Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.93 - Chronic Hospitals › Section 10.09.93.01 - 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) "Acute hospital" means an institution
				  that provides active, short-term medical diagnosis, treatment, and
				  care.
(2) "Administrative day"
				  means a day of medical services delivered to a participant who no longer
				  requires the level of care that the provider is licensed to deliver.
(3) "Admission" means the formal acceptance
				  by a hospital of a participant who is to be provided with room, board, and
				  medically necessary services in an area of the hospital where individuals stay
				  at least overnight.
(4) "Ancillary
				  services" means diagnostic and therapeutic services including but not limited
				  to radiology, laboratory tests, pharmacy, and physical therapy services,
				  provided exclusive of room and board.
(5) "Appropriate facility" means:
(a) A facility located within a 25-mile
				  radius of the participant's residence; or
(b) If acceptable to the participant, a more
				  distant facility, which is licensed and certified to render the participant's
				  required level of care, except when the only facility or facilities that
				  provide the level of care and specialized services required by the participant
				  exceed that distance.
(6) "Brain injury" means an injury or insult
				  to the brain that occurs after birth and is not related to congenital or
				  degenerative disease, which results in cognitive, physical, behavioral, or
				  emotional disability that is documented in the medical record.
(7) "Brain injury community integration
				  program" means a program located on the campus of a licensed chronic hospital
				  and approved by the Department to treat individuals with primary diagnoses of
				  brain injury resulting in functional limitations and disability, who need
				  services designed to transition to home or a community-based program of
				  services and supports.
(8) Chronic
				  Hospital.
(a) "Chronic hospital" means an
				  institution licensed by the Department of Health and Mental Hygiene in
				  accordance with COMAR
				  10.07.01.03B,
				  which provides services to patients with complex medical needs who do not
				  require hospitalization in an acute hospital, but whose treatment needs exceed
				  the capabilities of a nursing facility.
(b) "Chronic hospital" does not mean a:
(i) Long-term care hospital, as defined at
				  42 CFR §
														412.23(e); or
(ii) Long-term care facility, as defined at
				  42 CFR §
														483.5(a).
(9) "Concurrent review"
				  means a periodic reauthorization of continued medical eligibility for the level
				  of services provided by a chronic hospital which allows for close monitoring of
				  the participant's progress, treatment goals, and objectives, performed during
				  an inpatient hospitalization.
(10)
				  "Date of service" means:
(a) For inpatient
				  hospitalizations, the date of admission into a chronic hospital up to, but not
				  including, the date of discharge; or
(b) For outpatient services, the date
				  services are rendered in the outpatient department of the hospital.
(11) "Department" means the
				  Maryland Department of Health and Mental Hygiene, which is the single State
				  agency designated to administer the Medical Assistance Program under Title XIX
				  of the Social Security Act, 42 U.S.C. §
												1396 et
				  seq.
(12) "Designee" means any
				  entity designated to act on behalf of the Department.
(13) "Electronic signature" means a secure
				  electronic identification of an individual who authorizes an electronic record
				  or transaction.
(14) "Health
				  Services Cost Review Commission (HSCRC)" means the independent organization
				  within the Department of Health and Mental Hygiene which is responsible for
				  reviewing and approving rates for hospitals pursuant to Health-General Article,
				  Title 19, Subtitle 2, Annotated Code of Maryland.
(15) "Interdisciplinary team" means a
				  physician-led multidisciplinary clinical team consisting of, at a minimum:
(a) The participant or an individual of the
				  participant's choice;
(b) A
				  physician;
(c) A registered
				  nurse;
(d) A social
				  worker;
(e) The participant's case
				  manager; and
(f) Any other clinical
				  professional indicated by an individual's specific needs, including but not
				  limited to:
(i) A psychologist;
(ii) A behavioral analyst;
(iii) A dietitian or nutritionist; and
(iv) Licensed therapists in other
				  disciplines.
(16) "Medical Assistance Program" means the
				  program of comprehensive medical and other health-related care for indigent and
				  medically indigent persons.
(17)
				  "Medically necessary" means that the service or benefit is:
(a) Directly related to diagnostic,
				  preventative, curative, palliative, rehabilitative, or ameliorative treatment
				  of an illness, injury, disability, or health condition;
(b) Consistent with standards of good medical
				  practice;
(c) The most
				  cost-efficient service that can be provided without sacrificing effectiveness
				  or access to care; and
(d) Not
				  primarily for the convenience of the participant, family, or
				  provider.
(18)
				  "Medicare" means the medical insurance program administered by the federal
				  government under Title XVIII of the Social Security Act,
				  42 U.S.C. §
												1395 et seq.
(19) "Neuro-behavioral" means the discipline
				  within medical rehabilitation that focuses on behavioral impairments seen in
				  association with brain injury resulting from trauma, hypoxia, or
				  ischemia.
(20) "Out-of-State
				  hospital" means any hospital outside of Maryland, except for hospitals located
				  in the District of Columbia.
(21)
				  "Outpatient services" means services provided to the participant on the
				  hospital campus that do not require hospital admission.
(22) "Participant" means an individual who is
				  enrolled with the Department to receive Medical Assistance services.
(23) "Program" means the Maryland Medical
				  Assistance Program.
(24) "Provider"
				  means a chronic hospital which, through agreement with the Department, has been
				  identified as a Program provider by the issuance of a provider
				  number.