Maryland Administrative Code

.08 Recovery and Reimbursement. Recovery and reimbursement for this chapter 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 for this chapter are set forth in COMAR 10.09.36.

.10 Appeal Procedures. Appeal procedures for this chapter are set forth in COMAR 10.09.36.

.11 Interpretive Regulation. The interpretive regulation for this chapter is set forth in COMAR 10.09.36.

.01 Definitions. A. In this chapter, the following terms have the meanings indicated. B. Terms Defined. (1) “Acquisition cost” means actual cost of a product to a provider. (2) “Board” means the State Board of Examiners in Optometry. (3) “Department” means the Maryland Department…

.02 License Requirements. 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 medic…

.03 Conditions for Participation. 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. Ma…

.04 Covered Services. 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 visu…

.05 Limitations. 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 or…

.06 Preauthorization Requirements. 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) Replac…

.07 Payment Procedures. 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 …

.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 sour…

.09 Cause for Suspension or Removal and Imposition of Sanctions. 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 appl…

.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.

.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 …

.01 Definitions. 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 requirin…

.02 License Requirements. A. The Provider shall meet all license requirements as set forth in COMAR 10.09.36.02. 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 t…

.03 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…

.04 Covered Services 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 th…

.05 Limitations. 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 E…

.06 Preauthorization. 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 t…

.07 Payment Procedures. 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 complet…

.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, 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…

.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.

.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 participants without regard to the availability of federal financial participation, State regulations shal…

.01 Definitions. A. In this chapter, the following terms have the meanings indicated. B. Terms Defined. (1) “Administrative Services Organization (ASO)” means the contractor procured by the State to provide the Department with administrative support services to operate the Maryla…

.02 License Requirements. 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.

.03 Provider Requirements for Participation. 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…

.04 Participant Eligibility. 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 …

.05 Covered Services. 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) …

.06 Limitations. 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) …

.07 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 June 1…

.08 Recovery and Reimbursement. Recovery and reimbursement are as set forth in COMAR 10.09.36.07.

.09 Cause for Suspension or Removal and Imposition of Sanctions. Cause for suspension or removal and imposition of sanctions are as set forth in COMAR 10.09.36.08.

.10 Appeal Procedures for Providers. Appeal procedures for providers are as set forth in COMAR 10.09.36.09.

.11 Appeal Rights — Denial of Services. Appeal procedures for applicants and participants are as set forth in COMAR 10.01.04.

.12 Interpretive Regulation. State regulations are interpreted as set forth in COMAR 10.09.36.10.

.01 Definitions. A. In this chapter, the following terms have the meanings indicated. B. Terms Defined. (1) “Department” means the Maryland Department of Health, which is the single State agency designated to administer the Maryland Medical Assistance Program pursuant to Title XI…

.02 Licensure and Certification Requirements. 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 Arti…

.03 Conditions for Participation. 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.…

.04 Covered Services. 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 ar…

.05 Limitations. 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…

.06 Payment Procedures. 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…

.07 Recovery and Reimbursement. Recovery and reimbursement for this chapter are as set forth in COMAR 10.09.36.07.

.08 Cause for Suspension or Removal and Imposition of Sanctions. A. Cause for suspension or removal and imposition of sanctions for this chapter are as set forth in COMAR 10.09.36.08. B. The Department may consult with a peer review committee approved by a local chapter of the Am…

.09 Appeal Procedures. Appeal procedures for this chapter are set forth in COMAR 10.09.36.09.