reglab/statecodes huggingface dataset:
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.12 - Disposable Medical Supplies and Durable Medical Equipment › Section 10.09.12.05 - Limitations

Current through Register Vol. 51, No. 14, July 12, 2024
The Program does not cover:
A. Incontinency pants and disposable
				  underpads unless the following conditions are met:
(1) The incontinence supplies are medically
				  necessary for medical conditions associated with prolonged urinary or bowel
				  incontinence;
(2) For pull-on
				  underwear type garments, the recipient is capable of independently putting on
				  and removing the garment; and
(3)
				  Disposable incontinence supplies meet, at a minimum, the following absorbent
				  capacity standards:
(a) For children's
				  diapers and underwear, not less than 800cc;
(b) For youth diapers and underwear, not less
				  than 1,000cc;
(c) For small adult
				  diapers and underwear, not less than 1,200cc;
(d) For medium adult diapers and underwear,
				  not less than 1,750cc;
(e) For
				  large, extra large, and bariatric adult diapers and underwear, not less than
				  2,000cc; and
(f) For disposable
				  underpads, not less than 1,000 cc;
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.12 - Disposable Medical Supplies and Durable Medical Equipment › Section 10.09.12.06 - Prepayment Authorization Requirements

Current through Register Vol. 51, No. 14, July 12, 2024
A. Prepayment
				  authorization is required for:
(1) Disposable
				  medical supplies with a charge exceeding $500, except as specified in
				  §B(1) and (4) of this regulation and durable medical equipment on the
				  approved list of items as individual consideration (I/C);
(2) All incontinency pants for recipients 3
				  through 15 years old in excess of 240 in any 30-day period, and disposable
				  underpads for recipients 3 through 15 years old in excess of 135 in any 30-day
				  period;
(3) All incontinency pants
				  for recipients 16 years old or older in excess of 180 in any 30-day period, and
				  disposable underpads for recipients 16 years old or older in excess of 100 in
				  any 30-day period;
(4) All
				  disposable incontinency pants and all disposable underpads for recipients
				  younger than 3 years old;
(5)
				  Disposable medical supplies and durable medical equipment not on the approved
				  list of items;
(6) Any rental of
				  durable medical equipment after 3 months of rental;
(7) All repairs to purchased durable medical
				  equipment exceeding $500;
(8)
				  Durable medical equipment with a purchase price of $1,000 or more except as
				  specified in §B(1) and (3) of this regulation; and
(9) Medical equipment and supplies not listed
				  on the approved list of items.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.12 - Disposable Medical Supplies and Durable Medical Equipment › Section 10.09.12.07 - Payment Procedures

Current through Register Vol. 51, No. 14, July 12, 2024
A. Payment
				  procedures shall be as set forth in COMAR 10.09.36.04.
B. The provider's billed charges to the
				  Program may not exceed the provider's customary charge. If the item is free to
				  individuals not covered by Medicaid:
(1) The
				  provider:
(a) May charge the Program;
				  and
(b) Shall be reimbursed in
				  accordance with the provisions of this regulation; and
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.12 - Disposable Medical Supplies and Durable Medical Equipment › Section 10.09.12.08 - Recovery and Reimbursement

Current through Register Vol. 51, No. 14, July 12, 2024
Recovery and reimbursement shall be 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 10.09.12 - Disposable Medical Supplies and Durable Medical Equipment › Section 10.09.12.09 - 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
					 shall be 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 10.09.12 - Disposable Medical Supplies and Durable Medical Equipment › Section 10.09.12.10 - Appeal Procedures

Current through Register Vol. 51, No. 14, July 12, 2024
Appeal procedures shall be 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 10.09.12 - Disposable Medical Supplies and Durable Medical Equipment › Section 10.09.12.11 - Interpretive Regulation

Current through Register Vol. 51, No. 14, July 12, 2024
State Regulations shall be 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 10.09.13 - Ambulance and Wheelchair Van Services › Section 10.09.13.01 - 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) "Department" has the meaning stated in
				  COMAR 10.09.36.
(2) "Medical
				  Assistance Program" has the meaning stated in COMAR 10.09.36.
(3) "Medical Care Programs" has the meaning
				  stated in COMAR 10.09.36.
(4)
				  "Medicare" has the meaning stated in COMAR 10.09.36.
(5) "Program" has the meaning stated in COMAR
				  10.09.36.
(6) "Provider" has the
				  meaning stated in COMAR 10.09.36.
(7) "Recipient" has the meaning stated in
				  COMAR 10.09.36.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.13 - Ambulance and Wheelchair Van Services › Section 10.09.13.02 - Licensing Requirements

