Maryland Administrative Code

.04 Covered Services. The Program covers the facility-related services provided by the free-standing birth center for the care of the delivering mother and newborn, and covers the cost of; A. Support staff; B. The use of the free-standing birth center; and C. Supplies, linens, an…

.05 Limitations. A. The Program does not cover laboratory or x-ray services performed by another facility. The facility performing these services shall bill the Program directly. B. Professional services are to be billed separately from the free-standing birth center facility fee…

.06 Payment Procedures. A. The Program will reimburse free-standing birth centers for: (1) A facility fee of $2,000 for the care of the delivering mother and delivery of the newborn, if the delivery takes place at the facility; and (2) A facility fee of $500 for the care of the n…

.07 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 for any service covered by this chapter, the provider shall seek payment from that source first. If an insurance carrie…

.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. General policies governing the interpretive regulations that are applicable to all providers 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) “CMS” means Centers for Medicare and Medicaid Services. (2) “Department” means Maryland Department of Health. (3) "Independent Diagnostic Testing Facility (IDTF)” means a f…

.02 License Requirements. A. The provider shall meet all license requirements as set forth in COMAR 10.09.36.02. B. A facility or mobile unit that is operating radiological equipment shall be licensed or certified and registered by the Department of the Environment in accordance …

.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. B. Requirements for participation in the Program as an IDTF provider/mobile IDTF provider …

.04 Covered Services. A. The Program covers medically necessary radiology services rendered to a recipient in an IDTF when the services are: (1) Rendered in a CMS certified IDTF or an IDTF Mobile Unit; (2) Provided according to the laws and regulations of the state and locality i…

.05 Limitations. The Program does not cover the following: A. Services for which the IDTF provider cannot supply a properly completed order identifying the authorized ordering practitioner by National Provider Identifier (NPI); B. IDTF services ordered by an: (1) Individual who i…

.06 Preauthorization Requirements. Reserved.

.07 Payment Procedures. A. General policies for payment that are applicable to all providers are set forth in COMAR 10.09.36.04. B. IDTF providers shall identify the individual who ordered the diagnostic services by either: (1) Recording the National Provider Identifier (NPI) num…

.08 Recovery and Reimbursement. General policies governing recovery and reimbursement procedures that are applicable to all providers are set forth in COMAR 10.09.36.07.

.09 Cause for Suspension or Removal and Imposition of Sanctions. General policies governing the cause for suspension and removal and imposition of sanctions procedures that are applicable to all providers are set forth in COMAR 10.09.36.08.

.10 Appeal Procedures. General policies governing appeal procedures that are applicable to all providers are set forth in COMAR 10.09.36.09.

.01 Definitions. A. In this chapter, the following terms have the meanings indicated. B. Terms Defined. (1) “CMS” means Centers for Medicare and Medicaid Services. (2) “Department” means the Maryland Department of Health. (3) “Mammography” means the radiographic examination of th…

.02 License Requirements. A. Providers of Medical Assistance Program services shall, to the extent required by law, be licensed and legally authorized to practice or deliver services in the state in which the service is provided. B. The provider and the equipment personnel shall …

.03 Conditions for Participation. A. A provider shall meet all conditions for participation as set forth in COMAR 10.09.36.03. B. The provider shall also: (1) Be certified by CMS to furnish portable X-ray services; (2) Meet the licensure requirements as provided in Regulation .02…

.04 Covered Services. A. The Program covers medically necessary services rendered to recipients, when the services are: (1) Provided according to the laws and regulations of the State and locality in which they are rendered in accordance with 42 CFR §486.100; (2) Rendered by a ph…

.05 Limitations. The Program does not cover the following: A. Services for which the portable X-ray provider cannot provide a properly completed order identifying the authorized ordering physician or practitioner by National Provider Identifier (NPI); B. Services not adequately d…

.06 Preauthorization Requirements. Reserved.

.07 Payment Procedures. A. General policies for payment that are applicable to all providers are set forth in COMAR 10.09.36.04. B. The Department shall allow a single transportation payment for each trip the portable X-ray provider makes to a particular location. C. The Departme…

.08 Recovery and Reimbursement. General policies governing recovery and reimbursement procedures that are applicable to all providers are set forth in COMAR 10.09.36.07

.09 Cause for Suspension or Removal and Imposition of Sanctions. General policies governing the cause for suspension and removal and imposition of sanctions procedures that are applicable to all providers are set forth in COMAR 10.09.36.08.

