				  Cameras at both the originating and distant sites that provide clear,
				  synchronous video of the patient and provider, respectively, with the ability
				  to meet the clinical requirements of the service;
(2) Unless engaging in a telehealth with a
				  participant who is deaf or hard of hearing, microphones and speakers at both
				  the originating and distant sites, respectively, that provide clear,
				  synchronous, two-way audio transmission;
(3) Network connectivity and bandwidth at
				  both the originating and distant site sufficient to provide clear, synchronous
				  two-way video and audio for the full duration of the service;
(4) Display monitor size sufficient to
				  support diagnostic needs used in the telehealth services; and
(5) Utilize technology that meets the
				  standards required by State and federal laws governing the privacy and security
				  of protected health information (HIPAA compliant).
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.49 - Telehealth Services › Section 10.09.49.06 - Confidentiality

Current through Register Vol. 51, No. 14, July 12, 2024
The provider:
A.
				  Shall comply with all State and federal laws and regulations concerning the
				  privacy and security of protected health information, including but not limited
				  to:
(1) Health-General Article, Title 4,
				  Subtitle 3, Annotated Code of Maryland; and
(2) The Health Insurance Portability and
				  Accountability Act of 1996 (HIPAA),
				  42 U.S.C. §§
												1320d et seq., as amended, the HITECH Act,
				  42 U.S.C. §§
												17932, et seq., as amended, and 45 CFR Parts
				  160 and 164, as amended;
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.49 - Telehealth Services › Section 10.09.49.07 - Limitations

Current through Register Vol. 51, No. 14, July 12, 2024
A. A service
				  delivered via telehealth is subject to the same program restrictions,
				  preauthorizations, limitations, and coverage that exist for services delivered
				  in person.
B. A service delivered
				  via telehealth does not include:
(1) An
				  audio-only telephone conversation between a health care provider and a patient
				  unless provided on dates of service between July 1, 2021, and June 30, 2025,
				  inclusive;
(2) An electronic mail
				  message between a health care provider and a patient;
(3) A facsimile transmission between a health
				  care provider and a patient; or
(4)
				  A telephone conversation, electronic mail message, or facsimile transmission
				  between providers without direct interaction with the patient.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.49 - Telehealth Services › Section 10.09.49.08 - Reimbursement

Current through Register Vol. 51, No. 14, July 12, 2024
A. To receive
				  reimbursement for services delivered via telehealth, a provider shall:
(1) Be actively enrolled with Maryland
				  Medical Assistance on the date the service is rendered; and
(2) Comply with payment procedures as set
				  forth in COMAR 10.09.36.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.50 - EPSDT School Health-Related Services or Health-Related Early Intervention Services › Section 10.09.50.02 - Licensure and Certification

Current through Register Vol. 51, No. 14, July 12, 2024
A.
				  A provider shall ensure that the provider's employees who render school
				  health-related services meet the licensure and certification requirements for
				  their profession, as specified in §B of this regulation.
B. A professional employed by a provider
				  shall have the following qualifications:
(1)
				  An audiologist shall be licensed to practice in the jurisdiction in which
				  services are provided;
(2) A
				  professional counselor shall be licensed to practice in accordance with Health
				  Occupations Article, Title 17, Annotated Code of Maryland, in the jurisdiction
				  in which services are provided;
(3)
				  A nurse shall be a registered nurse or a practical nurse licensed to practice
				  in the jurisdiction in which services are provided:
(4) A nurse psychotherapist shall be licensed
				  to practice in the jurisdiction in which services are provided;
(5) A dietitian-nutritionist shall be
				  licensed to practice in the jurisdiction in which services are
				  provided;
(6) An occupational
				  therapist shall be licensed to practice in the jurisdiction in which services
				  are provided;
(7) An occupational
				  therapy assistant shall be licensed to practice in the jurisdiction in which
				  services are provided under the direction of a licensed occupational
				  therapist;
(8) A physical therapist
				  shall be licensed to practice in the jurisdiction in which services are
				  provided;
(9) A physical therapy
				  assistant shall be licensed to practice in the jurisdiction in which services
				  are provided under the direction of a licensed physical therapist;
(10) A psychiatrist shall be a physician
				  licensed to practice in the jurisdiction in which services are provided who is
				  certified by the American Board of Psychiatry and Neurology or who has
				  completed the minimum educational and training requirements to take the Board
				  examination;
(11) A psychologist shall be licensed to practice in
				  the jurisdiction in which services are provided;
(12) A social worker shall be licensed as a
				  clinical social worker to practice in the jurisdiction in which services are
				  provided; and
(13) A speech language pathologist shall be licensed
				  to practice in the jurisdiction in which services are provided
(14) A speech language pathology assistant
				  shall be licensed to practice in the jurisdiction in which services are
				  provided under the supervision of a licensed speech language pathologist;
				  and
(15) A therapeutic behavior
				  provider shall be approved by the Department in accordance with COMAR
				  10.09.50.05A.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.50 - EPSDT School Health-Related Services or Health-Related Early Intervention Services › Section 10.09.50.03 - Conditions for Participation