Current through Register Vol. 51, No. 14, July 12, 2024
Providers shall meet all licensing requirements 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 10.09.13 - Ambulance and Wheelchair Van Services › Section 10.09.13.03 - Conditions for Participation

Current through Register Vol. 51, No. 14, July 12, 2024
To participate in the Program, the provider shall:
A. Comply with the conditions for
				  participation as set forth in COMAR 10.09.36;
B. Be approved as a provider of ambulance
				  services by Medicare.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.13 - Ambulance and Wheelchair Van Services › Section 10.09.13.04 - Covered Services

Current through Register Vol. 51, No. 14, July 12, 2024
The program covers copayment and deductible payments for
					 Medicare-approved services to Maryland Medical Assistance
					 recipients.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.13 - Ambulance and Wheelchair Van Services › Section 10.09.13.05 - Limitations

Current through Register Vol. 51, No. 14, July 12, 2024
The Program does not cover any payment for service other
					 than coinsurance and deductible as approved by Medicare.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.13 - Ambulance and Wheelchair Van Services › Section 10.09.13.07 - Payment Procedures

Current through Register Vol. 51, No. 14, July 12, 2024
A. Payment
				  procedures for this chapter are set forth in COMAR 10.09.36.
B. The Department will authorize payment on
				  Medicare ambulance claims if:
(1) The provider
				  accepts Medicare assignments;
(2)
				  Medicare makes direct payment to the provider;
(3) The services are covered by the
				  Program;
(4) Initial billing is
				  made directly to Medicare according to Medicare guidelines;
(5) Medicare has determined that services
				  were medically justified.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.13 - Ambulance and Wheelchair Van Services › Section 10.09.13.08 - Recovery and Reimbursement

Current through Register Vol. 51, No. 14, July 12, 2024
Recovery and reimbursement for this chapter are 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 10.09.13 - Ambulance and Wheelchair Van Services › Section 10.09.13.09 - 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
					 for this chapter are 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 10.09.13 - Ambulance and Wheelchair Van Services › Section 10.09.13.10 - Appeal Procedures

Current through Register Vol. 51, No. 14, July 12, 2024
Appeal procedures for this chapter are 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 10.09.13 - Ambulance and Wheelchair Van Services › Section 10.09.13.11 - Interpretive Regulation

Current through Register Vol. 51, No. 14, July 12, 2024
The interpretive regulation for this chapter is 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 10.09.14 - Vision Care Services › Section 10.09.14.02 - License Requirements

Current through Register Vol. 51, No. 14, July 12, 2024
A. An
				  optometrist shall be licensed to practice optometry in the state in which
				  service is provided.
B. An optician
				  shall meet the legal requirements of the state in which the service is
				  provided.
C. An ophthalmologist
				  shall be licensed to practice medicine in the state in which the service is
				  provided.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.14 - Vision Care Services › Section 10.09.14.03 - Conditions for Participation

Current through Register Vol. 51, No. 14, July 12, 2024
To participate in the Program, the provider shall:
A. Apply for participation in the Program
				  using the application form designated by the Department;
B. Be approved for participation by the
				  Department;
C. Verify the
				  recipient's eligibility;
D.
				  Maintain adequate records for a minimum of 6 years and make them available,
				  upon request, to the Department or its designee;
E. Provide service without regard to race,
				  creed, color, age, sex, national origin, marital status, or physical or mental
				  handicap;
F. Not knowingly employ
				  an optometrist, optician, or physician to provide services to Medical
				  Assistance patients after that optometrist, optician, or physician has been
				  disqualified from the Program, unless prior approval has been received from the
				  Department.
G. Accept payment by
				  the Department as payment in full for services rendered and make no additional
				  charge to any person or covered services;
H. Use first quality materials that meet the
				  criteria established by the Department;
I. Place no restriction on a recipient's
				  right to select providers of the recipient's choice;
J. Agree that if the Program denies payment
				  or requests repayment on the basis that an otherwise covered service was not
				  medically necessary, the provider may not seek payment for that service from
				  the recipient;
K. Agree that if the
				  Program denies payment due to late billing, the provider may not seek payment
				  from the recipient.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.14 - Vision Care Services › Section 10.09.14.04 - Covered Services

