Maryland Administrative Code

.05 Limitations. A. Except as specifically identified as being covered under Regulation .04 of this chapter, the following are not covered: (1) Nonlegend drugs; (2) Medical supplies and durable equipment; (3) Any original prescription for a controlled substance dispensed more tha…

.05-1 Expanded Limitations. A. A drug is not covered for State-only participants if: (1) The manufacturer has not provided the same rebate to the State for State-only participants’ purchases of drugs as is required under Section 1927(c) of Title XIX of the Social Security Act (42…

.06 Preauthorization Requirements. A. The provider shall obtain preauthorization from the Department or its designee for any prescription for: (1) Antibiotic liquids requiring reconstitution for amounts exceeding a 14-day supply; (2) Nonmaintenance drugs for more than a 34 day su…

.07 Payment Procedures. A. The provider shall produce records to verify any charge to the Program upon request. B. The provider shall bill all appropriate insurance carriers before requesting payment from the Department. C. Billing time limitations for claims submitted pursuant t…

.08 Recovery and Reimbursement. 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 sou…

.09 Cause for Suspension or Removal and Imposition of Sanctions. A. If the Department determines that a provider, pharmacist, 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…

.10 Appeal Procedures. Providers filing appeals from administrative decisions made in connection with these regulations shall do so according to COMAR 10.09.36.09. Cross References 10.09.03.06E(3)

.11 Interpretive Regulation. 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 …

.12 Preferred Drug Program. A. The Department may establish a Pharmacy and Therapeutics Committee (Committee). B. The Committee shall consist of the following 12 members: (1) Five members of the Committee shall be Maryland licensed pharmacists residing in the State, including a p…

.01 Definitions. A. In this chapter, the following terms have the meanings indicated. B. Terms Defined. (1) “Activities of daily living” means functions normally associated with mobility, eating, elimination, body hygiene and dressing. (2) “Attending” means the role of an individ…

.02 License Requirements. A home health agency shall be licensed pursuant to Health-General Article, §§19-401—19-408, Annotated Code of Maryland, or shall be part of a hospital or related institution licensed pursuant to Health-General Article, §§19-301—19-359, Annotated Code of …

.03 Conditions for Participation. A. To be a provider, a home health agency shall be a participating home health agency under Medicare. B. To participate in the Program, the home health agency shall: (1) Apply for participation in the Program using the form designated by the Depa…

.04 Covered Services. A. The Program covers the services listed in §§B and C of this regulation when the services are: (1) Provided upon the written order of a physician, physician assistant, certified nurse midwife, or certified nurse practitioner; (2) Furnished under the curren…

.05 Limitations. The Program does not cover the following: A. Nonskilled services rendered by licensed nurses, physical therapists, occupational therapists and speech pathologists; B. Services and medical supplies that are not medically necessary and appropriate; C. Durable medic…

.06 Preauthorization Requirements. A. Preauthorization is required for: (1) More than one visit per type of service per day; (2) Any service or combination of services specified in Regulation .04 of this chapter and rendered during any 30-day period for which the provider anticip…

.07 Payment Procedures. A. The provider shall submit his request for payment on the form designated by the Department. B. To receive payment for services under Regulation .04 of this chapter, a provider and its workers shall use the Electronic Visit Verification method and data m…

.08 Recovery and Reimbursement. Recovery and reimbursement regulations are set forth in COMAR 10.09.36.

.09 Cause for Suspension or Removal and Imposition of Sanctions. Cause for suspension or removal and imposition of sanctions are set forth in COMAR 10.09.36.

.10 Appeal Procedures. Appeal procedures are set forth in COMAR 10.09.36.

.11 Interpretive Rule. State regulations are interpreted as set forth in COMAR 10.09.36.