Current through Register Vol. 51, No. 14, July 12, 2024
A.
				  General requirements for participation in EPSDT school health-related or
				  health-related early intervention services are that a:
(1) Provider shall:
(a) Meet all the requirements for
				  participation in the Program as set forth in COMAR
				  10.09.36.03A;
				  and
(b) Collaborate in the
				  provision of covered services with local health departments in accordance with
				  Education Article, §
												7-401, Annotated Code of
				  Maryland; and
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.50 - EPSDT School Health-Related Services or Health-Related Early Intervention Services › Section 10.09.50.04 - Covered Services

Current through Register Vol. 51, No. 14, July 12, 2024
A. The
				  Program covers the services listed in §B of this regulation when the
				  services are:
(1) Necessary to identify the
				  need for a health-related service or health-related early intervention service
				  that may be furnished as part of an IEP[J or an TFSP;
(2) Necessary to:
(a) Prevent disease, disability, and other
				  health conditions or their progression, and
(b) Promote physical and mental health and
				  efficiency;
(3)
				  Necessary for the maximum reduction of physical or mental disability and
				  restoration of a participant to the participant's best possible functional
				  level;
(4) Rendered in accordance
				  with accepted professional standards; and
(5) Delivered in accordance with an IEP or an
				  IFSP, which is developed at the time of referral for health-related services or
				  health-related early intervention services.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.50 - EPSDT School Health-Related Services or Health-Related Early Intervention Services › Section 10.09.50.05 - Limitations

Current through Register Vol. 51, No. 14, July 12, 2024
A. To participate
				  in the Program as a provider of health-related services or health-related early
				  intervention services, the provider shall be a local school system, a local
				  lead agency, a State-operated education agency, or State-supported education
				  agency.
B. Health-related services
				  or health-related early intervention services outlined in the IEP or the IFSP
				  shall be approved by the IEP or IFSP team for continued treatment.
C. Therapeutic behavior services may only be
				  provided if:
(1) Preauthorized through the
				  IEP or IFSP process and directly related to the IEP or IFSP;
(2) Services are not custodial;
(3) Services are considered medically
				  necessary by the IEP or IFSP team, which develops the recipient's IEP or IFSP;
(4) Delivered in the recipient's
				  home, school, or other setting if normal activities are disrupted;
(5) The therapeutic behavior aide is not a
				  member of the recipient's immediate family or an individual who ordinarily
				  resides in the recipient's home; and
(6) The recipient has:
(a) Maladaptive behavior;
(b) Warrants a behavioral plan;
(c) Behavior that is deviant from
				  developmentally appropriate behavior for the individual's chronological age as
				  determined by the IEP or IFSP team;
(d) A behavior plan that does not include
				  aversive techniques, restraints, and seclusion, or any of these; and
(e) No insurance coverage for therapeutic
				  behavior services when compensated as an individual service covered by another
				  third party insurance or part of a package of benefits covered by either
				  another third party insurance or another public agency.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.50 - EPSDT School Health-Related Services or Health-Related Early Intervention Services › Section 10.09.50.06 - Preauthorization

Current through Register Vol. 51, No. 14, July 12, 2024
Therapeutic behavior services shall be preauthorized
					 through the IEP or IFSP process.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.50 - EPSDT School Health-Related Services or Health-Related Early Intervention Services › Section 10.09.50.07 - Payment Procedures