Current through Register Vol. 51, No. 14, July 12, 2024
A. The
				  program covers the following vision care services:
(1) A maximum of one optometric examination
				  every 2 years for recipients 21 years old or older and a maximum of one every
				  year for recipients younger than 21 years old, to determine the extent of
				  visual impairment or the correction required to improve visual acuity, unless
				  the time limitations are waived by the Department, based on medical
				  necessity;
(2) Subject to §B,
				  of this regulation, a maximum of one pair of eyeglasses every year, unless the
				  time limitations are waived by the Department, based on medical
				  necessity;
(3) Examination and
				  eyeglasses for a recipient with a medical condition, other than normal
				  physiological change necessitating a change in eyeglasses (before the normal
				  time limits specified in §§A and B of this regulation have been met)
				  when a preauthorization has been procured;
(4) Visually necessary optometric care
				  rendered by an optometrist when these services are:
(a) Provided by the optometrist or a licensed
				  employee;
(b) Related to the
				  patient's health needs as diagnostic, preventive, curative, palliative, or
				  rehabilitative services; and
(c)
				  Adequately described in the patient's record; and
(5) Optician services when the services are:
(a) Provided by the optician, optometrist, or
				  ophthalmologist, or by an employee under the optician's, optometrist's, or
				  ophthalmologist's supervision and control;
(b) Adequately described in the patient's
				  record;
(c) Ordered or prescribed
				  by an ophthalmologist or optometrist.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.14 - Vision Care Services › Section 10.09.14.05 - Limitations

Current through Register Vol. 51, No. 14, July 12, 2024
A. The following
				  are not covered:
(1) Eyeglasses, ophthalmic
				  lenses, optical aids, and optician services rendered to recipients 21 years old
				  and older;
(2) Eyeglasses,
				  ophthalmic lenses, optical aids, and optician services rendered to recipients
				  which were not ordered as a result of a full or partial EPSDT screen;
(3) Repairs, except when repairs to
				  eyeglasses are more cost-effective than replacing with new
				  eyeglasses;
(4) Combination or
				  metal frames except when required for proper fit;
(5) Cost of travel by the provider;
(6) A general screening of a Medical
				  Assistance population;
(7) Visual
				  training sessions which do not include orthoptic treatment;
(8) Routine adjustment.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.14 - Vision Care Services › Section 10.09.14.06 - Preauthorization Requirements

Current through Register Vol. 51, No. 14, July 12, 2024
A. The
				  following services require written preauthorization:
(1) Optometric examinations to determine the
				  extent of visual impairment or the correction required to improve visual acuity
				  before expiration of the normal time limitations;
(2) Replacement of eyeglasses due to medical
				  necessity or because the eyeglasses were lost, stolen, or damaged before
				  expiration of the normal time limitations;
(3) Contact lenses;
(4) Subnormal vision aid examination and
				  fitting;
(5) Orthoptic treatment
				  sessions;
(6) Plastic lenses
				  costing more than equivalent glass lenses unless there are six or more diopters
				  of spherical correction or three or more diopters of astigmatic
				  correction;
(7) Absorptive lenses,
				  except cataract;
(8) Ophthalmic
				  lenses or optical aids when the diopter correction is less than:
(a) -0.50 D. sphere for myopia in the weakest
				  meridian;
(b) +0.75 D. sphere for
				  hyperopia in the weakest meridian;
(c) +0.75 additional for
				  presbyopia;
(d)
												±0.75 D.
				  cylinder for astigmatism;
(e) A
				  change in axis of 5° for cylinders of 1.00 diopter or more;
(f) A total of 4 prism diopters lateral or a
				  total of 1 prism diopters vertical.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.14 - Vision Care Services › Section 10.09.14.07 - Payment Procedures

Current through Register Vol. 51, No. 14, July 12, 2024
A. Form
				  for Request for Payment.
(1) The provider
				  shall submit a request for payment on the form designated by the
				  Department.
(2) The request for
				  payment shall document the following, when applicable:
(a) Preauthorization;
(b) Prescriptions;
(c) Need for combination or metal
				  frame;
(d) Laboratory
				  invoices.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.14 - Vision Care Services › Section 10.09.14.08 - Recovery and Reimbursement

