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10.14.02.00.htm 10.14.02.00. Title 10 MARYLAND DEPARTMENT OF HEALTH Subtitle 14 CANCER CONTROL Chapter 02 Reimbursement for Breast and Cervical Cancer Diagnosis and Treatment Authority: Health-General Article, §2-102, 2-104, and 2-105, Annotated Code of Maryland
10.14.02.01.htm 10.14.02.01. 01 Scope.. A. This chapter defines the reimbursed services for the diagnosis and treatment of breast cancer, cervical cancer, or precancerous cervical lesions, outlines the requirements for patient eligibility, and outlines the reimbursement and billing procedures for the reimbursed services.B. This chapter also defines the:. 1) Responsibilities and duties of the Department, the participating local health department, the hospital-coordinated breast and cervical cancer scree
10.14.02.02.htm 10.14.02.02. 02 Definitions.. A. In this chapter, the following terms have the meanings indicated.. B. Terms Defined.. 1) “Admission” means the formal acceptance by a hospital of a patient who is to be provided with room, board, and medically necessary services in an area of the hospital where the patient stays at least overnight.2) “Ambulatory surgical center” means a distinct, Medicare-certified entity that operates exclusively for the purpose of providing surgical services t
10.14.02.03.htm 10.14.02.03. 03 Patient Eligibility.. A. To be eligible to have a covered service reimbursed under the Program, an applicant shall:. 1) Be a resident;. 2) Be screened for breast cancer or cervical cancer, or both, by a:. a) Hospital;. b) Local health department; or. c) Health care provider;. 3) Be found to have an eligible medical condition as described in §B of this regulation;. 4) Meet the health insurance criteria specified in §C of this regulation;. 5) Meet the financial eli
10.14.02.04.htm 10.14.02.04. 04 Physician Services.. A. To be considered a participating physician in the Program, the provider shall:. 1) Provide a medical procedure or service related to the diagnosis and treatment of breast cancer, cervical cancer, or a precancerous cervical lesion;2) Have a current license to practice medicine in Maryland or a jurisdiction bordering Maryland;. 3) Agree to accept, for each covered medical procedure performed or service provided, the following reimbursement including,
10.14.02.04-1.htm 10.14.02.04-1. 04-1 Physician Assistant Services.. A. To be considered a participating physician assistant in the Program, the provider shall:. 1) Be licensed to practice as a physician assistant in Maryland or a jurisdiction bordering Maryland;2) Have a current written executed delegation agreement with a licensed supervising physician who is licensed to practice medicine in Maryland or a jurisdiction bordering on Maryland, if required by that jurisdiction;3) Agree to accept, for e
10.14.02.04-2.htm 10.14.02.04-2. 04-2 Certified Nurse Midwife Services.. A. To be considered a participating certified nurse midwife in the Program, the provider shall:. 1) Be a certified nurse midwife in Maryland or a jurisdiction bordering on Maryland and hold all certifications as required by the Maryland Board of Nursing;2) Agree to accept, for each reimbursed medical procedure performed or service provided, the following reimbursement including, if applicable, a medical management fee as desc
10.14.02.05.htm 10.14.02.05. 05 Nurse Practitioner Services.. A. To be considered a participating nurse practitioner in the Program, the provider shall:. 1) Be a certified nurse practitioner in Maryland or a jurisdiction bordering Maryland;. 2) Have a current written attestation with a physician who is licensed to practice medicine in Maryland or a jurisdiction bordering Maryland, if required by that jurisdiction;3) Agree to accept, for each reimbursed medical procedure performed or serv
10.14.02.06.htm 10.14.02.06. 06 Nurse Anesthetist Services.. A. To be considered a participating nurse anesthetist in the Program, the provider shall:. 1) Be a certified nurse anesthetist in Maryland or a jurisdiction bordering Maryland;. 2) Be currently collaborating with an anesthesiologist or other physician who is licensed to practice medicine in Maryland or a jurisdiction bordering Maryland in the manner prescribed by COMAR 10.27.06 or by the jurisdiction in which the service is 3) Agree to accept, for e
10.14.02.07.htm 10.14.02.07. 07 Physical Therapy Services.. A. To be considered a participating physical therapist in the Program, the provider shall:. 1) Be a physical therapist licensed to practice physical therapy in Maryland or a jurisdiction bordering Maryland;2) Agree to abide by the provisions set forth in this regulation by signing and sending to the Department the designated Departmental form;3) Follow standard health and safety procedures to protect an eligible patient from potential hazards;
10.14.02.08.htm 10.14.02.08. 08 Pharmacy Services.. A. To be considered a participating pharmacy in the Program, the provider shall:. 1) Obtain a permit from the Department pursuant to Health Occupations Article, Title 12, Annotated Code of Maryland;2) Agree to abide by the provisions set forth in this regulation by signing and sending to the Department the designated Departmental form;3) Agree to accept, as payment in full, the amount paid by the Program pursuant to §E of this regulation plus the amount paid
10.14.02.09.htm 10.14.02.09. 09 Hospital Services.. A. To be considered a participating hospital in the Program, the provider shall:. 1) Be licensed as a hospital in Maryland or a jurisdiction bordering Maryland;. 2) Agree to abide by the provisions set forth in this regulation by signing and sending to the Department the designated Departmental form;3) Agree to accept, as payment in full, the amount paid by the Program pursuant to §E of this regulation;4) Agree not to bill an eligible patient for an ad
10.14.02.10.htm 10.14.02.10. 10 Disposable Medical Supplies and Durable Medical Equipment.. A. To be considered a participating medical supply company in the Program, the provider of disposable medical supplies and durable medical equipment shall:1) To the extent required by law, be licensed and legally authorized to practice or deliver services in Maryland or a jurisdiction bordering Maryland;2) Agree to abide by the provisions set forth in this regulation by signing and sending to the Depar
10.14.02.11.htm 10.14.02.11. 11 Home Health Services.. A. To be considered a participating home health services provider in the Program, the provider of home health services shall:1) Be a home health services provider licensed in Maryland or a jurisdiction bordering Maryland;. 2) Agree to abide by the provisions set forth in this regulation and apply for participation in the Program by signing and sending to the Department the designated Departmental form;
10.14.02.12.htm 10.14.02.12. 12 Medical Laboratory Services.. A. To be considered a participating medical laboratory in the Program, the provider shall:. 1) Be in compliance with the applicable license requirements for a medical laboratory providing services for Maryland residents including, but not limited to:a) Requirements for Medicare certification;. b) Compliance with the requirements pursuant to COMAR 10.10.03.01 if operating in Maryland; and.
