reglab/statecodes huggingface dataset:
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.92 - Acute Hospitals › Section 10.09.92.12 - 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 10.09.92 - Acute Hospitals › Section 10.09.92.13 - Appeal Procedures

Current through Register Vol. 51, No. 14, July 12, 2024
A provider filing an appeal from an administrative decision
					 made in connection with these regulations shall do so according to COMAR
					 10.09.36.09.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.92 - Acute Hospitals › Section 10.09.92.14 - Interpretive Regulation

Current through Register Vol. 51, No. 14, July 12, 2024
General policies governing the interpretive regulations
					 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 10.09.93 - Chronic Hospitals › Section 10.09.93.02 - License Requirements

Current through Register Vol. 51, No. 14, July 12, 2024
A. In
				  order to participate in the Program, a provider shall:
(1) Be licensed by the Department pursuant to
				  Health-General Article, Title 19, Subtitle 3, Annotated Code of Maryland, as a
				  hospital; and
(2) Obtain any other
				  licenses required by COMAR 10.07.01.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.93 - Chronic Hospitals › Section 10.09.93.03 - Cost Settlement for State-operated Chronic Hospitals - Payments and Appeals

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. To participate in
				  the Program as a chronic hospital services provider, the provider shall:
(1) Meet the requirements of Title XLX of the
				  Social Security Act for participation as a hospital, as issued by the U.S.
				  Department of Health and Human Services;
(2) 24 hours per day, 7 days per week, meet
				  the following staffing requirements:
(a)
				  On-call or on-site physician services;
(b) On-site registered nurses;
(c) On-site respiratory therapist services;
				  and
(d) On-site advanced cardiac
				  life support services;
(3) Directly provide or make available
				  through contractual arrangements or transfer agreements, medically necessary
				  covered services;
(4) Accept
				  payment by the Program as payment in full for the covered service;
(5) Make available to the Department or its
				  designee the participant's medical record for review and certification of
				  medical necessity for admission and continuation of stay; and
(6) Maintain documentation of each contact
				  with the participant as part of the complete medical record, which, at a
				  minimum, includes:
(a) Date of
				  service;
(b) The participant's
				  chief medical complaint or reason for admission;
(c) A description of the services provided,
				  including:
(i) Progress notes;
(ii) Imaging studies;
(iii) Laboratory results;
(iv) Medication administration records;
				  and
(v) Discharge summary;
				  and
(d) A signature,
				  electronic or handwritten, along with the printed or typed name of the
				  individual providing care, with the appropriate title.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.93 - Chronic Hospitals › Section 10.09.93.04 - Specific Conditions for Provider Participation - Brain Injury Community Integration Program

Current through Register Vol. 51, No. 14, July 12, 2024
A. To
				  participate in the Program as a provider operating a brain injury community
				  integration program, the provider shall be:
(1) Accredited by the Commission on
				  Accreditation of Rehabilitation Facilities; and
(2) Approved by the Department to provide the
				  Program.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.93 - Chronic Hospitals › Section 10.09.93.05 - Covered Services

Current through Register Vol. 51, No. 14, July 12, 2024
A. Chronic
				  hospitals shall provide the following services:
(1) Complex respiratory care
				  services;
(2) Complex wound care
				  services;
(3) Services for
				  participants with multiple co-morbidities, including but not limited to
				  services necessary to care for:
(a)
				  Ventilator-assisted individuals who have been ventilator dependent for less
				  than 6 months and who need further medical stabilization or are candidates for
				  weaning from ventilator assistance;
(b) Tracheostomy participants who require
				  suctioning more frequently than every 2 hours or are candidates for
				  decannulation;
(c) More than two
				  extensive stage IV decubiti which require daily intensive treatment that is not
				  available in a nursing facility; or
(d) Extensive post-operative or
				  post-traumatic care with multiple drains or extensive dressing change or
				  therapies beyond the capabilities of a nursing facility;
(4) For participants admitted for medically
				  necessary rehabilitation services, physical therapy, occupational therapy, or
				  speech therapy, directed by an interdisciplinary team; and
(5) Ancillary services.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.93 - Chronic Hospitals › Section 10.09.93.06 - Limitations