Current through Register Vol. 51, No. 14, July 12, 2024
A.
				  If the recipient has insurance or other coverage, or if any other person is
				  obligated, either legally or contractually, to pay for or to reimburse the
				  recipient for services covered by this chapter, the provider shall seek payment
				  from that source first. If an insurance carrier rejects the claim or pays less
				  than the amount allowed by the Medical Assistance Program, the provider may
				  submit a claim to the Program. The provider shall submit a copy of the
				  insurance carrier's notice or remittance advice with his invoice. If payment is
				  made by both the Program and the insurance or other source for the same
				  service, the provider shall refund to the Department, within 60 days of
				  receipt, the amount paid by the Program, or the insurance or other source,
				  whichever is less.
B. A provider
				  shall reimburse the Department for any overpayment.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.14 - Vision Care Services › Section 10.09.14.09 - Cause for Suspension or Removal and Imposition of Sanctions

Current through Register Vol. 51, No. 14, July 12, 2024
A. If the
				  Department determines that a provider, ophthalmologist, optometrist, optician,
				  any agent or employee of the provider, or any person with an ownership interest
				  in the provider has failed to comply with applicable federal or State laws or
				  regulations, the Department may initiate one or more of the following actions
				  against the responsible party:
(1) Suspension
				  from Program;
(2) Withholding of
				  payment by the Program;
(3) Removal
				  from the Program;
(4)
				  Disqualification from future participation in the Program, either as a provider
				  or as a person providing services for which Program payment will be
				  claimed.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.14 - Vision Care Services › Section 10.09.14.10 - 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 according to COMAR
					 10.09.36.09A.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.14 - Vision Care Services › Section 10.09.14.11 - 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 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.15 - Podiatry Services › Section 10.09.15.02 - License Requirements

Current through Register Vol. 51, No. 14, July 12, 2024
A. The
				  Provider shall meet all license requirements as set forth in COMAR
				  10.09.36.02A.
B. In order to participate in the
				  Program a podiatrist shall be licensed to practice podiatry in the state in
				  which service is provided.
C. The
				  provider shall ensure that Clinical Laboratory Improvement Amendments (CLIA)
				  certification exists for all clinical laboratory services performed, and:
(1) If located in Maryland, comply with
				  requirements of Health-General Article, Title 17, Subtitles 2 and 3, Annotated
				  Code of Maryland, and COMAR 10.10.06; or
(2) If located out-of-State, comply with
				  other applicable standards established by the state or locality in which the
				  service is provided.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.15 - Podiatry Services › Section 10.09.15.03 - Conditions for Participation

Current through Register Vol. 51, No. 14, July 12, 2024
A. General
				  requirements for participation in the Program are that a provider shall:
(1) Comply with requirements 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 10.09.15 - Podiatry Services › Section 10.09.15.04 - Covered Services

Current through Register Vol. 51, No. 14, July 12, 2024
The Program covers the following medically necessary
					 services:
A. Podiatric services
				  rendered in the podiatrist's office, the participant's home, a hospital, a
				  nursing facility, a free standing clinic, or elsewhere, when these services
				  are:
(1) Performed by the podiatrist or another licensed
				  podiatrist in the podiatrist's employ;
(2) Performed on the:
(a) Human foot or ankle;
(b) Anatomical structures that attach to the
				  human foot; or
(c) Soft tissue
				  below the midcalf
(3)
				  Clearly related to the participant's individual medical needs as diagnostic,
				  curative, palliative, or rehabilitative services; and
(4) Adequately described on the participant's
				  medical record.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.15 - Podiatry Services › Section 10.09.15.05 - Limitations

Current through Register Vol. 51, No. 14, July 12, 2024
A. The Program does
				  not cover the following under this chapter:
(1) Services which are not medically
				  necessary;
(2) Investigational or
				  experimental drugs or procedures;
(3) Services prohibited by the Maryland
				  Podiatry Act or the State Board of Podiatric Medical Examiners;
(4) Services denied by Medicare as not
				  medically justified;
(5) Drugs and
				  supplies which are acquired by the podiatrist at no cost;
(6) Injections and visits solely for the
				  administration of injections, unless medical necessity and the patient's
				  inability to take oral medications are documented in the patient's medical
				  record;
(7) More than one visit per
				  day unless adequately documented in the patient's medical record as an
				  emergency;
(8) Visits by or to the
				  podiatrist solely for the purpose of the following:
(a) Prescription or drug pick-up,
(b) Collection of specimens for laboratory
				  procedures, except by venipuncture, capillary or arterial puncture;
				  and
(c) Interpretation of
				  laboratory tests or panels;
(9) Physical therapy;
(10) Orthotics and inlays of any type and
				  related services;
(11) Disposable
				  medical supplies;
(12)
				  Administration of anesthesia as a separate charge;
(13) Personal hygiene care;
(14)
				  Routine care, except visits for 
				  participants who are diabetic or who have a vascular disease affecting the
				  lower extremities;
(15)
				  Non-surgical hospital visits;
(16)
				  Laboratory or X-ray services not performed by the provider or under the direct
				  supervision of the provider; and
(17) Podiatric
				  inpatient hospital services rendered during an admission denied by the
				  utilization control agent or during a period that is in excess of the length of
				  stay authorized by the utilization control agent.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.15 - Podiatry Services › Section 10.09.15.06 - Preauthorization

