Maryland Administrative Code

.10 Cost Reporting — State-Operated Chronic Hospitals. A. The provider shall submit to the Department or its designee, in the form prescribed, financial and statistical data within 5 months after the end of the provider’s fiscal year unless the Department grants the provider an e…

.11 Cost Settlement — State-operated Chronic Hospitals. A. Final settlement for services in the provider’s fiscal year shall be determined based on Medicare retrospective cost principles found at 42 CFR §413, adjusted for Program allowable costs. Allowable costs specific to the P…

.12 Cost Settlement for State-operated Chronic Hospitals — Payments and Appeals. A. The Department or its designee shall notify each provider participating in the Program of the results of the final settlement under Regulation .11 of this chapter. B. Within 60 days after the prov…

.13 Recovery and Reimbursement. A. General policies governing recovery and reimbursement procedures applicable to all providers are set forth in COMAR 10.09.36.07. B. If refund of a payment as specified in §A of this regulation, is not made, the Department shall reduce its curren…

.14 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. Cross References 10.09.93.10E 10.09.93.12I

.15 Appeal Procedures. A provider filing an appeal from an administrative decision made in connection with these regulations shall do so according to COMAR 10.09.36.09.

.16 Interpretive Regulation. General policies governing the interpretive regulations 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) “Acute hospital” means an institution that provides active, short-term medical diagnosis, treatment, and care. (2) “Administrative day” means a day of medical services deli…

.02 License Requirements. A. In order to participate in the Program, a provider shall: (1) Be licensed by the Department pursuant to Health-General Article, Title 19, Subtitle 3, Annotated Code of Maryland, as a hospital; and (2) Obtain other licenses, as set forth in COMAR 10.07…

.03 Conditions for Participation. A. A provider shall meet all conditions for participation as set forth in COMAR 10.09.36. B. To participate in the Program as a special pediatric hospital services provider, the provider shall: (1) Meet the requirements of Title XIX of the Social…

.04 Covered Services. A. The Program covers the following inpatient services at special pediatric hospitals: (1) A hospital admission determined to be medically necessary for a participant who is stable enough for transfer to a post-acute setting and requires medical or rehabilit…

.05 Limitations. The Program does not cover: A. Investigational or experimental hospital services, procedures, or drugs; B. Inpatient admissions or outpatient visits solely for the administration of injections, unless medical necessity and the participant’s inability to take appr…

.06 Utilization Review. A. The Department or its designee shall conduct utilization review to determine that special pediatric hospital admissions and outpatient services are authorized only when medically necessary. B. Review Procedure. (1) For all admissions, the special pediat…

.07 Payment Procedures. A. HSCRC Reimbursement Principles. (1) Except for hospitals reimbursed under the provisions of §B of this regulation and except for administrative days, hospitals located in Maryland that participate in the Program shall charge and be reimbursed according …

.08 District of Columbia Hospital Reimbursement. A. Inpatient Services Base Rate Calculation. (1) A hospital in the District of Columbia shall: (a) Bill its usual and customary charges; and (b) Be reimbursed for covered services the lesser of its percentage of charges as calculat…

.09 Billing and Reimbursement Principles. A. The Program shall pay room and board charges for the day of admission, and may not pay room and board charges for the day of discharge from the hospital. B. The provider shall submit a request for payment according to procedures design…

.10 Recovery and Reimbursement. A. General policies governing recovery and reimbursement procedures applicable to all providers are set forth in COMAR 10.09.36.07. B. If refund of a payment as specified in §A of this regulation is not made, the Department shall reduce its current…

.11 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. Cross References 10.09.94.08C(5)

.12 Appeal Procedures. A provider filing an appeal from an administrative decision made in connection with these regulations shall do so according to COMAR 10.09.36.09.

.13 Interpretive Regulation. General policies governing the interpretive regulations that are applicable to 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) “Administrative day” means a day of medical services delivered to a participant who no longer requires the level of care which the provider is licensed to deliver and is aw…

.02 License Requirements. A. In order to participate in the Program, a provider shall: (1) Be licensed by the Department pursuant to Health-General Article, Title 19, Subtitle 3, Annotated Code of Maryland, as a specialty psychiatric hospital; and (2) Obtain other licenses, as se…

.03 Conditions for Participation. A. A provider shall meet all conditions for participation as set forth in COMAR 10.09.36.03. B. To participate in the Program as a special psychiatric hospital services provider, the provider shall: (1) Meet the requirements of Title XIX of the S…

.04 Covered Services. A. The Program covers the following inpatient special psychiatric hospital services: (1) Medically necessary services for the number of days, per admission, including days certified by the Department or its designee; (2) Medically necessary mental health ser…

