Maryland Administrative Code

.04 Conditions for Participation — General. A. In this chapter, targeted case management services are referred to as coordination of community services. B. Providers shall meet all the conditions for participation as set forth in COMAR 10.09.36.03. C. Administrative and Professio…

.05 Conditions for Participation — Staff Requirements. A. Staff Capability Requirements. The provider shall: (1) Employ only personnel who are appropriately qualified as set forth in this regulation; (2) Maintain sufficient staff required to meet the needs of the participants who…

.06 Covered Services. A. Only core services shall be authorized for payment by DDA as covered coordination of community services. B. The coordinator of community services shall provide the core services listed in this regulation to every participant assigned to the coordinator. C…

.07 Limitations. A. Restrictions may not be placed on a participant’s option to receive coordination of community services. B. Coordination of community services provided under this chapter does not restrict or otherwise affect eligibility for Title XIX benefits or other availabl…

.08 Payment Procedures. A. Request for Payment. (1) Requests for payment for the services covered under this chapter shall be submitted by a provider according to procedures set forth in COMAR 10.09.36.04. (2) Billing time limitations for services covered under this chapter are t…

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

.10 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 and 10.22.03.

.11 Appeal Procedures. A. Appeal procedures for providers shall be as set forth in COMAR 10.09.36.09. B. Appeal procedures for participants shall be as set forth in COMAR 10.01.04.

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

.01 Scope. A. This chapter applies to covered services delivered via synchronous telehealth and eligible for reimbursement by the Maryland Medicaid Program. B. The purpose of providing medically necessary services via telehealth is to improve: (1) Access to services, thus reducin…

.02 Definitions. A. In this chapter, the following terms have the meanings indicated. B. Terms Defined. (1) “Administrative services organization (ASO)” means an entity that manages the Public Behavioral Health System on behalf of the Department. (2) “Department” means the Maryla…

.03 Covered Services. Under the Telehealth Program, the Department shall cover: A. Medically necessary services covered by the Maryland Medical Assistance Program rendered via telehealth that shall be: (1) Distinct from services provided in person; (2) Able to be delivered using …

.04 Provider Conditions for Participation. A. To render or bill for services delivered via telehealth, the provider shall meet the requirements as set forth in: (1) COMAR 10.09.36.02; (2) COMAR 10.09.36.03; and (3) The COMAR chapter defining the covered service being rendered. B.…

.05 Technical Requirements. A. A provider of services delivered through telehealth shall adopt and implement technology in a manner that supports the standard of care to deliver the required service. B. A service delivered through synchronous audio-visual telehealth shall, at a m…

.06 Confidentiality. The provider: A. Shall comply with all State and federal laws and regulations concerning the privacy and security of protected health information, including but not limited to: (1) Health-General Article, Title 4, Subtitle 3, Annotated Code of Maryland; and (…

.07 Limitations. A. A service delivered via telehealth is subject to the same program restrictions, preauthorizations, limitations, and coverage that exist for services delivered in person. B. A service delivered via telehealth does not include: (1) An electronic mail message bet…

.08 Reimbursements. A. To receive reimbursement for services delivered via telehealth, a provider shall: (1) Be actively enrolled with Maryland Medical Assistance on the date the service is rendered; and (2) Comply with payment procedures as set forth in COMAR 10.09.36. B. Distan…

.09 Limitations. A. A service provided through telehealth is subject to the same program restrictions, preauthorizations, limitations, and coverage that exist for the service when provided in person. B. A telehealth service does not include: (1) An audio-only telephone conversati…

.10 Reimbursement. A. To receive reimbursement for telehealth services, a provider shall: (1) Be actively enrolled with Maryland Medical Assistance; (2) Participate with a telehealth partner that meets provider conditions for participation as set forth in Regulation .06 of this c…

.01 Definitions. A. In this chapter, the following terms have the meanings indicated. B. Terms Defined. (1) “Audiological evaluation” means identification, evaluation, and treatment of auditory impairments necessary to develop and implement an IFSP or an IEP pursuant to COMAR 13A…

.02 Licensure and Certification. A. A provider shall ensure that the provider's employees who render school health-related services meet the licensure or certification requirements for their profession, as specified in §B of this regulation. B. A professional employed by a provid…

.03 Conditions for Participation. A. General requirements for participation in EPSDT school health-related or health-related early intervention services are that a: (1) Provider shall: (a) Meet all the requirements for participation in the Program as set forth in COMAR 10.09.36.0…