Current through Register Vol. 51, No. 14, July 12, 2024
A. Request
				  for Payment.
(1) An approved provider shall
				  submit a request for payment of services rendered and completed under this
				  chapter as set forth in COMAR
				  10.09.36.04A. he
				  Department reserves the right to return to the provider, before payment, all
				  payment requests not properly prepared or submitted.
(2) A provider shall submit a request for
				  payment as set forth in COMAR
				  10.09.36.04A. he
				  completed form shall indicate the:
(a) Date or
				  dates of service;
(b) Participant's
				  name and Medical Assistance number;
(c) Provider's name, location, and provider
				  number; and
(d) Nature, unit or
				  units, and procedure code or codes of covered services provided.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.50 - EPSDT School Health-Related Services or Health-Related Early Intervention Services › Section 10.09.50.08 - Recovery and Reimbursement

Current through Register Vol. 51, No. 14, July 12, 2024
Recovery and reimbursement is as set forth in COMAR
					 10.09.36.07A.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.50 - EPSDT School Health-Related Services or Health-Related Early Intervention Services › Section 10.09.50.09 - 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
					 is as set forth in COMAR
					 10.09.36.08A.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.50 - EPSDT School Health-Related Services or Health-Related Early Intervention Services › Section 10.09.50.10 - Appeal Procedures

Current through Register Vol. 51, No. 14, July 12, 2024
Appeal procedures are set forth in COMAR
					 10.09.36.09A.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.50 - EPSDT School Health-Related Services or Health-Related Early Intervention Services › Section 10.09.50.11 - Interpretive Regulation

Current through Register Vol. 51, No. 14, July 12, 2024
Interpretive regulations are set forth in COMAR
					 10.09.36.10A.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.51 - Audiology Services › Section 10.09.51.02 - Licensure Requirements

Current through Register Vol. 51, No. 14, July 12, 2024
A. In
				  order to provide services as an audiologist under this chapter, an audiologist
(1) Shall shall be licensed by the State
				  Board of Examiners for Audiologists, Hearing Aid Dispensers, and
				  Speech-Language Pathologists to practice audiology, as defined in Health
				  Occupations Article, Title 2, Annotated Code of Maryland, or by the appropriate
				  licensing body in the jurisdiction in which the audiology services are
				  performed
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.51 - Audiology Services › Section 10.09.51.03 - 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. Specific requirements for participation in
				  the Program as an audiologist, audiology center or group, or hearing aid
				  dispenser are that the provider:
(1) Shall
				  meet the licensure requirements in accordance with Regulation .02 of this
				  chapter; and
(2) May not knowingly
				  employ another person to provide services to Maryland Medical Assistance
				  Program participants after that person has been disqualified from the Program
				  unless prior approval has been received from the
				  Department.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.51 - Audiology Services › Section 10.09.51.04 - Covered Services

Current through Register Vol. 51, No. 14, July 12, 2024
The Program covers the following medically necessary
					 services:
A. Audiology services, as
				  follows:
(1) For participants who are at risk
				  for or have a hearing impairment, audiology assessments using procedures
				  appropriate for the participant's developmental age and abilities;
				  and
(2) Hearing aid evaluations and
				  routine follow-up for participants with an identified hearing impairment, who
				  currently use or are being considered for hearing aids; and
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.51 - Audiology Services › Section 10.09.51.06 - Preauthorization Requirements

Current through Register Vol. 51, No. 14, July 12, 2024
A. The
				  Department requires preauthorization for the following services:
(1) All hearing aids;
(2) Certain hearing aid
				  accessories;
(3) All cochlear
				  implant devices and replacement components except microphone, transmitter
				  cables, and transmitting coils;
(4)
				  All auditory osseointegrated devices; and
(5) Repairs for hearing aids, cochlear
				  implants, and auditory osseointegrated components exceeding
				  $500.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.51 - Audiology Services › Section 10.09.51.07 - Payment Procedures

Current through Register Vol. 51, No. 14, July 12, 2024
A. To
				  obtain compensation from the Department for covered services, the provider
				  shall submit a request for payment using the format designated by the
				  Department.
B. Audiology services
				  are reimbursed in accordance with COMAR
				  10.09.23.01-1.
C. The provider shall be paid the lesser of:
(1) The provider's customary charge to the
				  general public, unless the service is free to individuals not covered by
				  Medicaid; or
(2) The rate in
				  accordance with the Department's fee schedule.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.51 - Audiology Services › Section 10.09.51.08 - Recovery and Reimbursement