Current through Register Vol. 51, No. 14, July 12, 2024
The Program does not cover:
A. Services for individuals who are not
				  eligible for Medicaid;
B. Services
				  for individuals who are not medically eligible for chronic hospital
				  services;
C. Services identified by
				  the Department or its designee as not medically necessary;
D. Hospital services, procedures, drugs, or
				  hospital admissions that are investigational or experimental;
E. Duplicated care or services;
F. Interpretation of laboratory tests or
				  panels;
G. Inpatient and outpatient
				  diagnostic and laboratory services not ordered by the attending physician or
				  other practitioner involved in the participant's care; or
H. Telephones, televisions, or personal
				  comfort items or services.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.93 - Chronic Hospitals › Section 10.09.93.07 - Medical Eligibility

Current through Register Vol. 51, No. 14, July 12, 2024
A. General
				  Requirements.
(1) An admission to a chronic
				  hospital is medically necessary for a participant whose:
(a) Medical condition is not stabilized
				  subsequent to a course of treatment at an acute hospital, or whose
				  deteriorating medical condition resulted in a readmission to an acute hospital
				  from a nursing facility or community setting; and
(b) Service and care needs require active and
				  continuing medical treatment at an intensity and frequency not provided in a
				  nursing facility, as defined in COMAR
				  10.09.10.01B,
				  such as:
(i) 24-hour availability of a
				  physician, physician assistant, or nurse practitioner, and associated nursing
				  staff; and
(ii) Active and
				  continuing medical treatment by a physician at least three times per week as
				  documented in the medical record, physician orders, and physician progress
				  notes.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.93 - Chronic Hospitals › Section 10.09.93.08 - Utilization Review

Current through Register Vol. 51, No. 14, July 12, 2024
A. Admission
				  and Prior Approval.
(1) For participants and
				  individuals who have applied for Medical Assistance, the provider shall request
				  a determination from the Department or its designee at the time of admission,
				  or at the time of application for Medical Assistance, that the individual meets
				  the medical eligibility criteria set forth in Regulation .07A of this
				  chapter.
(2) For a participant to
				  be preauthorized for services in a brain injury community integration program,
				  a provider that meets the requirements of Regulation .04 of this chapter shall
				  request a determination from the Department or its designee that the
				  participant meets the criteria set forth in Regulation .07B of this
				  chapter.
(3) If the provider
				  obtains the determination set forth in §A(1) or (2) of this regulation
				  after admission, the eligibility determination shall be effective on the date
				  that the determination was requested.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.93 - Chronic Hospitals › Section 10.09.93.09 - Payment Procedures

Current through Register Vol. 51, No. 14, July 12, 2024
A.
				  Reimbursement of Maryland Chronic Hospitals.
(1) In-State chronic hospitals shall be
				  reimbursed according to:
(a) Rates approved
				  by the HSCRC pursuant to COMAR 10.37.03; or
(b) The administrative day rate as follows:
(i) For a participant who is not
				  ventilator-dependent, payment for approved administrative days shall be the
				  estimated Statewide average Medicaid nursing facility payment rate as
				  determined by the Department; and
(ii) For a participant who is
				  ventilator-dependent, payment for approved administrative days shall be the
				  estimated average Medicaid nursing facility payment rate for
				  ventilator-dependent residents as determined by the Department.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.93 - Chronic Hospitals › Section 10.09.93.10 - Cost Reporting-State-Operated Chronic Hospitals

Current through Register Vol. 51, No. 14, July 12, 2024
A. The provider shall submit to the
				  Department or its designee, in the form prescribed, financial and statistical
				  data within 5 months after the end of the provider's fiscal year unless the
				  Department grants the provider an extension or the provider discontinues
				  participation in the Program.
B.
				  For hospitals who do not submit reports within 5 months, for whom an extension
				  has not been granted, and who are reimbursed according to Medicare standards
				  and principles for retrospective cost reimbursement as described in 42 CFR
				  § 413, the Department shall:
(1)
				  Withhold from the provider a maximum of 5 percent of the current monthly
				  interim payment starting the calendar month after the calendar month in which
				  the report is due and any subsequent calendar months until the report has been
				  submitted; and
(2) Refund
				  withholdings at cost settlement.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.93 - Chronic Hospitals › Section 10.09.93.11 - Cost Settlement - State-operated Chronic Hospitals