Current through Register Vol. 51, No. 14, July 12, 2024
A. Preauthorization
				  is required for any procedure not included in the current fee
				  schedule.
B. Preauthorization is
				  issued when:
(1) Program procedures are
				  met;
(2) The provider submits to
				  the Department adequate documentation demonstrating that the service to be
				  preauthorized is medically necessary.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.15 - Podiatry Services › Section 10.09.15.07 - Payment Procedures

Current through Register Vol. 51, No. 14, July 12, 2024
A. The provider
				  shall submit his request for payment on the form designated by the Department
				  including all required documentation.
B. The Department reserves the right to
				  return to the provider, before payment, all invoices not properly signed and
				  completed.
C. The provider shall
				  bill the provider's customary fees, but may not bill a fee in excess of that
				  charged the general public for similar services, except for injectable drugs
				  and dispensed medical supplies, in which case the provider shall charge the
				  Program the provider's acquisition cost. If the service is free to individuals
				  not covered by Medicaid:
(1) The provider:
(a) May charge the Program; and
(b) Shall be reimbursed in accordance with
				  §D of this regulation; and
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.15 - Podiatry Services › Section 10.09.15.08 - Recovery and Reimbursement

Current through Register Vol. 51, No. 14, July 12, 2024
A.
				  If the participant has insurance or other coverage, or if any other person is
				  obligated, either legally or contractually, to pay for or to reimburse the
				  participant for services covered by this chapter, the provider shall seek
				  payment from that source first. If an insurance carrier rejects the claim or
				  pays less than the amount allowed by the Medical Assistance Program, the
				  provider may submit a claim to the Program. The provider shall submit a copy of
				  the insurance carrier's notice or remittance advice with his invoice. If
				  payment is made by both the Program and the insurance or other source for the
				  same service, the provider shall refund to the Department, within 60 days of
				  receipt, the amount paid by the Program, or the insurance or other source,
				  whichever is less.
B. A provider
				  shall reimburse the Department for any overpayment.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.15 - Podiatry Services › Section 10.09.15.09 - Cause for Suspension or Removal and Imposition of Sanctions

Current through Register Vol. 51, No. 14, July 12, 2024
A. If the
				  Department determines that a provider, podiatrist, any agent or employee of the
				  provider, or any person with an ownership interest in the provider has failed
				  to comply with applicable federal or State laws or regulations, the Department
				  may initiate one or more of the following actions against the responsible
				  party:
(1) Suspension from the
				  Program;
(2) Withholding of payment
				  by the Program;
(3) Removal from
				  the Program;
(4) Disqualification
				  from future participation in the Program, either as a provider or as a person
				  providing services for which Program payment will be claimed.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.15 - Podiatry Services › Section 10.09.15.10 - 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 according to COMAR
					 10.09.36.09A.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.15 - Podiatry Services › Section 10.09.15.11 - 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 participants 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 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.16 - Behavioral Health Crisis Services › Section 10.09.16.02 - License Requirements