Current through Register Vol. 51, No. 14, July 12, 2024
Recovery and reimbursement requirements are as set forth in
					 COMAR 10.09.36.07A.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.51 - Audiology Services › Section 10.09.51.09 - 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
					 is as set forth in COMAR
					 10.09.36.08A.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.51 - Audiology Services › Section 10.09.51.10 - Appeal Procedures

Current through Register Vol. 51, No. 14, July 12, 2024
Appeal procedures are as set forth in COMAR
					 10.09.36.09A.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.51 - Audiology Services › Section 10.09.51.11 - Interpretation of State Regulations

Current through Register Vol. 51, No. 14, July 12, 2024
State regulations are interpreted as set forth in COMAR
					 10.09.36.10A.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.52 - Service Coordination for Children with an IEP or Enrolled in the Autism Waiver › Section 10.09.52.02 - Participant Eligibility

Current through Register Vol. 51, No. 14, July 12, 2024
A participant is eligible for Service Coordination
					 if:
A. The individual is enrolled as a
				  waiver participant in accordance with the requirements of COMAR 10.09.56 and
				  this chapter; or
B. The following
				  requirements are met:
(1) The participant,
				  for whom free and appropriate education is provided under the Individuals with
				  Disabilities Education Act, is aged 3 through 20 years old;
(2) An IEP team determines that the
				  participant is a child with disabilities who:
(a) Is eligible for special education and
				  related services, and
(b) Needs an
				  IEP;
(3) The participant
				  elects, or the participant's parent elects on the participant's behalf, to
				  receive the services available under this chapter; and
(4) The participant is not a resident of any of the
				  facilities that receive Medicaid reimbursement for residential
				  services.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.52 - Service Coordination for Children with an IEP or Enrolled in the Autism Waiver › Section 10.09.52.03 - Conditions for Participation for Autism Waiver Service Coordination Providers

Current through Register Vol. 51, No. 14, July 12, 2024
A. General
				  requirements for participation in the Program are that a provider shall:
(1) Meet all the conditions for participation
				  as set forth in COMAR 10.09.36; and
(2) If delivering services via telehealth,
				  comply with COMAR 10.09.49 and any subregulatory guidance issued by the
				  Department.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.52 - Service Coordination for Children with an IEP or Enrolled in the Autism Waiver › Section 10.09.52.03-1 - Conditions for Participation for Autism Waiver Service Coordination Providers

Current through Register Vol. 51, No. 14, July 12, 2024
A. General
				  requirements for participation in the Program are that a provider shall:
(1) Meet all the conditions for participation
				  as set forth in COMAR 10.09.36; and
(2) If delivering services via telehealth,
				  comply with COMAR 10.09.49 and any subregulatory guidance issued by the
				  Department.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.52 - Service Coordination for Children with an IEP or Enrolled in the Autism Waiver › Section 10.09.52.04 - Covered Services - IEP Service Coordination

Current through Register Vol. 51, No. 14, July 12, 2024
A. The Program
				  shall reimburse for the services in §§B-D of this regulation when the
				  services have been documented, pursuant to the requirements of this chapter, as
				  medically necessary.
B. Initial
				  IEP.
(1) Definition. "Unit of service" means:
(a) A completed initial IEP, signed by all
				  members of the IEP team; and
(b) At
				  least one contact by the participant's service coordinator in person, in
				  writing, via telehealth, or by telephone with the participant or the
				  participant's parent, on the participant's behalf relating to development of
				  the IEP.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.52 - Service Coordination for Children with an IEP or Enrolled in the Autism Waiver › Section 10.09.52.04-1 - Covered Services - Autism Waiver Service Coordination - General Requirements

Current through Register Vol. 51, No. 14, July 12, 2024
A. Autism
				  Waiver Service Coordination is intended to:
(1) Assist a waiver participant in gaining
				  access to the Autism Waiver services approved in the waiver participant's
				  waiver plan of care;
(2) Assure
				  coordination of the waiver participant's Autism Waiver services with other
				  services received by the waiver participant; and
(3) Assure that the waiver participant's full
				  range of needs are adequately met, so as to assure the individual's:
(a) Appropriate placement in the
				  community;
(b) Health and
				  safety;
(c) Quality of care;
				  and
(d) Access to authorized,
				  necessary services.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.52 - Service Coordination for Children with an IEP or Enrolled in the Autism Waiver › Section 10.09.52.04-2 - Covered Services - Autism Waiver Service Coordination - Specific Requirements

