Maryland Administrative Code

.14 Payment Procedures — Request for Payment. A. A provider shall submit a request for payment for the services covered under this chapter according to the procedures set forth in COMAR 10.09.36. B. Billing time limitations for the services covered under this chapter are the same…

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

.16 Cause for Suspension or Removal and Imposition of Sanctions. Cause for suspension or removal and imposition of sanctions is set forth in COMAR 10.09.36. Cross References 10.09.69.02B(54)

.17 Table of Rare and Expensive Disease Diagnosis. ICD10 ICD 10 Description Age Limit B20 Human immunodeficiency virus (HIV) disease 0—20 C96.0 Multifocal and multisystemic Langerhans-cell histiocytosis 0—64 C96.5 Multifocal and unisystemic Langerhans-cell histiocytosis 0—64 C96.…

.18 Appeals Procedures. Appeal procedures are as set forth in COMAR 10.01.04 and 10.09.36.

.01 Definitions. A. The following terms have the meanings indicated. B. Terms Defined. (1) “Department” means the Maryland Department of Health, the State agency designated to administer the Maryland Medical Assistance Program under Title XIX of the Social Security Act, 42 U.S.C.…

.02 License Requirements. A. The provider shall meet all license requirements as set forth in COMAR 10.09.36.02. B. A physician, nurse practitioner, or physician assistant providing services in an SBHC shall be licensed and legally authorized to practice in the state in which the…

.03 Conditions for Participation. A. General requirements for participation in the Program are that a provider shall: (1) Meet the conditions for participation as set forth in COMAR 10.09.36; and (2) If delivering services via telehealth, comply with COMAR 10.09.49 and any subreg…

.04 Covered Services. An SBHC, designated by the Department as meeting the criteria specified in Regulation .03 of this chapter, is eligible for reimbursement by the Program for the following services: A. Comprehensive well-child care, including the administration of vaccines in …

.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. Basic school health services as defined in COMAR 13A.05.05.05.…

.06 Reimbursement Methodology. A. The provider shall charge the Program the provider’s customary charge to the general public for similar services and charge the provider’s acquisition cost for injectable drugs or dispensed medical supplies. B. If the service is free to individua…

.07 Payment Procedures. A. The provider shall submit a completed request for payment in the format designated by the Department or HealthChoice MCO, including required documentation. B. The dental provider shall submit a request for payment in the format designated by the Departm…

.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 this chapter shall do so according to COMAR 10.09.36.09.

.11 Interpretive Regulation. State regulations shall be interpreted in conformity with 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, the single State agency designated to administer the Medical Assistance Program under Title XIX of the Social Security…

.02 License Requirements. A. License requirements under this chapter are found in COMAR 10.09.36.02. B. The provider shall ensure that all X-ray and other radiological equipment is maintained and inspected in compliance with the requirements of Environment Article, Title 8, Subti…

.03 Conditions for Participation. A. The 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, comply with COMAR 10.09.49 and an…

.04 Covered Services. The Program covers the following medically necessary services rendered to participants in a free-standing urgent care center: A. Acute illnesses with a sudden onset; B. Minor trauma; C. Diagnostic, preventive, curative, palliative, rehabilitative, or amelior…

.05 Limitations. The Program does not cover the following: A. Services not medically necessary; B. Investigational and experimental drugs and procedures; C. Services denied by Medicare as not medically necessary; D. Services rendered via telehealth that do not comply with the tel…

.06 Payment Procedures. A. Payment for free-standing urgent care centers is as follows: (1) Urgent care centers are reimbursed a facility fee, which is determined by the Program; (2) In addition to the facility fee, the Program shall reimburse for services rendered by the physici…

.07 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 th…

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

.09 Appeal Procedures. Providers filing appeals from administrative decisions made in connection with this chapter shall do so according to COMAR 10.09.36.09.

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

.01 Definitions. A. The following terms have the meanings indicated. B. Terms Defined. (1) “Department” means the Maryland Department of Health, the single State agency designated to administer the Maryland Medical Assistance Program under Title XIX of the Social Security Act, 42…

.02 Certification Requirements. The home visiting program provider shall have an active accreditation status from one of the following evidence-based home visiting models: A. Healthy Families America (HFA); or B. Nurse Family Partnership (NFP).

.03 Conditions for Participation. A. General requirements for participation in the Program are that a provider shall meet all conditions for participation as set forth in COMAR 10.09.36.03; and B. Specific requirements for participation in the home visiting program are that the p…

.04 Covered Services. The Program covers home visiting services rendered in the program participant’s home when the services: A. Are rendered during the birthing parent’s prenatal period and postpartum periods; and B. If not rendered in person, comply with the telehealth requirem…

.05 Limitations. The Program does not cover: A. Expenses including: (1) Administrative overhead; (2) Lactation consulting services; and (3) Program start-up costs for evidence-based model accreditation, initial training, or consultation; or B. Services that are not medically nece…

.06 Payment Procedures. A. The provider shall submit the request for payment in the format designated by the Department. B. The Program reserves the right to return to the provider, before payment, all invoices not properly signed, completed, and accompanied by properly completed…

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

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

.09 Appeal Procedures. Providers filing appeals from administrative decisions made in connection with this chapter shall do so according to COMAR 10.09.36.09

.01 Purpose and Scope. This chapter establishes requirements for qualified State and local corrections facilities to make presumptive eligibility determinations effective July 1, 2017.

.02 Definitions. A. In this chapter, the following terms have the meanings indicated. B. Terms Defined. (1) “Applicant” means an individual who has applied for presumptive eligibility at a participating qualified correctional facility. (2) “Application” means the presumptive elig…

.03 Requirements. A. A correctional facility based in Maryland is eligible to participate as a presumptive eligibility entity. B. The eligibility worker shall: (1) Using the Department’s eligibility verification system, verify the individual is not actively enrolled in the Maryla…

.04 Presumptive Eligibility Criteria. A. An individual shall apply for presumptive eligibility through a participating correctional facility. B. An individual who applies for presumptive eligibility shall attest to: (1) The citizenship requirements in COMAR 10.09.24.05; (2) The r…

.05 Eligible Populations. If an incarcerated inmate in a Maryland-based correctional facility is determined to be eligible for one of the following coverage groups, the individual may qualify for presumptive eligibility for correctional facilities: A. Parents and other caretaker …

.06 Limitations. Presumptive eligibility may not be granted to an individual who: A. Is currently enrolled in the Maryland Medical Assistance Program or Medicare; B. With the exception of pregnant women, had a prior presumptive eligibility period during the last 12 months; C. Doe…

.07 Coverage Span. A. Presumptive eligibility begins on the day the presumptive eligibility worker determines the individual is presumptively eligible. B. Presumptive eligibility ends on the earlier of: (1) The day the individual is determined eligible for Medical Assistance; or …

.08 Presumptive Eligibility Appeal Rights. An individual or an organization does not have appeal rights for presumptive eligibility determinations.

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

.02 License Requirements. To participate in the Program, a provider shall meet the license requirements stated in COMAR 10.09.36.02 and 10.63.01.03.

.03 Conditions for Provider Participation. A. A provider shall be in compliance with COMAR 10.09.36.03 and 10.63.01.05. B. A provider of community-based substance use disorder services shall include: (1) Community-based substance use disorder providers that: (a) Are licensed by t…

.04 Participant Eligibility and Referral. A. A participant may self-refer or be referred to substance use disorder treatment by a: (1) Provider; (2) Family member; (3) Caregiver; or (4) Local health authority. B. An individual is eligible for substance use disorder services if: (…