Current through Register Vol. 51, No. 14, July 12, 2024
To participate in the Program, a provider shall meet the
					 license requirements stated in COMAR
					 10.09.36.02,
					 10.63.01.05, and
					 10.63.02.03.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.16 - Behavioral Health Crisis Services › Section 10.09.16.03 - Provider Requirements 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, a provider of behavioral health crisis services shall:
(1) Meet the conditions for licensure and
				  practice as set forth in COMAR 10.63.01, 10.63.02, and 10.63.06;
(2) Have clearly defined and written patient
				  care policies;
(3) Maintain, either
				  manually or electronically, adequate documentation of each contact with a
				  participant as part of the medical record, which, at a minimum, meets the
				  following requirements:
(a) Includes the date
				  of service with service start and end times;
(b) Includes the participant's primary
				  behavioral health complaint or reason for the visit;
(c) Includes a brief description of the
				  service provided, including progress notes;
(d) Includes an official e-Signature, or a
				  legible signature, along with the printed or typed name, and appropriate title
				  of each individual providing services, including each separate member of the
				  mobile crisis team;
(e) Is made
				  available to the Department or its designee as requested; and
(f) Complies with all federal statutes and
				  regulations, including but not limited to the Health Insurance Portability and
				  Accountability Act, 42
				  U.S.C. §
													1320D et seq., and implementing
				  regulations at 42 CFR Part 2 and 45 CFR Parts 160 and
				  164.04.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.16 - Behavioral Health Crisis Services › Section 10.09.16.04 - Participant Eligibility

Current through Register Vol. 51, No. 14, July 12, 2024
A. A
				  participant is eligible for mobile crisis team services and behavioral health
				  crisis stabilization center services if they are experiencing a crisis as
				  defined in Regulation .01 of this chapter.
B. A participant is eligible for behavioral
				  health crisis services if the service is appropriate to the specific provider
				  type listed in Regulation .05 of this chapter.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.16 - Behavioral Health Crisis Services › Section 10.09.16.05 - Covered Services

Current through Register Vol. 51, No. 14, July 12, 2024
A. The
				  Department shall reimburse for the services in §§B-C of this
				  regulation when these services have been documented, pursuant to the
				  requirements in this chapter, as necessary.
B. Mobile crisis team services shall:
(1) Comply with COMAR 10.63.03.20;
(2) Consist of an in-person response by at
				  minimum a two-person team;
(3)
				  Include an initial assessment by a licensed mental health professional, which
				  may be rendered via telehealth only when the licensed mental health
				  professional functions as a third team member;
(4) Involve the following interventions and
				  objectives:
(a) Crisis intervention and
				  stabilization of the individual's behavioral health crisis;
(b) Safety planning; and
(c) Referrals to community supports,
				  including behavioral health providers, health providers, or social and other
				  services; and
(5) Include
				  mobile crisis follow-up outreach by means of telephone, telehealth, or
				  in-person contact with the individual served, family members, caregivers, or
				  referred providers.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.16 - Behavioral Health Crisis Services › Section 10.09.16.06 - Limitations

Current through Register Vol. 51, No. 14, July 12, 2024
A. The Program
				  does not cover the following:
(1) Services
				  not delivered in compliance with Regulation .05 of this chapter;
(2) Services not medically
				  necessary;
(3) Investigational or
				  experimental drugs and procedures;
(4) Services solely for the purpose of:
(a) Prescribing medication;
(b) Administering medication;
(c) Drug or supply pick-up;
(d) Collecting laboratory
				  specimens;
(e) Interpreting
				  laboratory tests or panels; or
(f)
				  Administering injections;
(5) Separate reimbursement to an employee of
				  a program for services that have been provided by and reimbursed directly to a
				  program;
(6) Services provided to
				  or for the primary benefit of individuals other than the participant;
(7) Mobile crisis team services rendered by
				  telehealth with the exception of those specified as permissible via telehealth
				  in Regulation .05 of this chapter;
(8) Behavioral health crisis stabilization
				  center services rendered by telehealth with the exception of those specified in
				  COMAR 10.63.03.21;
(9) Services
				  provided to participants in a hospital inpatient setting; and
(10) Services rendered but not appropriately
				  documented.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.16 - Behavioral Health Crisis Services › Section 10.09.16.07 - Payment Procedures

Current through Register Vol. 51, No. 14, July 12, 2024
A. General
				  policies governing payment procedures that are applicable to all providers are
				  set forth in COMAR 10.09.36.04.
B.
				  Billing time limitations for claims submitted under this chapter are set forth
				  in COMAR 10.09.36.06.
C. Rates for
				  the services outlined in this chapter shall be as follows:
(1) For services outlined in this regulation
				  as delivered through a mobile crisis team:
(a)
				  Mobile crisis team services - $111.80 per 15-minute unit increment;
				  and
(b) Mobile crisis follow-up
				  outreach - $111.80 per 15-minute unit increment.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.16 - Behavioral Health Crisis Services › Section 10.09.16.08 - Recovery and Reimbursement