Current through Register Vol. 51, No. 14, July 12, 2024
A. Waiver
				  Initial Assessment.
(1) Definition. For the
				  purposes of this section, "unit of service" means:
(a) A completed initial waiver plan of care,
				  submitted to MSDE and signed by the service coordinator, the waiver participant
				  or the parent or parents of a minor child, and all other members of the waiver
				  multidisciplinary team; or
(b) The
				  provision of all necessary services specified in §A(2) of this
				  regulation.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.52 - Service Coordination for Children with an IEP or Enrolled in the Autism Waiver › Section 10.09.52.05 - Limitations

Current through Register Vol. 51, No. 14, July 12, 2024
A. Service
				  Coordination for Children with an IEP or enrolled in the Autism Waiver is
				  advisory in nature except for Autism Waiver Service Coordination, covered under
				  Regulations .03-1, .04-1, and .04-2 of this chapter.
B. A restriction may not be placed on a
				  qualified participant's option to receive the services covered under this
				  chapter except that Autism Waiver Service Coordination, as defined by
				  Regulations .03-1, .04-1, and .04-2 of this chapter, is required for waiver
				  eligible persons who choose to enroll in the Autism Waiver.
C. The services covered under this chapter
				  may not restrict or otherwise affect the:
(1)
				  Participant's eligibility for Title XIX benefits or other available benefits or
				  programs except as limited by §E of this regulation;
(2) Freedom of the participant's parent to
				  select from all available services for which the participant is found to be
				  eligible;
(3) Participant's
				  parent's free choice among qualified providers of services covered under this
				  chapter, as well as among service providers of other services for which the
				  participant qualifies; or
(4)
				  Provider's right to bill the Program for other covered Program
				  services.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.52 - Service Coordination for Children with an IEP or Enrolled in the Autism Waiver › Section 10.09.52.06 - Payment Procedures

Current through Register Vol. 51, No. 14, July 12, 2024
A. Request for
				  Payment.
(1) An approved provider shall submit
				  requests for payment for the services covered under this chapter according to
				  procedures established by the Program. The Program reserves the right to return
				  to the provider, before payment, all requests not properly completed.
(2) A provider shall:
(a) Bill the Program for the appropriate fee
				  or fees specified in §C of this regulation;
(b) Accept payment from the Program as
				  payment in full for the services covered under this chapter and make no
				  additional charge to the participant or any other party; and
(c) Submit a request for payment in the
				  manner specified by the Program, that includes the:
(i) Date or dates of service,
(ii) Participant's name and Medical
				  Assistance number,
(iii) Provider's
				  name, location, and Medicaid provider number; and
(iv) Nature, unit or units, and procedure
				  code or codes of covered services provided.
(3) Providers that convene or conduct an IEP
				  team or teams in accordance with COMAR 13A.05.01 may bill the Program for all
				  IEP-related services contained in this chapter.
(4) Providers that participate on, but do not
				  convene or conduct, an IEP team or teams, may only bill for ongoing service
				  coordination, only for day students. These providers may not bill for ongoing
				  service coordination for the residential students who reside in facilities that
				  receive Medical Assistance reimbursement for residential services.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.52 - Service Coordination for Children with an IEP or Enrolled in the Autism Waiver › Section 10.09.52.07 - Recovery and Reimbursement

Current through Register Vol. 51, No. 14, July 12, 2024
Recovery and reimbursement are as set forth in COMAR
					 10.09.36.07B.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.52 - Service Coordination for Children with an IEP or Enrolled in the Autism Waiver › Section 10.09.52.08 - 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
					 is as set forth in COMAR
					 10.09.36.08B.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.52 - Service Coordination for Children with an IEP or Enrolled in the Autism Waiver › Section 10.09.52.09 - Appeal Procedures

Current through Register Vol. 51, No. 14, July 12, 2024
Appeal procedures are those set forth in COMAR
					 10.09.36.09B.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.52 - Service Coordination for Children with an IEP or Enrolled in the Autism Waiver › Section 10.09.52.10 - Interpretive Regulation

Current through Register Vol. 51, No. 14, July 12, 2024
State regulations are interpreted in accordance with COMAR
					 10.09.36.10B.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.53 - Early and Periodic Screening, Diagnosis, and Treatment: Nursing Services for Individuals Younger than 21 Years Old › Section 10.09.53.02 - Licensing Requirements