10.14.02.13.htm 10.14.02.13. 13 Freestanding Ambulatory Surgical Center Services.. A. To be considered a participating freestanding ambulatory surgical center in the Program, the provider shall:1) Be Medicare certified to provide ambulatory surgical services in Maryland or a jurisdiction bordering Maryland;2) Comply with COMAR 10.09.42.02 and .03B;. 3) Agree to abide by the provisions set forth in this regulation by signing and sending to the Department the designated Departmental form;4) Agree to accept, as pa
10.14.02.14.htm 10.14.02.14. 14 Occupational Therapy Services.. A. To be considered a participating occupational therapist in the Program, the provider shall:. 1) Be an occupational therapist licensed to practice occupational therapy in Maryland or a jurisdiction bordering Maryland;2) Agree to abide by the provisions set forth in this regulation by signing and sending to the Department the designated departmental form;3) Follow standard health and safety procedures to protect an eligible pati
10.14.02.15.htm 10.14.02.15. 15 Medical Management Fee.. A. A participating health care provider eligible to receive a medical management fee may be one of the following:1) Anesthesiologist;. 2) Certified nurse midwife;. 3) Family practitioner;. 4) Gynecologist;. 5) Medical internist;. 6) Medical oncologist;. 7) Nurse anesthetist;. 8) Nurse practitioner;. 9) Pathologist;. 10) Physician assistant;. 11) Radiation oncologist;. 12) Radiologist;. 13) Surgeon; and.
10.14.02.16.htm 10.14.02.16. 16 Department, Local Health Department, Hospital, and Health Care Provider Responsibilities.. A. The Department is responsible for the following:. 1) Developing the necessary administrative forms needed for the Program including, but not limited to, a:a) Standard application form to determine eligibility of patients;. b) Release of patient information form; and. c) Participating health care provider agreement form;. 2) Distributing the administrative forms to the following:.
10.14.02.17.htm 10.14.02.17. 17 Reimbursement.. A. The Department shall reimburse a participating health care provider only for a medical service or procedure related to the diagnosis and treatment of breast cancer, cervical cancer, or a precancerous cervical lesion for an eligible patient.B. The Department shall reimburse a participating health care provider a medical management fee pursuant to Regulation .15 ofC. The participating health care provider shall reimburse the Department for an overpayment..
10.14.02.18.htm 10.14.02.18. 18 Liability.. Responsibility for liability for services provided, and for the availability of appropriate insurance coverage, rests with the participating health care provider.
10.14.02.19.htm 10.14.02.19. 19 Termination from the Program.. A. If the Department determines that a participating health care provider has failed to comply with the applicable regulations of this chapter, the Department may terminate the written agreement with the provider by giving 30 days notice in writing to the participating health care provider.B. The participating health care provider may terminate the provider agreement with the Department by:1) Giving 30 days notice in writing to the Department; and.
10.14.02.20.htm 10.14.02.20. 20 Appeal Procedures.. A. A provider filing an appeal of the Department’s decision to terminate the provider’s agreement with the Program shall do so according to State Government Article, Title 10, Subtitle 2, Annotated Code of Maryland.B. A provider shall file an appeal within 30 days of receipt of written notice of termination..
10.14.02.21.htm 10.14.02.21. 21 Billing and Reimbursement Time Limitations.. A. The Program may not reimburse claims received for payment more than 12 months after the date of service except as specified in §B―D of this regulation.B. To obtain reimbursement from the Program, a health care provider that originally submits a claim to Medicare or another health insurer shall also submit the claim to the Program within a period whereby the Program receives the claim within the latter of:
10.14.02.22.htm 10.14.02.22. 22 Maryland Health Insurance Plan Coverage.. A. In lieu of providing direct reimbursement to participating health care providers, the Program may pay MHIP, if available, to provide health coverage for individuals enrolled in the Program who are also eligible for MHIP.B. The Program may pay MHIP, if available, for health coverage for eligible patients, including:. 1) MHIP premiums;. 2) Pre-existing condition buy-downs; and. 3) Any MHIP fees.. C. The Program may not pa
10.14.02.23.htm 10.14.02.23. 23 Funding Availability.. Payment under this chapter is contingent on the availability of funds in accordance with State Finance and Procurement Article, §7-234 and 7-235, Annotated Code of Maryland.
10.14.02.9999.htm 10.14.02.9999. Administrative History Effective date:. Regulations .01―12 under new Chapter, Reimbursement for Breast and Cervical Cancer Diagnosis and Treatment, adopted as an emergency provision effective March 31, 1993 (20:8 Md. R. 715) Regulations .03 and .10 amended as an emergency provision effective May 24, 1993 (20:12 Md. R. 995) amendments to Regulation .10 expired June 30, 1993; adopted permanently effective September 13, 1993 (20:18 Md. R. 1430) ―Regulations .01―12 repeal
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