Current through Register Vol. 51, No. 14, July 12, 2024
Recovery and reimbursement are as set forth in COMAR
					 10.09.36.07.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.16 - Behavioral Health Crisis Services › Section 10.09.16.09 - 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
					 are 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 10.09.16 - Behavioral Health Crisis Services › Section 10.09.16.10 - Appeal Procedures for Providers

Current through Register Vol. 51, No. 14, July 12, 2024
Appeal procedures for providers are as set forth in COMAR
					 10.09.36.09.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.16 - Behavioral Health Crisis Services › Section 10.09.16.11 - Appeal Rights - Denial of Services

Current through Register Vol. 51, No. 14, July 12, 2024
Appeal procedures for applicants and participants are as
					 set forth in COMAR 10.01.04.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.16 - Behavioral Health Crisis Services › Section 10.09.16.12 - Interpretive Regulation

Current through Register Vol. 51, No. 14, July 12, 2024
State regulations are interpreted as 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 10.09.17 - Physical Therapy Services › Section 10.09.17.02 - Licensure and Certification Requirements

Current through Register Vol. 51, No. 14, July 12, 2024
A. To provide services as a physical
				  therapist under this chapter, a physical therapist shall be licensed by the
				  State Board of Physical Therapy Examiners of Maryland to practice physical
				  therapy, as defined in Health Occupations Article, Title 13, Annotated Code of
				  Maryland, or by the appropriate licensing body in the jurisdiction where the
				  physical therapy services are performed.
B. To provide services as a physical
				  therapist assistant under this chapter, a physical therapist assistant shall
				  licensed by the State Board of Physical Therapy Examiners of Maryland to
				  practice as a physical therapist assistant as defined:
(1) In Health Occupations Article, Title 13,
				  Annotated Code of Maryland; or
(2)
				  By the appropriate licensing body in the jurisdiction where the physical
				  therapy assistant services are performed.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.17 - Physical Therapy Services › Section 10.09.17.03 - Conditions for Participation

Current through Register Vol. 51, No. 14, July 12, 2024
To participate in the Program, the provider shall:
A. Comply with all requirements established
				  in COMAR 10.09.36;
B. If delivering
				  services via telehealth, comply with COMAR 10.09.49 and any subregulatory
				  guidance issued by the Department; and
C. Maintain the office and medical equipment
				  so that they are free of hazards to the health and safety of
				  participants.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.17 - Physical Therapy Services › Section 10.09.17.04 - Covered Services

Current through Register Vol. 51, No. 14, July 12, 2024
A. The Physical
				  Therapy Program covers medically necessary physical therapy services ordered in
				  writing by a physician, doctor of dental surgery or of dental medicine,
				  physician assistant, nurse practitioner, nurse midwife, or podiatrist when the
				  services are:
(1) Provided by a licensed
				  physical therapist or by a licensed physical therapist assistant under a
				  licensed physical therapist's direct supervision;
(2) Provided in the provider's office, the
				  patient's home, a domiciliary level facility, or via telehealth in accordance
				  with COMAR 10.09.49 or other subregulatory guidance issued by the
				  Department;
(3) Diagnostic,
				  rehabilitative, or therapeutic, and directly related to the written treatment
				  order;
(4) Of sufficient complexity
				  and sophistication, or the condition of the patient is such, that the services
				  of a physical therapist are required;
(5) Rendered pursuant to a written treatment
				  order which:
(a) Is signed and dated by the
				  prescriber,
(b) Specifies the
				  following:
(i) Part or parts to be treated;
				  and
(ii) Expected results of
				  physical therapy treatments;
(c) Is kept on file by the therapist as a
				  part of the patient's permanent record, subject to review by the Department or
				  its designee; and
(d) Is not
				  altered by the therapist unless:
(i)
				  Medically indicated;
(ii) Signed by
				  the therapist;
(iii) Necessary
				  changes are made;
(iv) The
				  prescriber is notified of the change; and
(v) The change is noted in the patient's
				  record; and
(6)
				  Recorded in the patient's permanent record which includes:
(a) The treatment order of the
				  prescriber;
(b) The initial
				  evaluation by the therapist and significant past history;
(c) All pertinent diagnoses and
				  prognoses;
(d) Contraindications,
				  if any; and
(e) Progress notes
				  documented in accordance with the requirements listed in COMAR
				  10.38.03.02-1A(2),
				  C, and D.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.17 - Physical Therapy Services › Section 10.09.17.05 - Limitations