.05 Limitations. A. There are limitations placed on the coverage of some special psychiatric hospital inpatient and outpatient services. B. The Program does not cover: (1) Special psychiatric hospital services, procedures, drugs or admissions that are investigational or experimen…

.06 Utilization Review Requirements. A. Elective Inpatient Preauthorization Reviews. (1) The special psychiatric hospital shall only request preauthorization for inpatient stays when such services: (a) Cannot be provided on an outpatient basis; or (b) Can only be provided in a fa…

.07 Payment Procedures. A. Reimbursement Principles. (1) The Department will make no direct reimbursement to any State-operated hospital. The Department will claim federal fund recoveries from the U.S. Department of Health and Human Services for services to participants in State-…

.08 Recovery and Reimbursement. A. General policies governing recovery and reimbursement procedures applicable to all providers are set forth in COMAR 10.09.36.07. B. If refund of a payment as specified in §A of this regulation, is not made, the Department shall reduce its curren…

.09 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. Cross References 10.09.95.11E 10.09.95.12J

.10 Appeal Procedures. A provider filing an appeal from an administrative decision made in connection with these regulations shall do so according to COMAR 10.09.36.09.

.11 Submitting Cost Reports. A. The provider shall submit to the Department or its designee, in the form prescribed, financial and statistical data within 5 months after the end of the provider’s fiscal year unless the Department grants the provider an extension or the provider d…

.12 Cost Settlement. A. The Department or its designee shall notify each provider participating in the Program of the results of the final settlement under Regulation .07 of this chapter. B. Within 60 days after the provider receives the notification described in §A of this regul…

.13 Interpretive Regulation. General policies governing the interpretive regulations applicable to all providers are set forth in COMAR 10.09.36.10.

.01 Purpose and Scope. A. This chapter applies to remote patient monitoring services reimbursed by the Maryland Medical Assistance Program effective January 1, 2018. B. The purpose of providing medically necessary services via remote patient monitoring is to assist participants i…

.02 Definitions. A. In this chapter, the following terms have the meanings indicated. B. Terms Defined. (1) “Certified nurse midwife” means an individual who meets the licensure and conditions of participation for certified nurse midwives set forth in COMAR 10.09.01. (2) “Certifi…

.03 License Requirements. A. The provider shall: (1) Meet all license requirements as set forth in COMAR 10.09.36.02; and (2) Be licensed in the state in which the participant resides. B. A home health agency shall be: (1) Licensed pursuant to Health-General Article, §§19-401—19-…

.04 Provider Conditions for Participation. A. To provide remote patient monitoring, the provider shall: (1) Be enrolled with an active status as a Maryland Medical Assistance Program provider on the date the service is rendered; (2) Be a: (a) Physician; (b) Physician assistant; (…

.05 Participant Eligibility for Services. A participant is eligible to receive remote patient monitoring services if: A. The participant is enrolled in the Maryland Medical Assistance Program on the date the service is rendered; B. The participant consents to remote patient monit…

.06 Covered Services. A. Remote patient monitoring services include: (1) Installation; (2) Education for the participant in the use of the equipment; and (3) Daily monitoring of vital signs and other medical statistics. B. The remote patient monitoring provider shall establish an…

.07 Limitations. A. Remote patient monitoring services are only covered for participants who meet the eligibility criteria specified in Regulation .05 of this chapter. B. The Program does not cover: (1) Remote patient monitoring equipment; (2) Upgrades to remote patient monitorin…

.08 Preauthorization Requirements. The Department may preauthorize services when the provider submits to the Department adequate documentation demonstrating the: A. Participant’s condition meets the criteria listed in Regulation .05 of this chapter; and B. Participant has not alr…

.09 Payment Methodology. A. After providing the services outlined in Regulation .06 of this chapter, the remote patient monitoring provider shall submit the request for payment using the format designated by the Department. B. Home health agencies shall: (1) Bill on a UB04; and (…

.10 Recovery and Reimbursement. Recovery and reimbursement shall be in accordance with COMAR 10.09.36.07.

.11 Cause for Suspension or Removal and Imposition of Sanctions. Cause for suspension or removal and imposition of sanctions shall be in accordance with COMAR 10.09.36.08.

.12 Appeal Procedures. Providers filing appeals from administrative decisions made in connection with these regulations shall do so in accordance with COMAR 10.09.36.09.

.13 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 Purpose. The people of Maryland are entitled to the highest level of competency, reliability, and accuracy that reasonably may be expected from a medical laboratory or crime laboratory. It is the intent of this subtitle to protect the public and individual health by requiring…