Current through Register Vol. 51, No. 14, July 12, 2024
A. Nurses
				  rendering or supervising the provision of private duty nursing services shall
				  be licensed in accordance with licensing requirements specified in COMAR
				  10.09.36.02B.
B. An agency providing services
				  pursuant to this chapter shall meet all applicable licensure and certification
				  requirements of the jurisdiction in which the agency is providing
				  services.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.53 - Early and Periodic Screening, Diagnosis, and Treatment: Nursing Services for Individuals Younger than 21 Years Old › Section 10.09.53.03 - Conditions for Participation

Current through Register Vol. 51, No. 14, July 12, 2024
Requirements for participation for nursing services are
					 that a provider shall:
A. Meet the
				  general Medical Assistance provider requirements as specified in COMAR
				  10.09.36.03;
B. Be licensed as a:
(1) Residential service agency under COMAR
				  10.07.05; or
(2) Home health agency
				  under COMAR 10.07.10;
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.53 - Early and Periodic Screening, Diagnosis, and Treatment: Nursing Services for Individuals Younger than 21 Years Old › Section 10.09.53.04 - Covered Services

Current through Register Vol. 51, No. 14, July 12, 2024
A. The Program
				  shall cover services rendered by a nurse, CNA, or HHA when the:
(1) Services are ordered by the participant's
				  primary medical provider and renewed every 60 days after that;
(2) Services are directly related to the plan
				  of care;
(3) Services are described
				  in the nursing care plan and progress notes;
(4) Services are of a scope that is more
				  individual and continuous than what is available under the home health
				  program;
(5) Services are delivered
				  in the recipient's home, or other setting when normal life activities take the
				  recipient outside the home;
(6)
				  Services include supervision of family caregivers in the home while family
				  caregivers practice the skills necessary to provide care to the recipient in
				  accordance with the established plan of care;
(7) Services are preauthorized in accordance
				  with Regulation .06 of this chapter;
(8) Services are received by the participant as
				  documented by the signature of the participant or the participant's
				  representative on the nursing provider's official form;
(9) Services are determined medically
				  necessary for a participant after the provider has completed an initial nursing
				  assessment that reflects the participant's need for an awake and alert
				  caregiver;
(10) Participant has at
				  least one caregiver willing and able to accept responsibility for the
				  participant's care when the nurse, CNA, or HHA is not available;
(11) Caregiver provides documentation of each
				  of the following when applicable:
(a) The
				  caregiver's work schedule along with commuting times;
(b) The caregiver's school attendance as
				  defined in Regulation .02 of this chapter along with commuting times;
				  and
(c) Emergency circumstances, as
				  determined by the Department, including but not limited to the inability of the
				  primary caregiver to provide care due to hospitalization or an acute
				  debilitating illness for up to a 60-day period; and
(12) Services are provided only in the
				  absence of the willing and able caregiver during sleeping hours and during the
				  times documented in §A(11) of this regulation.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.53 - Early and Periodic Screening, Diagnosis, and Treatment: Nursing Services for Individuals Younger than 21 Years Old › Section 10.09.53.06 - Preauthorization Requirements

Current through Register Vol. 51, No. 14, July 12, 2024
A. The
				  Department or the Department's designee shall preauthorize nursing services,
				  according to medical necessity, frequency, and duration, as a prerequisite to
				  payment beyond the initial assessment.
B. Preauthorization is issued when:
(1) Program procedures are met;
(2) Program limitations are met;
(3) The requirements specified in this
				  chapter are met; and
(4) The
				  Department or the Department's designee determines that the services are
				  medically necessary.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.53 - Early and Periodic Screening, Diagnosis, and Treatment: Nursing Services for Individuals Younger than 21 Years Old › Section 10.09.53.07 - Payment Procedures

Current through Register Vol. 51, No. 14, July 12, 2024
A. Payment
				  procedures are as set forth in COMAR
				  10.09.36.04 and .06.
B. Payments.
(1) Payments shall be made directly to a
				  qualified provider.
(2) To receive
				  payment for services under Regulation .04 of this chapter, a provider and its
				  workers shall use the electronic visit verification method and data management
				  system approved by the Department to document time and submit claims in
				  accordance with COMAR
				  10.09.36.03-2.
(3) Providers shall be paid the lesser of:
(a) The provider's customary charge to the
				  general public unless the service is free to individuals not covered by
				  Medicaid; or
(b) The rate
				  established according to the fee schedule published by the
				  Department.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.53 - Early and Periodic Screening, Diagnosis, and Treatment: Nursing Services for Individuals Younger than 21 Years Old › Section 10.09.53.08 - Recovery and Reimbursement