Current through Register Vol. 51, No. 14, July 12, 2024
A. Final settlement for services in the
				  provider's fiscal year shall be determined based on Medicare retrospective cost
				  principles found at 42 CFR § 413, adjusted for Program allowable costs.
				  Allowable costs specific to the Program shall be limited to a base year cost
				  per discharge increased by the applicable federal rate of increase times the
				  number of Program discharges for that fiscal year.
B. Base Year. For purposes of determining
				  limits on the increase of cost, in accordance with Medicare regulations, the
				  base year for an existing provider shall be the first year of entering into the
				  Program or the first year separate rates for the unit or units of service or
				  services are approved.
C. The
				  provider shall supply the Department or its designee the assurances necessary
				  to establish that its customary charges to participants liable for payment
				  exceed the allowable cost for these services.
D. Revision of Interim Rates. The provider
				  may request an interim rate revision should the actual and projected cost
				  exceed the interim rate by 10 percent. The provider shall furnish the
				  Department or its designee with appropriate schedules showing the reason for
				  the increase and any other information supporting the request. The Department
				  will lower the provider's interim rate to closely approximate the final
				  allowable reasonable cost based on the results of the prior year's review. The
				  provider may request not more than two interim rate revisions during the
				  accounting year.
E. Cost
				  Settlement. The provider shall submit to the Department or its designee a
				  Medicaid cost report based on actual data using the cost reporting forms used
				  by Medicare for retrospective cost reimbursement. The provider shall also
				  submit a copy of its Maryland Medical Assistance log. The submitted cost report
				  shall be in sufficient detail to support a separate cost finding for designated
				  Maryland Medical Assistance unique cost centers. Tentative cost settlements may
				  not be performed on a routine basis. However, the Program reserves the right to
				  calculate tentative settlements in limited cases, when appropriate, as
				  determined by the Department. The provider shall furnish the Department or its
				  designee with a finalized Medicare cost report for the cost reporting year. The
				  Department will base final settlement on the results of the finalized Medicare
				  cost reports.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.93 - Chronic Hospitals › Section 10.09.93.12 - Cost Settlement for State-operated Chronic Hospitals - Payments and Appeals

Current through Register Vol. 51, No. 14, July 12, 2024
A. The
				  Department or its designee shall notify each provider participating in the
				  Program of the results of the final settlement under Regulation .11 of this
				  chapter.
B. Within 60 days after
				  the provider receives the notification described in §A of this regulation,
				  the Department shall pay the amount due to the provider regardless of whether
				  the provider files an appeal.
C.
				  The provider may request review of the settlement under Regulation .11 of this
				  chapter by filing written notice with the Program's Appeal Board within 30 days
				  after receipt of the notification of the results of the settlement from the
				  Department or its designee.
D. The
				  Appeal Board shall be composed of the following:
(1) A representative of the hospital industry
				  who is:
(a) Knowledgeable in Medicare and
				  Medicaid reimbursement principles; and
(b) Appointed by the Secretary of the
				  Department;
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.93 - Chronic Hospitals › Section 10.09.93.13 - Recovery and Reimbursement

Current through Register Vol. 51, No. 14, July 12, 2024
A.
				  General policies governing recovery and reimbursement procedures applicable to
				  all providers are set forth in COMAR 10.09.36.07.
B. If refund of a payment as specified in
				  §A of this regulation, is not made, the Department shall reduce its
				  current payment to the provider by the amount of the duplicate payment,
				  overpayment, or third-party payment.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.93 - Chronic Hospitals › Section 10.09.93.14 - 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 10.09.93 - Chronic Hospitals › Section 10.09.93.15 - Appeal Procedures

Current through Register Vol. 51, No. 14, July 12, 2024
A provider filing an appeal from an administrative decision
					 made in connection with these regulations shall do so according to COMAR
					 10.09.36.09.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.93 - Chronic Hospitals › Section 10.09.93.16 - Interpretive Regulation

Current through Register Vol. 51, No. 14, July 12, 2024
General policies governing the interpretive regulations
					 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 10.09.94 - Special Pediatric Hospitals › Section 10.09.94.02 - License Requirements