Current through Register Vol. 51, No. 14, July 12, 2024
A. The Program does
				  not cover the following:
(1) Services
				  provided in a facility or by a group where reimbursement for physical therapy
				  is covered by another segment of the Program;
(2) Services performed by physical therapist
				  assistants when not under the direct supervision of a physical
				  therapist;
(3) Services performed
				  by physical therapy aides; or
(4)
				  Experimental treatment.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.17 - Physical Therapy Services › Section 10.09.17.06 - Payment Procedures

Current through Register Vol. 51, No. 14, July 12, 2024
A. The
				  provider shall submit the request for payment of services rendered according to
				  procedures established by the Department and in the format designated by the
				  Department.
B. The provider shall
				  certify on the invoice that the treatment order is on file and was in effect at
				  the time that services were rendered.
C. The provider shall specify on the invoice
				  the type of treatment provided.
D.
				  A provider shall bill the Program the provider's customary charge. If the
				  service is free to individuals not covered by Medicaid:
(1) The provider:
(a) May charge the Program; and
(b) Shall be reimbursed in accordance with
				  the rate provisions of §E of this regulation; and
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.17 - Physical Therapy Services › Section 10.09.17.07 - Recovery and Reimbursement

Current through Register Vol. 51, No. 14, July 12, 2024
Recovery and reimbursement for this chapter 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 10.09.17 - Physical Therapy Services › Section 10.09.17.08 - Cause for Suspension or Removal and Imposition of Sanctions

Current through Register Vol. 51, No. 14, July 12, 2024
A. Cause for
				  suspension or removal and imposition of sanctions for this chapter are as set
				  forth in COMAR
				  10.09.36.08A.
B. The Department may consult with
				  a peer review committee approved by a local chapter of the American Physical
				  Therapy Association. The Department will give consideration to the findings and
				  recommendations of this group.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.17 - Physical Therapy Services › Section 10.09.17.09 - Appeal Procedures

Current through Register Vol. 51, No. 14, July 12, 2024
Appeal procedures for this chapter 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 10.09.17 - Physical Therapy Services › Section 10.09.17.10 - Interpretive Regulation

Current through Register Vol. 51, No. 14, July 12, 2024
The interpretive regulation for this chapter is 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 10.09.18 - Oxygen and Related Respiratory Equipment Services › Section 10.09.18.03 - Conditions for Participation

Current through Register Vol. 51, No. 14, July 12, 2024
To participate in the Program, the provider shall:
A. Unless exempt from Medicare accreditation
				  requirements:
(1) Be accredited by a
				  Medicare-approved accreditation organization;
(2) Effective November 1, 2011, provide
				  documentation of:
(a) Accreditation;
				  or
(b) Having submitted an
				  application for accreditation; and
(3) Effective April 1, 2012, be accredited or
				  terminated from the Program;
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.18 - Oxygen and Related Respiratory Equipment Services › Section 10.09.18.04 - Covered Services

Current through Register Vol. 51, No. 14, July 12, 2024
A. The
				  following medically necessary items and services are covered for pulmonary use
				  in the patient's home or nursing facility pursuant to §§B, C, D, and
				  E of this regulation:
(1) Rental or purchase
				  for use in patient's home or nursing facility of:
(a) Oxygen, gaseous (tank
				  contained);
(b) Oxygen,
				  liquid.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.18 - Oxygen and Related Respiratory Equipment Services › Section 10.09.18.05 - Limitations

Current through Register Vol. 51, No. 14, July 12, 2024
A. The Program does
				  not cover:
(1) Any service or items not
				  identified in Regulation .04 of this chapter;
(2) Demurrage;
(3) Charges for delivery;
(4) Equipment prescribed primarily to provide
				  comfort or convenience, including, but not limited to, air conditioners and
				  room humidifiers;
(5) Items which
				  are investigational or experimental in nature;
(6) Oxygen and related equipment not for
				  pulmonary use;
(7) Pre-set oxygen
				  for emergency use;
(8) Trach string
				  or tape.
Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.18 - Oxygen and Related Respiratory Equipment Services › Section 10.09.18.06 - Prepayment Authorization Requirements

Current through Register Vol. 51, No. 14, July 12, 2024
A. The following items require a written
				  prepayment authorization:
(1) Nasal
				  continuous positive pressure (NCPAP) system;
(2) Custom made tracheostomy tubes;
				  and
(3) Intermittent positive
				  pressure breathing (IPPB) machine.