Maryland Administrative Code

.03 Conditions for Participation. 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) Accre…

.04 Covered Services. 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) Oxyg…

.05 Limitations. 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 conditioner…

.06 Prepayment Authorization Requirements. 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. B. Prepayment …

.07 Payment Procedures. A. The provider shall submit request for payment on the forms designated by the Department, with attachments when applicable. B. The Department reserves the right to return to the provider, before payment, all invoices not properly signed and completed and…

.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 any service 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, any agent or employee of a provider, or any person with an ownership interest in the provider, has failed to comply with applicable federal or State laws or regulatio…

.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 Scope. These regulations govern the administration of grants to counties, municipal corporations, and nonprofit organizations for the provision of safety-net transportation services to Medical Assistance Program recipients. The grant funds are to be used by grantees to: A. Sc…

.02 Definitions. A. In this chapter, the following terms have the meanings indicated. B. Terms Defined. (1) “Ambulance” means a specially designed vehicle used for transporting the sick or injured, which has necessary patient care equipment including a stretcher, clean linens, fi…

.03 Procedure for Submission of Proposals. A. The Secretary shall request proposals for the award of transportation grants. B. An applicant shall include in the applicant's proposal a description of how the applicant intends to carry out the duties required by these regulations. …

.04 Services to Recipients. A. A grantee is responsible for arranging or providing nonemergency transportation to and from medically necessary covered services to Medical Assistance recipients and, when necessary, their attendants, who have no other means of transportation availa…

.05 Limitations. Monies from a grant provided under these regulations may not be used to pay for the following: A. Emergency transportation services; B. Medicare ambulance services; C. Transportation to or from Veterans Administration hospitals unless it is to receive treatment f…

.06 Notices to Recipients. Whenever a grantee determines that the grantee will not arrange or provide transportation for a recipient who has requested transportation at least 24 hours in advance, even though the recipient has no available transportation resource, the grantee shal…

.07 Documentation. A grantee shall document the following items and make the documentation available to the Department upon request: A. Whether the recipient had other transportation available or could reschedule the appointment to a time when transportation would be available; B…

.08 Accountability. The Department shall: A. Follow all applicable policies required by COMAR 10.04.04 when approving grants; and B. Reconcile each grant on a yearly basis.

.09 Responsibility to Recipients. A grantee is expected to meet the transportation needs of recipients in a grantee's county out of grant funds. In those circumstances when the grant funds are insufficient, the grantee shall contact the Program's staff specialist for transportati…

.10 Interpretive Regulation. These regulations shall be interpreted in conformity with applicable federal statutes and regulations.

.01 Definitions. A. In this chapter, the following terms have the meanings indicated. B. Terms Defined. (1) “Activities of daily living” means tasks or activities that include, but are not limited to: (a) Bathing and completing personal hygiene routines; (b) Dressing and changing…

.02 Requirements for Provider Licensing or Certification. The following health professionals providing services under this chapter shall be licensed to practice in the jurisdiction in which services are rendered: A. Registered nurses; B. Licensed practical nurses; C. Certified me…

.03 Participant Eligibility. A. To participate in the Program, the participant shall: (1) Be determined by the Department to need assistance with one or more activities of daily living; (2) Be eligible for Medicaid under an eligibility coverage group described in COMAR 10.09.24, …

.04 Conditions for Provider Participation — General Requirements. A. To participate as a provider of a service covered under this chapter, a provider: (1) Shall meet all of the conditions for participation as a Medicaid provider as set forth in COMAR 10.09.36, except as otherwise…

.05 Specific Conditions for Provider Participation — Personal Assistance. A. Personal assistance service providers shall: (1) Be licensed as a residential service agency under COMAR 10.07.05 to provide Level Two or Level Three home care services; (2) Employ a registered nurse who…

.06 Specific Conditions for Provider Participation — Supports Planning. To participate in the Program as a supports planning provider under Regulation .10 of this chapter, a provider shall: A. Agree to be monitored by the Department; and B. Be: (1) Identified by the Department th…

.07 Specific Conditions for Provider Participation — Nurse Monitoring. To participate in the Program as a nurse monitoring provider under Regulation .11 of this chapter, a provider shall: A. Be designated by the Department through a process approved by the Centers for Medicare an…

.08 Covered Services — General. The Program shall reimburse for the services specified in Regulations .09—.11 of this chapter, when, pursuant to the requirements of this chapter, these services have been preauthorized by the Department in the participant’s plan of service, billed…

.09 Covered Services — Personal Assistance. A. The Program covers personal assistance services that are approved in the plan of service and rendered to a participant by a qualified provider in the participant’s home or a community setting. B. The Program covers the following serv…

.10 Covered Services — Supports Planning. A. Supports planning services shall: (1) Address the individualized needs of the participant; (2) Be sensitive to the educational background, culture, and general environment of the participant; (3) Support the participant to self-direct …

.11 Covered Services — Nurse Monitoring. A. The Program covers the following services when provided by a nurse monitor: (1) Being available to give instruction and to answer questions; (2) Complying with the Department’s reportable events policy; and (3) Maintaining an up-to-date…

.12 Conditions for Reimbursement. The Program shall reimburse for the services specified in Regulations .09—.11 of this chapter, if provided in accordance with the requirements of this chapter, and if the service: A. Is recommended on the participant’s plan of service as necessar…

.13 Limitations. A. The Department shall establish a budget for personal assistance services that may be included in the participant’s plan of service, based on each participant’s assessed need. B. The Program does not cover the following services: (1) Service primarily for the p…

.14 Payment Procedures. A. Request for Payment — Personal Assistance. To receive payment as a personal assistance provider agency under Regulation .09 of this chapter, a provider and its workers shall use the telephonic time-keeping system approved by the Department to: (1) Docum…

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

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

.17 Appeal Procedures — Providers. Appeal procedures shall be as set forth in: A. COMAR 10.09.36.09; and B. COMAR 10.01.03.

.18 Appeal Procedures — Applicants and Participants. Appeal procedures for applicants and participants are those set forth in: A. COMAR 10.09.24.13; and B. COMAR 10.01.04.

.19 Interpretive Regulation. Interpretive regulatory requirements shall be as set forth in COMAR 10.09.36.10.

.20 Implementation Date. This chapter shall be implemented October 1, 2015.

.01 Purpose and Scope. This chapter establishes requirements for individual pharmacists who enroll in the Program.

.02 Definitions. A. In this chapter, the following terms have the meanings indicated. B. Terms Defined. (1) “Board” means the Maryland Board of Pharmacy. (2) “Maryland Medical Assistance Program” means the program of comprehensive medical and other health-related care for indigen…

.03 Provider Qualifications and Conditions for Participation. The pharmacist shall meet: A. Licensure requirements set forth in COMAR 10.09.36.02; B. Conditions for participation set forth in COMAR 10.09.36.03; and C. Conditions for their license under the Board of Pharmacy as st…

.04 Covered Services. The Program covers the following medically necessary services when rendered by a pharmacist: A. Services rendered within the pharmacist’s lawful scope of practice as defined by the Board and otherwise covered by the Program in accordance with COMAR 10.09.02.…

.05 Limitations. The following are not covered: A. Pharmacist administered drugs obtained from manufacturers who do not participate in the federal Drug Rebate Program; B. Medical supplies usually included in an office visit; C. Services not medically necessary; D. Investigational…

.06 Payment Procedures. A. The provider shall adhere to general provider payment procedures established in COMAR 10.09.36.04. B. The provider shall be reimbursed in accordance with COMAR 10.09.02.07D. C. Effective January 1, 2024, medication therapy management shall be reimbursed…

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

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