Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.15 - Podiatry Services › Section 10.09.15.01 - 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) "Ambulatory surgical center" means any
				  distinct, Medicare-certified entity that operates exclusively for the purpose
				  of providing surgical services to patients not requiring
				  hospitalization.
(2) "Board" means
				  the State Board of Podiatric Medical Examiners.
(3) "Department" means the State Department
				  of Health and Mental Hygiene, the single State agency designated to administer
				  the Maryland Medical Assistance Program under Title XIX of the Social Security
				  Act, 42 U.S.C.
				  1396 et seq.
(4) "Emergency services" means treatment for
				  traumatic injury or infection other than athlete's foot or chronic mycotic
				  infection of the nail bed.
(5)
				  "Hospital" means an institution which falls within the jurisdiction of
				  Health-General Article, Title 19, Subtitle 3, Annotated Code of Maryland, and
				  is licensed pursuant to COMAR 10.07.01, or other applicable standards
				  established by the state in which the service is provided.
(6) "Medical Assistance Program" means a
				  program of comprehensive medical and other health-related care for indigent and
				  medically indigent persons.
(7)
				  "Medically necessary" has the meaning stated in COMAR
				  10.09.36.01A.
(8) "Medicare" means the insurance
				  program administered by the Federal Government under Title XVIII of the Social
				  Security Act, 42 U.S.C.
				  1395 et seq.
(9) "Nursing facility" means a skilled
				  nursing facility certified for participation pursuant to Title XVIII or Title
				  XIX of the Social Security Act, or an intermediate care facility certified for
				  participation pursuant to Title XIX of the Social Security Act, which has
				  entered into a provider agreement with the Department.
(10) "Participant" means an individual who is
				  certified as eligible for, and is receiving, Medical Assistance benefits.
(11) "Personal hygiene care" means
				  routine hygienic care in the absence of pathology.
(12) "Podiatrist" means a Doctor of Podiatry
				  (D.P.M.) who is licensed to practice podiatry by the Board or by the state in
				  which the service is rendered.
(13)
				  Practice Podiatry.
(a) "Practice podiatry"
				  means to diagnose or surgically, medically, or mechanically treat any ailment
				  of the:
(i) Human foot or ankle;
(ii) Anatomical structures that attach to the
				  human foot; or
(iii) Soft tissue
				  below the midcalf.
(b)
				  "Practice podiatry" does not include:
(i)
				  Surgical treatment of acute ankle fracture; or
(ii) Administration of an anesthetic, other
				  than a local anesthetic.
(14) "Preauthorization" means an approval
				  required from the Department or its designee before rendering
				  services.
(15) "Program" means the
				  Maryland Medical Assistance Program.
(16) "Provider" means
				  an individual, association, partnership, or an incorporated or unincorporated
				  group of podiatrists, duly licensed to provide services for participants, and
				  who, through appropriate agreement with the Department, has been identified as
				  a Program provider by the issuance of an individual account number.
(17) "Routine care" means the cutting or
				  removing of corns and calluses, and the trimming, cutting, clipping, or
				  debriding of toenails.
(18)
				  "Utilization control agent" means the organization responsible for reviewing
				  the use of medical services to determine medical necessity and lengths of stay
				  according to professional standards.