Current through Register Vol. 51, No. 14, July 12, 2024
A. In
				  order to participate in the Program, a provider shall:
(1) Be licensed by the Department pursuant to
				  Health-General Article, Title 19, Subtitle 3, Annotated Code of Maryland, as a
				  hospital; and
(2) Obtain other
				  licenses, as set forth in COMAR 10.07.01.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.94 - Special Pediatric Hospitals › Section 10.09.94.03 - 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.
B. To participate in the
				  Program as a special pediatric hospital services provider, the provider shall:
(1) Meet the requirements of Title XLX of the
				  Social Security Act for participation as a hospital, as issued by the U.S.
				  Department of Health and Human Services;
(2) Directly provide, or make available
				  through contractual arrangements or transfer agreements, medically necessary
				  covered services;
(3) Accept
				  payment by the Program as payment in full for the covered services;
(4) Make available to the Department or its
				  designee the participant's medical record for review and certification of
				  medical necessity for admission and continuation of stay; and
(5) Maintain documentation of each contact
				  with the participant as part of the complete medical record, which, at a
				  minimum, includes:
(a) Date of
				  service;
(b) The participant's
				  chief medical complaint or reason for admission or outpatient visit;
(c) A description of the services provided,
				  including:
(i) Progress notes;
(ii) Imaging studies;
(iii) Laboratory results;
(iv) Medication administration records;
				  and
(v) Discharge summary;
				  and
(d) A signature,
				  electronic or handwritten, along with the printed or typed name of the
				  individual providing care, with the appropriate title.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.94 - Special Pediatric Hospitals › Section 10.09.94.04 - Covered Services

Current through Register Vol. 51, No. 14, July 12, 2024
A. The
				  Program covers the following inpatient services at special pediatric hospitals:
(1) A hospital admission determined to be
				  medically necessary for a participant who is stable enough for transfer to a
				  post-acute setting and requires medical or rehabilitative services that:
(a) Cannot be provided at a lower level of
				  care; and
(b) Meets the medical
				  eligibility criteria under Regulation .06 of this chapter;
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.94 - Special Pediatric Hospitals › Section 10.09.94.05 - Limitations

Current through Register Vol. 51, No. 14, July 12, 2024
The Program does not cover:
A. Investigational or experimental hospital
				  services, procedures, or drugs;
B.
				  Inpatient admissions or outpatient visits solely for the administration of
				  injections, unless medical necessity and the participant's inability to take
				  appropriate oral medications is documented in the participant's medical
				  record;
C. Outpatient visits
				  intended to accomplish one or more of the following:
(1) Prescription drug or food supplement
				  pick-up;
(2) Collection of
				  specimens for laboratory procedures;
(3) Recording of an electrocardiogram;
				  or
(4) Ascertaining the
				  participant's weight;
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.94 - Special Pediatric Hospitals › Section 10.09.94.06 - Utilization Review

Current through Register Vol. 51, No. 14, July 12, 2024
A. The
				  Department or its designee shall conduct utilization review to determine that
				  special pediatric hospital admissions and outpatient services are authorized
				  only when medically necessary.
B.
				  Review Procedure.
(1) For all admissions, the
				  special pediatric hospital shall provide:
(a)
				  The elements of a participant's medical record specified by the Department or
				  its designee for preadmission review, and request to certify the participant's
				  admission; and
(b) Sufficient
				  clinical information or documentation to the Department or its designee that
				  supports the need for admission to a special pediatric hospital including, but
				  not limited to:
(i) Current medical health
				  status;
(ii) Treatment received to
				  date;
(iii) Proposed treatment plan
				  for requested admission; and
(iv)
				  Expected length of stay.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.94 - Special Pediatric Hospitals › Section 10.09.94.07 - Payment Procedures

Current through Register Vol. 51, No. 14, July 12, 2024
A. HSCRC
				  Reimbursement Principles.
(1) Except for
				  hospitals reimbursed under the provisions of §B of this regulation and
				  except for administrative days, hospitals located in Maryland that participate
				  in the Program shall charge and be reimbursed according to rates approved by
				  the HSCRC pursuant to COMAR 10.37.03.
(2) If the Program discontinues using rates
				  which have been approved by HSCRC, the Program shall reimburse a provider:
(a) According to Medicare standards and
				  principles for retrospective cost reimbursement described in 42 CFR § 413
				  ; or
(b) On the basis of charges if
				  less than reasonable cost.
(3) The Department may not reimburse for the
				  services of a hospital's salaried or contractual physicians as a separate line
				  item.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.94 - Special Pediatric Hospitals › Section 10.09.94.08 - District of Columbia Hospital Reimbursement

Current through Register Vol. 51, No. 14, July 12, 2024
A. Inpatient Services Base Rate Calculation.
(1) A hospital in the District of Columbia
				  shall:
(a) Bill its usual and customary
				  charges; and
(b) Be reimbursed for
				  covered services the lesser of its percentage of charges as calculated in
				  §A(2) of this regulation or its charges.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.94 - Special Pediatric Hospitals › Section 10.09.94.09 - Billing and Reimbursement Principles