Current through Register Vol. 51, No. 14, July 12, 2024
Recovery and reimbursement are those set forth in COMAR
					 10.09.36.07B.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.53 - Early and Periodic Screening, Diagnosis, and Treatment: Nursing Services for Individuals Younger than 21 Years Old › Section 10.09.53.09 - 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
					 is as set forth in COMAR
					 10.09.36.08B.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.53 - Early and Periodic Screening, Diagnosis, and Treatment: Nursing Services for Individuals Younger than 21 Years Old › Section 10.09.53.10 - Appeal Procedures

Current through Register Vol. 51, No. 14, July 12, 2024
Appeal procedures are those set forth in COMAR
					 10.09.36.09B.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.53 - Early and Periodic Screening, Diagnosis, and Treatment: Nursing Services for Individuals Younger than 21 Years Old › Section 10.09.53.11 - Interpretive Regulation

Current through Register Vol. 51, No. 14, July 12, 2024
State regulations are interpreted as set forth in COMAR
					 10.09.36.10B.
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 10.09.54.01 - 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) "Activities of daily living" means tasks
				  or activities that include, but are not limited to:
(a) Bathing and completing personal hygiene
				  routines;
(b) Dressing and changing
				  clothes;
(c) Eating;
(d) Toileting, including:
(i) Bladder and bowel requirements;
(ii) Routines associated with the achievement
				  or maintenance of continence; and
(iii) Incontinence care;
(e) Mobility, including:
(i) Transferring from a bed, chair, or other
				  structure;
(ii) Moving, turning,
				  and positioning the body while in bed or in a wheelchair; and
(iii) Moving about indoors or
				  outdoors.
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 10.09.54.02 - Licensing and Certification Requirements

Current through Register Vol. 51, No. 14, July 12, 2024
A. Assisted living services providers shall
				  be licensed by the Department in accordance with COMAR 10.07.14.
B. The following health professionals
				  providing services under this chapter shall be licensed to practice in the
				  jurisdiction in which services are rendered:
(1) Physicians;
(2) Registered nurses;
(3) Licensed practical nurses;
(4) Occupational therapists;
(5) Physical therapists;
(6) Dietitians;
(7) Nutritionists;
(8) Social workers; and
(9) Psychologists.
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 10.09.54.03 - Participant Eligibility

Current through Register Vol. 51, No. 14, July 12, 2024
A. General
				  Requirements.
(1) To be eligible for
				  participation, an individual shall be determined by the Department to meet the
				  conditions of §§B-E of this regulation.
(2) Eligibility for waiver services shall be
				  reevaluated every 12 months or more frequently if needed due to a significant
				  change in the participant's condition, needs, or financial status.
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 10.09.54.05 - Specific Conditions for Provider Participation - Assisted Living

Current through Register Vol. 51, No. 14, July 12, 2024
A. To participate
				  in the program as a provider of assisted living services under this chapter a
				  provider shall:
(1) Be licensed by the
				  Department at the time that services are rendered, in accordance with COMAR
				  10.07.14, to provide assisted living services;
(2) Be or employ a manager who is qualified
				  as:
(a) A licensed physician;
(b) A licensed registered nurse;
(c) A licensed practical nurse; or
(d) An individual with at least 3 years'
				  experience in direct patient care in a private home, certified home, or
				  health-related facility;
(3) Employ an alternate assisted living
				  manager who meets the requirements as specified in §A(2) of this
				  regulation.
(4) Have at least one
				  staff person per eight residents on duty at all times during daytime hours, and
				  have a staff-to-resident ratio at night which is adequate to provide the
				  required services and maintain the facility in a safe and orderly condition,
				  with additional staffing if required by the Department depending on residents'
				  functional levels;
(5) Participate
				  in training on the waiver billing process and other waiver requirements, as
				  specified by the Department;
(6)
				  Have the appropriate insurance coverage to cover the provider and its employees
				  and vehicles if the provider chooses to transport participants to medical,
				  social, recreational, and other services;
(7) Cooperate with other service providers
				  and quality assurance monitors by:
(a)
				  Facilitating on-site visits of authorized quality assurance monitors to review
				  compliance with waiver and regulatory requirements;
(b) Facilitating a case manager's on-site
				  visits to the facility, which shall occur at least quarterly, to review the
				  facility, regulatory compliance, service provision, and participants' status
				  and needs;
(c) Communicating with a
				  participant's case manager concerning the participant's status, needs, and
				  service provision;
(d) Informing
				  the case manager within 1 working day of any significant change in the
				  participant's status and service needs;
(e) Facilitating, as necessary and
				  appropriate, the delivery of authorized waiver and State Plan services in the
				  plan of service; and
(f)
				  Facilitating waiver participant's relocation to comparable housing, if
				  necessary, including transfer of all personal belongings and financial
				  arrangements; and
(8)
				  Submit claims consistent with the provisions of Regulation .22 of this
				  chapter.
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 10.09.54.06 - Specific Conditions for Provider Participation - Behavior Consultation

