Maryland Administrative Code

.04 Covered Services. A. The Program covers the ABA services set forth in §B of this regulation when the services are: (1) Medically necessary; (2) Preauthorized by the Program or its designee; (3) Delivered in accordance with the participant's treatment plan; and (4) Supported b…

.05 Limitations. A. ABA services are only available to participants under the EPSDT program. B. ABA services shall be delivered in a home or community setting, including a clinic, when medically necessary. C. The provider may not bill the Program for: (1) Services that are: (a) P…

.06 Payment Procedures. A. The provider shall follow all procedures in accordance with COMAR 10.09.36. B. The Program shall provide fee-for-service reimbursement for covered ABA services to the following ABA providers who meet the conditions for participation set forth in Regulat…

.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 shall be as set forth in COMAR 10.09.36.08.

.09 Appeals Procedures. Appeal procedures are as set forth in COMAR 10.09.36.09.

.10 Interpretive Regulation. This chapter shall be 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) “Active treatment” means inpatient psychiatric services which involve implementation of a professionally developed and supervised individual plan of care described in 42 CF…

.02 Licensure Requirements. A. In order to participate in the Program a provider shall: (1) Be licensed by the Department in accordance with requirements of Health-General Article, §19-308, Annotated Code of Maryland; (2) Meet the standards established by COMAR 10.07.04; and (3) …

.03 General Conditions for Participation. To participate in the Program as a residential treatment center for emotionally disturbed children and adolescents, a provider shall: A. Meet the requirements for participation as defined in 42 CFR §440.160 (inpatient psychiatric services…

.04 Covered Services. The Program covers inpatient psychiatric services for the diagnosis, active treatment, and care of recipients under 21 years old with mental disease when the services are: A. Medically necessary; B. Performed under the direction of a physician; C. Certified …

.05 Limitations. The Program does not cover the following: A. Services not specified in Regulation .04 of this chapter; B. Services not medically necessary; C. Investigational and experimental drugs and procedures; D. A day of inpatient care solely for the purpose of performing d…

.06 Preauthorization Requirements. The following procedures or services require preauthorization: A. Out-of-State admissions. Adequate documentation shall be provided demonstrating that the placement meets one of the conditions as follows: (1) Effective services at an in-State fa…

.07 Payment Procedures. A. Reimbursement Principles. (1) The Department will make no direct reimbursement to any State-operated residential treatment center for recipients. The Department will claim federal fund recoveries from the Department of Health and Human Services for serv…

.08 Recovery and Reimbursement. A. If the recipient has insurance, or if any other person is obligated either legally or contractually to pay for, or to reimburse, the recipient for any services covered by this chapter, the provider shall seek payment from that source. If payment…

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

.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 10.09.29.14B(1)

.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 Cost Reporting. A. The provider shall: (1) Include, for purposes of cost finding, direct and indirect costs applicable to recipient care; (2) In the cost report, specifically identify costs associated with related organizations; (3) Maintain adequate financial records and sta…

.13 Interim Rates. A. A provider shall have its interim rate updated annually. B. A provider's interim rate shall be adjusted at the beginning of each fiscal year, by applying the Centers for Medicare and Medicaid Services' published federal fiscal year market basket index relati…

.14 Field Verification. A. The Department or its designee shall: (1) Conduct a field verification, at least every 3 years, of the reported costs of each facility participating in the Program, if the amount of the facility's reimbursement would justify the expense of a field verif…

.15 Change of Ownership. A. The current owner of a residential treatment center shall: (1) Notify the Program of the contemplated sale of a facility or controlling interest in it not less than 30 days before the date of the change of ownership; and (2) Before the date of the chan…

.01 Purpose. The purpose of this chapter is to codify policy regarding comprehensive evaluations performed for the purpose of determining eligibility for services or informing individuals of available services or as required for Geriatric Evaluation Services (GES) or Preadmission…