Current through Register Vol. 51, No. 14, July 12, 2024
A. The Program shall pay room and board
				  charges for the day of admission, and may not pay room and board charges for
				  the day of discharge from the hospital.
B. The provider shall submit a request for
				  payment according to procedures designated by the Department.
C. Payments of Medicare Claims.
(1) Payment of Medicare claims is authorized
				  if:
(a) The provider accepts Medicare
				  assignment;
(b) Medicare makes
				  direct payment to the provider;
(c)
				  Medicare determined that services were medically necessary;
(d) The services are covered by the Program;
				  and
(e) Initial billing is made
				  directly to Medicare according to Medicare guidelines.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.94 - Special Pediatric Hospitals › Section 10.09.94.10 - Recovery and Reimbursement

Current through Register Vol. 51, No. 14, July 12, 2024
A.
				  General policies governing recovery and reimbursement procedures applicable to
				  all providers are set forth in COMAR 10.09.36.07.
B. If refund of a payment as specified in
				  §A of this regulation is not made, the Department shall reduce its current
				  payment to the provider by the amount of the duplicate payment, overpayment, or
				  third-party payment.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.94 - Special Pediatric Hospitals › Section 10.09.94.11 - 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 10.09.94 - Special Pediatric Hospitals › Section 10.09.94.12 - Appeal Procedures

Current through Register Vol. 51, No. 14, July 12, 2024
A provider filing an appeal from an administrative decision
					 made in connection with these regulations shall do so according to COMAR
					 10.09.36.09.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.94 - Special Pediatric Hospitals › Section 10.09.94.13 - Interpretive Regulation

Current through Register Vol. 51, No. 14, July 12, 2024
General policies governing the interpretive regulations
					 that are applicable to 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 10.09.95 - Special Psychiatric Hospitals › Section 10.09.95.02 - License Requirements

Current through Register Vol. 51, No. 14, July 12, 2024
A. In
				  order to participate in the Program, a provider shall:
(1) Be licensed by the Department pursuant to
				  Health-General Article, Title 19, Subtitle 3, Annotated Code of Maryland, as a
				  specialty psychiatric hospital; and
(2) Obtain other licenses, as set forth in
				  COMAR 10.07.01.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.95 - Special Psychiatric Hospitals › Section 10.09.95.03 - 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. To participate in
				  the Program as a special psychiatric hospital services provider, the provider
				  shall:
(1) Meet the requirements of Title XIX
				  of the Social Security Act for participation as a hospital, as issued by the
				  Department of Health and Human Services;
(2) Meet the following staffing requirements
				  24 hours per day, 7 days per week:
(a)
				  On-call or on-site physician services including psychiatric
				  physicians;
(b) On-site registered
				  nurses;
(c) On-site advanced
				  cardiac life support services;
(3) If licensed to provide inpatient
				  psychiatric services for individuals younger than 21 years old:
(a) Meet the requirements for participation
				  as defined in 42 CFR §
													440.160; and
(b) Provide acute psychiatric services as
				  defined in 42 CFR Part 441, Subpart D;
(4) Directly provide or make available
				  through contractual arrangements or transfer agreements, medically necessary
				  covered services;
(5) Accept
				  payment by the Program as payment in full for the covered service;
(6) Make available to the Department or its
				  designee the participant's medical record for review and certification of
				  medical necessity for admission and continuation of stay;
(7) Maintain documentation of each contact
				  with the participant as part of the medical record, which, at a minimum,
				  includes:
(a) Date of service;
(b) A plan of treatment as defined in
				  Regulation .01B of this chapter;
(c) The participant's chief medical complaint
				  or reason for visit;
(d) A
				  description of the services provided, including:
(i) Progress notes;
(ii) Imaging studies;
(iii) Laboratory results;
(iv) Medication administration records;
				  and
(v) Discharge summary;
				  and
(e) A signature,
				  electronic or handwritten, along with the printed or typed name of the
				  individual providing care, with the appropriate title;
(8) Submit to the Department or its designee
				  within 5 months of the close of the hospital's fiscal year, as required by the
				  Department, a hospital cost report for outpatient services which are subject to
				  cost settlement in accordance with Regulation .11 of this chapter;
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.95 - Special Psychiatric Hospitals › Section 10.09.95.04 - Covered Services

