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10.02.01.00.htm 10.02.01.00. Title 10 DEPARTMENT OF HEALTH AND MENTAL HYGIENE Subtitle 02 DIVISION OF REIMBURSEMENTS Chapter 01 Charges for Services Provided Through the Department of Health and Mental Hygiene Authority: Health-General Article, §16-201―16-407, Annotated Code of Maryland
10.02.01.01.htm 10.02.01.01. 01 Purpose.. It is the intent of this chapter that:. A. The cost of care of a recipient of services be determined in accordance with the charges for health services set under this chapter;B. There be a single or, if appropriate, bundled charge for each health service rendered to an individual, including an individual in a group session or family group session; andC. The methods for determining full costs be uniform among all units..
10.02.01.02.htm 10.02.01.02. 02 Scope.. This chapter applies to:. A. All inpatient facilities operated by the Department;. B. All local health departments' programs funded by the Department;. C. All private or public alcohol and drug abuse providers funded by the Behavioral Health Administration;D. Adult day care funded by the Office of Health Services; and. E. Family planning services funded by the Prevention and Health Promotion Administration..
10.02.01.03.htm 10.02.01.03. 03 Definitions.. A. In this chapter, the following terms have the meanings indicated.. B. Terms Defined.. 1) "Charge" means the dollar amount set or approved by the Secretary for each clinic visit, day of care, hour, procedure, or other unit of service, as specified in the Schedule of Charges, which is the single rate to be charged all recipients of service, estates, third-party payers and insurers, or chargeable persons.2) "Chargeable person" means:.
10.02.01.04.htm 10.02.01.04. 04 Setting of Charges for Local Health Departments.. A. The Secretary shall approve a Schedule of Charges for each local health department containing the CPT-based charges for health services provided by the local health department which remain in effect until changed as provided in this chapter.B. CPT-Based Charge.. 1) Each health service for which payment is sought shall be assigned an applicable CPT code.. 2) Approved Method for Determining CPT-Based Charges..
10.02.01.05.htm 10.02.01.05. 05 Setting of Charges for State-Operated Inpatient Facilities.. A. Inpatient Charge.. 1) For each fiscal year, a daily per capita inpatient cost of care for a State-operated inpatient facility shall be determined by:a) Utilizing the legislatively approved budget for the inpatient facility;. b) Adding the federal indirect cost and Statewide and departmental overhead, less shared cost, for the applicable fiscal year; andc) Dividing the amount determined in §A(1)b) of th
10.02.01.06.htm 10.02.01.06. 06 Setting of Charges for Private Providers.. A. A private provider shall submit annually, to the Division, a cost report and proposed recommended Schedule of Charges, pursuant to instructions provided by the Division.B. At least annually, the Secretary shall approve a Schedule of Charges recommended for each private provider containing the per service charges for each private provider which remain in effect until changed as provided in this chapter.C. Per Service Charge. A
10.02.01.07.htm 10.02.01.07. 07 Setting of Charges for Laboratories Administration.. A. The Laboratories Administration shall submit annually, to the Division, a cost report and proposed recommended Schedule of Charges, pursuant to instructions provided by the Division.B. At least annually, the Secretary shall approve a Schedule of Charges recommended for each type of laboratory service which remains in effect until changed as provided in this chapter.
10.02.01.08.htm 10.02.01.08. 08 Determination of Ability to Pay and Fees to be Collected.. A. For inpatient care rendered in facilities operated by the Department, fees shall be established in conformity with applicable statutory requirements and regulations issued by the Secretary. The following apply:1) The total cost of care of each recipient of services is, in the first instance, the responsibility of the recipient of services and also the chargeable person as provided in Health-General Article,
10.02.01.09.htm 10.02.01.09. 09 Billing and Collection of Charges and Fees.. A. Billings and collections for care rendered in State operated inpatient facilities shall be calculated by the Department in accordance with the following procedures:1) The Department shall conduct a financial investigation of a recipient of services or chargeable persons' ability-to-pay in accordance with the requirements of COMAR 10.04.02.03 and COMAR 10.04.02.04;2) Based on the foregoing investigation, the Depar
10.02.01.10.htm 10.02.01.10. 10 Distribution and Application of Amounts Collected.. A. All payments made under the provisions of this subtitle for services rendered through facilities and programs of the Department shall be made to and collected by the Department, and shall be accounted for and deposited into the General Funds of the State Treasury by the Department.B. Local health departments and other providers shall report all funds collected as revenues which are to be treated in accor
10.02.01.11.htm 10.02.01.11. 11 Records and Reports Required.. A. An individual financial record for each recipient of services or chargeable person shall be maintained, which shall contain relevant financial information including:1) The ability-to-pay determination, including, when available, applicable documents appropriate to the verification of assets, income, expenses, allowances and exemptions;2) The types and dates of services rendered and the approved charges, the amounts and dates of collections;
10.02.01.9999.htm 10.02.01.9999. Administrative History Effective date: January 6, 1976 (3:4 Md. R. 215). Promulgated as emergency provision April 14, 1976 (3:11 Md. R. 586). Regulations .01―07 amended effective July 21, 1976 (3:15 Md. R. 791). Regulation .02 amended effective May 5, 1986 (13:9 Md. R. 1027). Regulation .04 amended as an emergency provision effective March 18, 1985 (12:7 Md. R. 693) adopted permanently effective June 3, 1985 (12:11 Md. R. 1047)Regulation .04 amended as an emergency provision e
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