.04 Covered Services. A. The Program covers the services listed in §B and C of this regulation when the services are: (1) Necessary to identify the need for a health-related service or health-related early intervention service; (2) Necessary to: (a) Prevent disease, disability, a…

.05 Limitations. A. To participate in the Program as a provider of health-related services or health-related early intervention services, the provider shall be a local school system, a local lead agency, a State-operated education agency, or State-supported education agency. B. H…

.06 Preauthorization. A. Therapeutic behavioral services shall be preauthorized through the IEP or IFSP process. B. Psychological services that are not delivered in accordance with an IEP or IFSP shall be preauthorized by the Administrative Services Organization in accordance wit…

.07 Payment Procedures. A. Request for Payment. (1) An approved provider shall submit a request for payment of services rendered and completed under this chapter as set forth in COMAR 10.09.36.04. The Department reserves the right to return to the provider, before payment, all pa…

.08 Recovery and Reimbursement. Recovery and reimbursement is 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 is as set forth in COMAR 10.09.36.08.

.10 Appeal Procedures. Appeal procedures are set forth in COMAR 10.09.36.09.

.11 Interpretive Regulation. Interpretive regulations are 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) “Audiologist” means a professional who is licensed in accordance with Regulation .02 of this chapter who treats hearing disorders and communication problems. (2) “Audiology…

.02 Licensure Requirements. A. In order to provide services as an audiologist under this chapter, an audiologist shall be licensed by the State Board of Examiners for Audiologists, Hearing Aid Dispensers, and Speech-Language Pathologists to practice audiology, as defined in Healt…

.03 Conditions for Participation. A. A provider shall meet all conditions for participation as set forth in COMAR 10.09.36.03. B. Specific requirements for participation in the Program as an audiologist, audiology center or group, or hearing aid dispenser are that the provider: (…

.04 Covered Services. The Program covers the following medically necessary services: A. Audiology services, as follows: (1) For participants who are at risk for or have a hearing impairment, audiology assessments using procedures appropriate for the participant’s developmental ag…

.05 Limitations. A. Covered audiology services, including hearing aids, cochlear implants, and auditory osseointegrated devices are limited to: (1) Unless the time limitation is waived by the Program, one audiology assessment per year; (2) The initial coverage of unilateral or bi…

.06 Preauthorization Requirements. A. The Department requires preauthorization for the following services: (1) All hearing aids; (2) Certain hearing aid accessories; (3) All cochlear implant devices and replacement components except microphone, transmitter cables, and transmittin…

.07 Payment Procedures. A. To obtain compensation from the Department for covered services, the provider shall submit a request for payment using the format designated by the Department. B. Audiology services are reimbursed in accordance with COMAR 10.09.23.01-1. C. The provider …

.08 Recovery and Reimbursement. Recovery and reimbursement requirements 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 is as set forth in COMAR 10.09.36.08.

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

.11 Interpretation of State Regulations. 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) “Autism” has the meaning stated in COMAR 10.09.56.01C. (2) “Autism Waiver” or “Waiver” means the Home and Community-Based Services Waiver for Children with Autism Spectrum …

.02 Participant Eligibility. A participant is eligible for Service Coordination if: A. The individual is enrolled as a waiver participant in accordance with the requirements of COMAR 10.09.56 and this chapter; or B. The following requirements are met: (1) The participant, for who…

.03 Conditions for Participation for IEP Service Coordination Providers. A. General requirements for participation in the Program are that a provider shall: (1) Meet all the conditions for participation as set forth in COMAR 10.09.36; and (2) If delivering services via telehealth…

.03-1 Conditions for Participation for Autism Waiver Service Coordination Providers. A. General requirements for participation in the Program are that a provider shall: (1) Meet all the conditions for participation as set forth in COMAR 10.09.36; and (2) If delivering services vi…

.04 Covered Services. A. The Program shall reimburse for the services in §§B—D of this regulation when the services have been documented, pursuant to the requirements of this chapter, as medically necessary. B. Initial IEP. (1) Definition. “Unit of service” means: (a) A completed…

.04-1 Covered Services — Autism Waiver Service Coordination — General Requirements. A. Autism Waiver Service Coordination is intended to: (1) Assist a waiver participant in gaining access to the Autism Waiver services approved in the waiver participant's waiver plan of care; (2) …