Current through Register Vol. 51, No. 14, July 12, 2024
A. The
				  Program covers the following inpatient special psychiatric hospital services:
(1) Medically necessary services for the
				  number of days, per admission, including days certified by the Department or
				  its designee;
(2) Medically
				  necessary mental health services authorized in accordance with COMAR
				  10.09.59.08 and as set forth in
				  Regulation .05B(4) of this chapter;
(3) Medically necessary services when these
				  services are:
(a) Necessary for the provision
				  of diagnostic, curative, palliative, or rehabilitative treatment; and
(b) Described in the participant's medical
				  record in sufficient detail to support the invoices submitted for
				  services.
(4)
				  Administrative days for the length of time certified by the Department or its
				  designee;
(5) Leaves of absence for
				  therapeutic reasons or extenuating circumstances up to 12 hours per day, if the
				  participant returns the same day, before the census check; and
(6) Observation services. B. The Program
				  covers partial hospitalization when the hospital has:
(1) Written approval from the Office of
				  Licensing and Certification Programs to be a provider of partial
				  hospitalization in accordance with COMAR 10.21.02;
(2) A certificate of need from the Maryland
				  Health Resources Planning Commission, if required, to be a provider of partial
				  hospitalization; and
(3) Obtained
				  preauthorization in accordance with COMAR 10.09.59.08.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.95 - Special Psychiatric Hospitals › Section 10.09.95.06 - Utilization Review Requirements

Current through Register Vol. 51, No. 14, July 12, 2024
A.
				  Elective Inpatient Preauthorization Reviews.
(1) The special psychiatric hospital shall
				  only request preauthorization for inpatient stays when such services:
(a) Cannot be provided on an outpatient
				  basis; or
(b) Can only be provided
				  in a facility that is licensed as a special psychiatric hospital.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.95 - Special Psychiatric Hospitals › Section 10.09.95.07 - Payment Procedures

Current through Register Vol. 51, No. 14, July 12, 2024
A.
				  Reimbursement Principles.
(1) The Department
				  will make no direct reimbursement to any State-operated hospital. The
				  Department will claim federal fund recoveries from the U.S. Department of
				  Health and Human Services for services to participants in State-operated
				  hospitals.
(2) The Department shall
				  compare the current rates with the projected upper payment limit for inpatient
				  days of service on or after July 1, 2012, in freestanding private psychiatric
				  hospitals in Maryland whose rates for commercial providers are set by the
				  HSCRC.
(3) If the rates do not
				  exceed the projected upper payment limit calculated by the Department, the
				  Department shall reimburse these hospitals using a rate of 94 percent of the
				  current rates for services set by the HSCRC for each hospital's commercial
				  providers in the fiscal year the prospective payments are made.
(4) If the rates do exceed the projected
				  upper payment limit calculated by the Department, the per diem payments to each
				  such hospital shall be decreased by the same proportion that the projected
				  upper payment limit is exceeded.
(5) If the Program discontinues using rates
				  which have been approved by HSCRC, the Program shall reimburse providers:
(a) According to Medicare standards and
				  principles for retrospective cost reimbursement described in 42 CFR § 413
				  ; or
(b) On the basis of charges if
				  less than reasonable cost.
(6) The Department may not reimburse for the
				  services of a hospital's salaried or contractual physicians as a separate line
				  item. When HSCRC has included these salaries in the hospital's costs, charges
				  for these services shall be included in the room and board rate or the
				  appropriate ancillary service only.
(7) Payment advances other than those made in
				  accordance with HSCRC regulations may not be made routinely.
(8) Inpatient and outpatient services in
				  District of Columbia special psychiatric and outpatient services in in-State
				  special psychiatric hospitals are cost-settled on an annual basis according to
				  §B of this regulation.
(9)
				  Effective October 1, 2018, an out-of-State special psychiatric hospital shall
				  be reimbursed the lesser of its charges or the amount reimbursable by the host
				  state's Title XIX agency.
(10) An
				  out-of-State provider shall submit proof of host state rates on an annual
				  basis.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.95 - Special Psychiatric Hospitals › Section 10.09.95.08 - Recovery and Reimbursement

Current through Register Vol. 51, No. 14, July 12, 2024
A.
				  General policies governing recovery and reimbursement procedures applicable to
				  all providers are set forth in COMAR 10.09.36.07.
B. If refund of a payment as specified in
				  §A of this regulation, is not made, the Department shall reduce its
				  current payment to the provider by the amount of the duplicate payment,
				  overpayment, or third-party payment.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.95 - Special Psychiatric Hospitals › Section 10.09.95.09 - 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 10.09.95 - Special Psychiatric Hospitals › Section 10.09.95.10 - Appeal Procedures