.02 Definitions. A. The following terms have the meanings indicated. B. Terms Defined. (1) “Comprehensive evaluation” means the assessment performed by a nurse or social worker, or both, using the tools designated by the Department, of a participant’s medical, social, and functio…

.03 Licensing Requirements. The following health professionals providing services under this regulation shall be licensed to practice in the jurisdiction in which services are rendered: (1) Nurses; (2) Nurse practitioners; (3) Psychiatrists; (4) Psychologists; and (5) Social work…

.04 Conditions for Participation. Specific requirements for participation in the Program are that providers shall: A. Ensure that all individuals performing services under Regulation .05 of this chapter meet the licensure requirements as provided in Regulation .03 of this chapter…

.05 Covered Services. A. The Program reimburses for completed comprehensive evaluations, which include assessment by a nurse, social worker, or both. B. The comprehensive evaluation or designated form is to be completed within the following time frames: (1) 3 business days for al…

.06 Limitations. A. The comprehensive evaluation is advisory in nature and is designed to assist individuals in identifying and using appropriate long term care services. B. A restriction may not be placed on the qualified recipient’s option to receive the comprehensive evaluatio…

.07 Payment Procedures. A. Request for Payment. (1) Requests for payment of services rendered shall be submitted according to procedures established by the Department. Payment requests which are not properly prepared or submitted may not be processed, but shall be returned unpaid…

.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. 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. Interpretive regulatory requirements are 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” has the meaning stated in COMAR 10.09.36. (2) “Emergency medical services (EMS) provider " has the meaning stated in Education Article, §13–516, Annotated Code…

.02 Licensing Requirements. A provider shall meet all licensing requirements: A. Set forth in COMAR 10.09.36; and B. In the jurisdiction where the service is provided.

.03 Conditions for Participation. To participate in the Program, the provider shall: A. Comply with the conditions for participation set forth in COMAR 10.09.36; B. Certify that all third-party payers are routinely billed for services; C. Retain all documentation, including but n…

.04 Covered Services. A. Emergency Medical Transportation Services. The Program covers the following services when provided by an enrolled emergency service transporter to an eligible participant in response to a 911 call: (1) Medical services delivered at the scene of a 911 resp…

.05 Limitations. Under this chapter, the Program does not cover: A. Services not rendered in response to a 911 call unless delivered as part of a mobile integrated health visit; B. Services performed or billed by an emergency services transporter that is not enrolled in the Progr…

.06 Payment Procedures. A. Payment procedures for this chapter are set forth in COMAR 10.09.36. B. Emergency Medical Transportation Services Reimbursement. (1) Payment for covered services provided in response to each 911 call incident is the lesser of: (a) The amount billed; or …

.07 Recovery and Reimbursement. Recovery and reimbursement under this chapter are set forth in COMAR 10.09.36.

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

.09 Appeal Procedures. Appeal procedures under this chapter are set forth in COMAR 10.09.36.

.01 Definitions. A. The following terms have the meanings indicated. B. Terms Defined. (1) “Case management” means services which will assist participants in gaining access to the full range of Medical Assistance services, as well as to any additional needed medical, social, hous…

.02 Licensing Requirements. A. Registered nurses participating in targeted case management for HIV-infected individuals shall be licensed pursuant to Health Occupations Article, Title 7, Annotated Code of Maryland, or pursuant to comparable licensing requirements of the jurisdict…

.03 Conditions for Participation. A. General requirements for participation in the Medical Assistance Program are that providers shall meet all the conditions for participation as set forth in COMAR 10.09.36.03. B. Specific requirements for participation in the Program as a provi…

.04 Covered Services. The Program covers the following services when they have been documented as medically necessary: A. HIV Diagnostic Evaluation Services. (1) These services shall include, as a unit of service, performance of a bio-psychosocial assessment and development or re…

.05 Limitations. A. HIV-targeted case management shall be advisory in nature. B. A restriction may not be placed on qualified recipients' option to receive HIV case management services. C. HIV-targeted case management does not restrict or otherwise affect: (1) Eligibility for Tit…