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10.01.10.00.htm 10.01.10.00. Title 10 DEPARTMENT OF HEALTH AND MENTAL HYGIENE Subtitle 01 PROCEDURES Chapter 10 Payment for Off-Grounds Medical Services Authority: Health General Article, §2-104(b) Annotated Code of Maryland
10.01.10.01.htm 10.01.10.01. 01 Purpose.. The Secretary of Health and Mental Hygiene (DHMH) has established accounts for the purpose of payment of off-grounds medical services. These accounts are to be used by DHMH facilities whose clients receive services from private medical providers that the facility cannot furnish or secure by contract. The care could include laboratory work, services from medical specialties, and acute hospitalization. The care does not include ambulance transportation.
10.01.10.02.htm 10.01.10.02. 02 Definitions.. A. In this chapter, the following terms have the meanings indicated.. B. Terms Defined.. 1) "Client" means a resident or patient in a Department of Health and Mental Hygiene facility.. 2) "Department" means the Department of Health and Mental Hygiene.. 3) Facility.. a) "Facility" means an inpatient or residential facility owned and operated by the Department.. b) "Facility" includes Mental Hygiene Administration institutions, Developmental Disabilities Admini
10.01.10.03.htm 10.01.10.03. 03 Requirements.. A. All facilities shall provide or arrange for the provision of medical care required by individuals placed in Department facilities.B. All facilities shall purchase medical services that cannot be provided in the facility by the facility's staff or visiting consultants from providers appropriately licensed in the state in which the service is to be rendered.C. All facilities shall purchase medical services from medical providers who agree to invoice the fa
10.01.10.04.htm 10.01.10.04. 04 Payment Procedures.. A. Medical providers shall collect to the extent possible from third-party payers such as Medical Assistance, Medicare, and private insurers.B. Facilities shall direct medical providers to invoice the facility for the cost of those services not covered by third-party payers. For Medical Assistance recipients, the Secretary or the Secretary's designee shall determine which services are specifically provided for in the facility's budget an
10.01.10.05.htm 10.01.10.05. 05 Recovery and Reimbursement.. A. If a client has insurance or if any other person is obligated, either legally or contractually, to pay for, or to reimburse the client for any service covered by this chapter, the medical provider shall seek payment from that source.B. Payment. If payment is made by both the facility and insurance or other payer, the following conditions apply:1) If the facility has paid all or part of the invoice and the third-party payer has made payment th
10.01.10.9999.htm 10.01.10.9999. Administrative History Effective date:. Regulations .01―07 adopted as an emergency provision effective September 1, 1983 (10:20 Md. R. 1780) adopted permanently effective December 19, 1983 (10:25 Md. R. 2268)Regulation .02B amended effective February 20, 1989 (16:3 Md. R. 342). Regulation .04D amended effective February 20, 1989 (16:3 Md. R. 342) ―. Chapter revised effective December 20, 1993 (20:25 Md. R. 1946).
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