Current through Register Vol. 51, No. 14, July 12, 2024
A provider filing an appeal from an administrative decision
					 made in connection with these regulations shall do so according to COMAR
					 10.09.36.09.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.95 - Special Psychiatric Hospitals › Section 10.09.95.11 - Submitting Cost Reports

Current through Register Vol. 51, No. 14, July 12, 2024
A. The
				  provider shall submit to the Department or its designee, in the form
				  prescribed, financial and statistical data within 5 months after the end of the
				  provider's fiscal year unless the Department grants the provider an extension
				  or the provider discontinues participation in the Program.
B. For hospitals who do not submit reports
				  within 5 months, for whom an extension has not been granted, and who are
				  reimbursed according to Medicare standards and principles for retrospective
				  cost reimbursement as described in 42 CFR § 413, the Department shall:
(1) Withhold from the provider a maximum of 5
				  percent of the current monthly interim payment starting the calendar month
				  after the calendar month in which the report is due and any subsequent calendar
				  months until the report has been submitted; and
(2) Refund withholdings at cost
				  settlement.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.95 - Special Psychiatric Hospitals › Section 10.09.95.12 - Cost Settlement.

Current through Register Vol. 51, No. 14, July 12, 2024
A. The
				  Department or its designee shall notify each provider participating in the
				  Program of the results of the final settlement under Regulation .07 of this
				  chapter.
B. Within 60 days after
				  the provider receives the notification described in §A of this regulation,
				  the Department shall pay the amount due to the provider regardless of whether
				  the provider files an appeal.
C.
				  The provider may request review of the settlement under Regulation .07 of this
				  chapter by filing written notice with the Program's Appeal Board within 30 days
				  after receipt of the notification of the results of the settlement from the
				  Department or its designee.
D. The
				  Appeal Board shall be composed of the following:
(1) A representative of the hospital industry
				  who is:
(a) Knowledgeable in Medicare and
				  Medicaid reimbursement principles; and
(b) Appointed by the Secretary of the
				  Department;
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.95 - Special Psychiatric Hospitals › Section 10.09.95.13 - Interpretive Regulation

Current through Register Vol. 51, No. 14, July 12, 2024
General policies governing the interpretive regulations
					 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 10.09.96 - Remote Patient Monitoring › Section 10.09.96.01 - Purpose and Scope

Current through Register Vol. 51, No. 14, July 12, 2024
A. This chapter
				  applies to remote patient monitoring services reimbursed by the Maryland
				  Medical Assistance Program effective January 1, 2018.
B. The purpose of providing medically
				  necessary services via remote patient monitoring is to assist participants in
				  managing and controlling their chronic conditions in order to reduce
				  readmissions and emergency department visits and to improve quality of
				  care
C. The target populations are
				  high-risk Maryland Medical Assistance Program participants with a chronic
				  disease capable of monitoring via remote patient monitoring.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.96 - Remote Patient Monitoring › Section 10.09.96.03 - License Requirements

Current through Register Vol. 51, No. 14, July 12, 2024
A. The
				  provider shall:
(1) Meet all license
				  requirements as set forth in COMAR
				  10.09.36.02; and
(2) Be licensed in the state in which the
				  participant resides.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.96 - Remote Patient Monitoring › Section 10.09.96.04 - Provider Conditions for Participation

Current through Register Vol. 51, No. 14, July 12, 2024
A. To provide remote patient monitoring, the
				  provider shall:
(1) Be enrolled with an
				  active status as a Maryland Medical Assistance Program provider on the date the
				  service is rendered;
(2) Be a:
(a) Physician;
(b) Physician assistant;
(c) Certified nurse practitioner;
				  or
(d) Home health agency when
				  remote patient monitoring services are prescribed by a physician; and
(3) Meet the requirements for
				  participation in the Medical Assistance Program as set forth in COMAR
				  10.09.36.03.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.96 - Remote Patient Monitoring › Section 10.09.96.05 - Participant Eligibility for Services