.01 Definitions. A. In this chapter, the following terms have the meanings indicated. B. Terms Defined. (1) “Adverse action” means any action taken by the DASO to deny, reduce, terminate, delay, or suspend a covered service. (2) “Aftercare” means the period of follow-up care afte…

.02 License Requirements. A. The provider shall meet all license requirements as set forth in COMAR 10.09.36.02. B. A dentist shall be licensed and legally authorized to practice dentistry in the state in which service is provided. C. All dentists and dental hygienists working fo…

.03 Provider Qualifications and Conditions for Participation. 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 an…

.04 Covered Services. A. The Program covers medically necessary dental services for participants younger than 21 years old and eligible former foster care participants younger than 26 years old, including but not limited to the following: (1) Emergency, preventive, diagnostic, an…

.05 Limitations. A. The Program places the following limitations upon covered services: (1) Reimbursement for a complete radiographic survey or full series of X-rays of the mouth may not be made more frequently than once every 3 years to the same provider, or in the case of a gro…

.06 Preauthorization Requirements. A. Preauthorization is issued when: (1) Program procedures are met; (2) Program limitations are met; (3) The provider submits to the Department, adequate documentation demonstrating that the service to be preauthorized is medically necessary; an…

.07 Payment Procedures. A. To obtain compensation from the Department for covered services, the provider shall submit a request for payment on the form designated by the Department with the following data or attachments: (1) If applicable, the preauthorization number shall be ins…

.08 Recovery and Reimbursement. 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 …

.09 Cause for Suspension or Removal and Imposition of Sanctions. A. If the Department determines that a provider, dentist, 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…

.10 Appeal Procedures. A. Providers may exercise appeal rights pursuant to State Government Article, Title 10, Subtitle 2, Annotated Code of Maryland. B. The provider may appeal a decision to the Office of Administrative Hearings as specified in COMAR 10.09.36.09.

.11 Interpretive Regulation. Except when the language of a specific regulation indicates an attempt by the Department to provide reimbursement for covered services to Program participants without regard to the availability of federal financial participation, State regulations sha…

.01 Scope. This chapter governs residential substance use disorder services for adults, effective July 1, 2017.

.02 Definitions. A. In this chapter, the following terms have the meanings indicated. B. Terms Defined. (1) “Accrediting body” means an entity approved by the Secretary or the Secretary’s designee, under Health-General Article, §19-2302, Annotated Code of Maryland. (2) “Administr…

.03 Licensure Requirements. To participate in the Program, a provider shall: A. Meet the license requirements stated in COMAR 10.09.36.02 and, after April 1, 2018, COMAR 10.63.01.05; B. Be accredited by a Maryland-approved accrediting body; and C. Be licensed by the Behavioral He…

.04 Conditions for Participation. 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…

.05 Participant Eligibility and Referral. A participant is eligible for substance use disorder services under this chapter if the participant: A. Is enrolled in the Program and is not enrolled in Medicare on the day a service is rendered; B. Meets the Department’s medical necessi…

.06 Covered Services. A. A residential, low intensity level 3.1 provider shall provide: (1) Therapeutic substance use disorder services for a minimum of 5 hours per week; and (2) Services in a structured environment in combination with low-intensity treatment and ancillary servic…

.07 Limitations. The Program does not cover the following in a residential substance use disorder treatment facility for adults: A. Services not medically necessary; B. ASAM Level 2 services by any provider; C. Except for services rendered to individuals in a residential, low-int…

.08 Authorization Requirements. A. The provider shall obtain authorization from the ASO to provide residential substance use disorder services outlined in Regulation .06 of this chapter. B. The ASO agent shall authorize services that are: (1) Medically necessary for the applicabl…

.09 Payment Procedures. 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. For dates of service from J…

.10 Recovery and Reimbursement. Recovery and reimbursement shall be as set forth in COMAR 10.09.36.07.

.11 Cause for Suspension or Removal and Imposition of Sanctions. Causes for suspension or removal and imposition of sanctions shall be as set forth in COMAR 10.09.36.08.

.12 Appeals Procedures. Appeals procedures shall be as set forth in accordance with COMAR 10.09.36.09.

.01 Definitions. A. The following terms have the meanings indicated. B. Terms Defined. (1) “Adult Day Care Assessment and Planning System (ADCAPS)” means a system that is comprised of a comprehensive assessment completed by a registered nurse, which is designed to evaluate the pa…

.02 Licensing Requirements. The provider shall be licensed under COMAR 10.12.04. Cross References 10.09.07.03A

.03 Conditions for Participation. Requirements for providing medical day care services are that the providers shall: A. Meet the licensure requirements as provided in Regulation .02 of this chapter; B. Meet the requirements of COMAR 10.09.36; C. Be open to participants at least 6…

.04 Staffing Requirements. A. The medical day care center shall have adequate staffing capability to monitor the participants at all times. The composition of the staff depends in part on the needs of the participants and on the number of participants the medical day care center …