.10 Appeal Procedures. General policies governing appeal procedures that are applicable to all providers are set forth in COMAR 10.09.36.09.

.01 Scope. The purpose of this chapter is to implement a home and community-based services benefit for children and youth with serious emotional disturbances (SED) and their families, authorized under a 1915(i) Medicaid State Plan Amendment. Eligible participants are served by ca…

.02 Definitions. A. In this chapter, the following terms have the meanings indicated. B. Terms Defined. (1) “1915(c)” means a federal waiver that allows states to provide home- and community-based care to individuals who would otherwise be institutionalized. (2) “1915(i)” means t…

.03 Participant Eligibility. A. For an applicant to be eligible for 1915(i) services, the applicant shall meet all of the criteria in §§B—H of this regulation. B. The applicant shall be younger than 18 years old at the time of enrollment. C. The applicant shall reside in a home- …

.04 Termination of Participant Enrollment. A. A participant shall be disenrolled from the 1915(i), as of the date established by the Department, if the participant: (1) No longer meets all of the criteria for 1915(i) eligibility specified in §§A—H of Regulation .03 of this chapte…

.05 1915(i) Model. A. The 1915(i) shall provide community-based treatment to children with SED or co-occurring diagnosis through the care coordination model. B. Enrollment in 1915(i) services qualifies and requires the participant to receive case management services through a CCO…

.06 Conditions for Provider Participation. A. The Department shall grant approval to providers to be eligible to receive Medicaid funds for 1915(i) services if the provider meets the requirements set forth in this chapter. B. Application. To provide 1915(i) services, a provider a…

.07 Denial, Emergency Suspension of Approval, and Disciplinary Action. A. Denial of Approval. (1) If the Department proposes to deny approval to an applicant under the provisions of this chapter, the Department shall give written notice of the proposed denial to the: (a) Provider…

.08 General Conditions for 1915(i) Services Provider Participation. A. A provider of 1915(i) services shall: (1) Provide the documentation required by the Department for initial approval and provider recertification, or as requested by the Department; (2) Be approved by the Depar…

.09 Covered Services — Family Peer Support Services. Family peer support services: A. May be provided without the presence of the participant; B. Are delivered by a family peer support partner employed by a family support organization (FSO); C. May include, but are not limited to…

.10 Covered Services — Youth Peer Support Services. A. Youth Peer Specialists. (1) Youth peer support services shall be delivered directly to the participant by a youth peer specialist who is: (a) Employed by a FSO as defined in COMAR 10.09.89.09D; (b) A peer recovery specialist …

.11 Covered Services — Respite Services. Respite services: A. Include a set of specific short-term services documented in the POC that include: (1) A schedule of the participant's activities during respite; (2) Medication monitoring, if needed; (3) The frequency, duration, and in…

.12 Covered Services — Expressive and Experiential Behavioral Services. A. Expressive and experiential behavioral services: (1) May be provided to an individual or group; (2) Provide sensory modalities to participants to assist in achieving POC objectives; and (3) Include: (a) Ar…

.13 Covered Services — Intensive In-Home Services. A. Intensive In-Home Services (IIHS): (1) Are strengths-based interventions with the child and his or her identified family that includes a series of components, such as: (a) Functional assessments and treatment planning; (b) Ind…

.14 Limitations. A. Reimbursement shall be made by the Program only when all of the requirements of this chapter are met. B. The Program may not reimburse for: (1) Services that are: (a) Provided by a member of the recipient’s immediate family or an individual who resides in the …

.15 Payment Procedures. A. Request for Payment. (1) An approved provider shall submit requests for payment for the services covered under this chapter according to the procedures set forth in COMAR 10.09.36.04. (2) The provider shall: (a) Bill the ASO in accordance with the payme…

.16 Recovery and Reimbursements. Recovery and reimbursement are set forth in COMAR 10.09.36.07.

.17 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 and 10.21.10.

.18 Appeal Procedures for Providers. Appeal procedures for providers are those set forth in COMAR 10.09.36.09.

.19 Appeal Procedures for Applicants and Participants. Appeal procedures for applicants and participants are those set forth in COMAR 10.01.04, 10.09.24.13, and 10.09.70.

.01 Scope. A. This chapter applies to providers organized to deliver mental health case management services for children and youth. B. The purpose of mental health case management care coordination is to assist participants in gaining access to needed medical, mental health, soci…