Current through Register Vol. 51, No. 14, July 12, 2024
A participant is eligible to receive remote patient
					 monitoring services if:
A. The
				  participant is enrolled in the Maryland Medical Assistance Program on the date
				  the service is rendered;
B. The
				  participant consents to remote patient monitoring services and has the
				  capability to utilize the monitoring tools and take actions to improve
				  self-management of the chronic disease;
C. The participant has the internet
				  connections necessary to host the equipment in the home;
D. The participant is at risk for avoidable hospital
				  utilization due to a poorly controlled chronic disease capable of being
				  monitored via remote patient monitoring; and
E. The provision of remote patient monitoring
				  may reduce the risk of preventable hospital utilization and promote improvement
				  in control of the chronic condition.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.96 - Remote Patient Monitoring › Section 10.09.96.06 - Covered Services

Current through Register Vol. 51, No. 14, July 12, 2024
A. Remote
				  patient monitoring services include:
(1)
				  Installation;
(2) Education for the
				  participant in the use of the equipment; and
(3) Daily monitoring of vital signs and other
				  medical statistics.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.96 - Remote Patient Monitoring › Section 10.09.96.07 - Limitations

Current through Register Vol. 51, No. 14, July 12, 2024
A. Remote patient
				  monitoring services are only covered for participants who meet the eligibility
				  criteria specified in Regulation .05 of this chapter.
B. The Program does not cover:
(1) Remote patient monitoring
				  equipment;
(2) Upgrades to remote
				  patient monitoring equipment;
(3)
				  The internet connections necessary to transmit the results of remote patient
				  monitoring services to the provider's offices; or
(4) More than:
(a) 2 months of remote patient monitoring
				  services per episode; and
(b) Two
				  episodes per year per participant.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.96 - Remote Patient Monitoring › Section 10.09.96.08 - Preauthorization Requirements

Current through Register Vol. 51, No. 14, July 12, 2024
The Department may preauthorize services when the provider
					 submits to the Department adequate documentation demonstrating the:
A. Participant's condition meets the criteria
				  listed in Regulation .05 of this chapter; and
B. Participant has not already been
				  preauthorized for two episodes during the past rolling calendar year.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.96 - Remote Patient Monitoring › Section 10.09.96.09 - Payment Methodology

Current through Register Vol. 51, No. 14, July 12, 2024
A. After
				  providing the services outlined in Regulation .06 of this chapter, the remote
				  patient monitoring provider shall submit the request for payment using the
				  format designated by the Department.
B. Home health agencies shall:
(1) Bill on a UB04; and
(2) Be paid a monthly rate.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.96 - Remote Patient Monitoring › Section 10.09.96.10 - Cause for Suspension or Removal and Imposition of Sanctions

Current through Register Vol. 51, No. 14, July 12, 2024
Recovery and reimbursement shall be in accordance with
					 COMAR 10.09.36.07.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.96 - Remote Patient Monitoring › Section 10.09.96.11 - 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 in accordance with COMAR 10.09.36.08.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.96 - Remote Patient Monitoring › Section 10.09.96.12 - Appeal Procedures

Current through Register Vol. 51, No. 14, July 12, 2024
Providers filing appeals from administrative decisions made
					 in connection with these regulations shall do so in accordance with COMAR
					 10.09.36.09.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.96 - Remote Patient Monitoring › Section 10.09.96.13 - Interpretive Regulation

Current through Register Vol. 51, No. 14, July 12, 2024
Except when the language of a specific regulation indicates
					 an intent by the Department to provide reimbursement for covered services to
					 Program recipients without regard to the availability of federal financial
					 participation, State regulations shall be interpreted in conformity with
					 applicable federal statutes and regulations.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 3 › Subtitle 10 - LABORATORIES › Chapter 10.10.01 - General › Section 10.10.01.01 - Purpose

Current through Register Vol. 51, No. 14, July 12, 2024
The people of Maryland are entitled to the highest level of
					 competency, reliability, and accuracy that reasonably may be expected from a
					 medical laboratory or crime laboratory. It is the intent of this subtitle to
					 protect the public and individual health by requiring a medical laboratory or
					 crime laboratory to employ qualified personnel and to operate under reliable
					 procedures, effective quality control and quality assurance programs, and
					 qualified supervision.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 3 › Subtitle 10 - LABORATORIES › Chapter 10.10.01 - General › Section 10.10.01.02 - Scope

Current through Register Vol. 51, No. 14, July 12, 2024
A. This subtitle
				  contains the standards and requirements that a medical laboratory shall meet
				  to:
(1) Obtain and retain a license to offer
				  to perform or perform tests on human specimens; and
(2) Certify chemists and analysts in crime
				  laboratories to perform approved testing procedures for controlled dangerous
				  substances.