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10.09.01.00.htm 10.09.01.00. Title 10 MARYLAND DEPARTMENT OF HEALTH Subtitle 09 MEDICAL CARE PROGRAMS Chapter 01 Nurse Practitioner Services Authority: Health-General Article, §2-104(b) 15-103, and 15-105, Annotated Code of Maryland
10.09.01.01.htm 10.09.01.01. 01 Definitions.. A. The following terms have the meanings indicated.. B. Terms Defined.. 1) "Certified nurse practitioner" means:. a) A registered nurse who by reason of certification under COMAR 10.27.07 may practice in Maryland as a nurse practitioner under the terms of those regulations; orb) If out of State, a registered nurse who qualifies as a nurse practitioner in the state in which services are provided.2) "Department" means the Maryland Department of H
10.09.01.02.htm 10.09.01.02. 02 License and Certification Requirements.. A. The provider shall meet all license requirements as set forth in COMAR 10.09.36.02.. B. A certified nurse practitioner applying for provider status shall:. 1) Hold a current license to practice registered nursing in Maryland, and be certified as a nurse practitioner by the Nursing Board; or2) Meet the nurse practitioner regulatory requirements of the state in which the services are provided.
10.09.01.03.htm 10.09.01.03. 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. Specific requirements for participation in the Program as a nurse practitioner provider require that the provider:1) Meet the requirements as described in Regulation .02B of this chapter;. 2) Have a written agreement with a licensed physician, if required by the state in which services ar
10.09.01.04.htm 10.09.01.04. 04 Covered Services.. A. The Program covers medically necessary services rendered to recipients in accordance with:. 1) The functions allowed under the Maryland Nurse Practice Act or COMAR 10.27.07 and the certified nurse practitioner's written agreement with a physician; or2) If out-of-State, those functions authorized in the state in which the services are provided.. B. The services in §A shall be clearly related to the recipient's medical needs and described in the
10.09.01.05.htm 10.09.01.05. 05 Limitations.. The Program does not cover the following under these regulations:. A. Services not encompassed by the certified nurse practitioner's written agreement with the physician, if required by the state in which services are provided;B. Services not medically necessary;. C. Services prohibited by the Maryland Nurse Practice Act or by COMAR 10.27.07;. D. Services prohibited in the state in which services are provided;.
10.09.01.06.htm 10.09.01.06. 06 Payment Procedures.. A. The provider shall submit the request for payment on the form designated by the Department.. B. The Department reserves the right to return to the provider, before payment, all invoices not properly signed, completed, and accompanied by any properly completed forms required by the Department.C. The provider shall charge the Program the provider’s customary charge to the general public for similar services and charge the provider’s acquisit
10.09.01.07.htm 10.09.01.07. 07 Recovery and Reimbursement.. A. The provider shall reimburse the Department for any overpayment.. B. If the recipient has insurance or other coverage, or if any other person is obligated either legally or contractually to pay for or to reimburse the recipient for services covered by this chapter, the provider shall seek payment from that source first. If an insurance carrier rejects the claim or pays less than the amount allowed by the Program, the provider may submit
10.09.01.08.htm 10.09.01.08. 08 Cause for Suspension or Removal and Imposition of Sanctions.. A. If the Department determines that a provider, any agent or employee of a provider, or any person with an ownership interest in the provider, has failed to comply with all applicable federal or State laws or regulations, the Department may initiate one or more of the following actions against the responsible party:1) Suspension from the Program;. 2) Withholding part or all of the payment by the Program;.
10.09.01.09.htm 10.09.01.09. 09 Appeal Procedures.. A. Providers filing appeals of administrative decisions made in connection with these regulations shall do so according to State Government Article, Title 10, Subtitle 2, and Health-General Article, §2-201―2-207, Annotated Code of Maryland.B. Appeals shall be filed within 30 days of receipt of the notice of the administrative decision..
10.09.01.10.htm 10.09.01.10. 10 Interpretive Regulation.. Except when the language of a specific regulation indicates an intent by the Department to provide reimbursement for covered services which are provided without regard to the availability of federal financial participation, State regulations shall be interpreted in conformity with applicable federal statutes and regulations.
10.09.01.9999.htm 10.09.01.9999. Administrative History Effective date: May 14, 1990 (17:9 Md. R. 1090). Regulation .01 amended effective May 31, 1999 (26:11 Md. R. 854). Regulation .02C amended effective May 31, 1999 (26:11 Md. R. 854). Regulations .02 and .03 amended as an emergency provision effective September 16, 1992 (19:20 Md. R. 1812) amended permanently effective January 1, 1993 (19:25 Md. R. 2205)Regulation .05G, Q amended effective May 31, 1999 (26:11 Md. R. 854). Regulation .06 amended as
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