Current through Register Vol. 51, No. 14, July 12, 2024
To participate in the program as a provider of behavior
					 consultation services under this chapter a provider shall:
A. Be:
(1) A
				  health services agency that:
(a) Employs a
				  qualified individual or individuals to render behavior consultation services;
				  and
(b) Assures supervision of the
				  individual rendering behavior consultation services by a licensed mental health
				  professional or by a bachelor's level nurse with 4 years of experience or with
				  an appropriate graduate degree; or
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 10.09.54.07 - Specific Conditions for Provider Participation - Senior Center Plus

Current through Register Vol. 51, No. 14, July 12, 2024
To participate in the program as a provider of Senior
					 Center Plus services under this chapter a provider shall:
A. Be approved and monitored by the Maryland
				  Department of Aging as a nutrition service provider;
B. Meet all local and State requirements to
				  operate as a nutrition site, which include but are not limited to inspection
				  and approval of the facility by the local fire marshal, periodic fire drills,
				  and inspection and approval by the local sanitarian to assure compliance with
				  health department requirements for food service facilities;
C. Assure that the facility provides an
				  accessible environment, in compliance with the Americans with Disabilities Act
				  (ADA), 28 CFR Part 36 ;
D. Maintain
				  adequate records on participants, including progress notes and
				  outcomes;
E. Provide at least one
				  staff person per eight clients, with additional staffing if required by the
				  Maryland Department of Aging depending on participants' functional
				  levels;
F. Employ as the center's
				  manager or in another staff position an individual who:
(1) Is a licensed health professional or a
				  licensed social worker;
(2) Has at
				  least 3 years' experience in direct patient care at an adult day care center,
				  nursing facility, or health-related facility; and
(3) Participates in training specified and
				  approved by the Maryland Department of Aging;
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 10.09.54.08 - Specific Conditions for Provider Participation - Family Training

Current through Register Vol. 51, No. 14, July 12, 2024
To participate in the Program as a provider of family
					 training under this chapter a provider shall:
A. Be a self-employed trainer or an agency
				  that employs qualified trainers in accordance with §§B-D of this
				  regulation;
B. Have demonstrated
				  experience with the skill being taught;
C. Be willing to meet at the participant's
				  home to provide services; and
D.
				  Employ licensed registered nurses, occupational therapists, physical
				  therapists, or social workers who are appropriately experienced and licensed to
				  provide the needed training.
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 10.09.54.09 - Specific Conditions for Provider Participation - Dietitian and Nutritionist Services

Current through Register Vol. 51, No. 14, July 12, 2024
To participate in the program as a provider of dietitian
					 and nutritionist services under this chapter a provider shall be a:
A. Dietitian or nutritionist who is licensed
				  in accordance with COMAR 10.56.01 and Health Occupations Article, Title 5,
				  Annotated Code of Maryland; or
B.
				  Professional group or agency which employs an individual who is licensed in
				  accordance with §A of this regulation.
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 10.09.54.10 - Specific Conditions for Provider Participation - Medical Day Care Services

Current through Register Vol. 51, No. 14, July 12, 2024
To participate in the program as a provider of medical day
					 care services under this chapter a provider shall:
A. Meet the licensure requirements as
				  provided in COMAR 10.12.04; and
B.
				  Meet the requirements of COMAR 10.09.07.