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10.09.04.00.htm 10.09.04.00. Title 10 DEPARTMENT OF HEALTH AND MENTAL HYGIENE Subtitle 09 MEDICAL CARE PROGRAMS Chapter 04 Home Health Services Authority: Health-General Article, §2-104(b) 15-103, and 15-105, Annotated Code of Maryland
10.09.04.01.htm 10.09.04.01. 01 Definitions.. A. In this chapter, the following terms have the meanings indicated.. B. Terms Defined.. 1) "Activities of daily living" means functions normally associated with mobility, eating, elimination, body hygiene and dressing.2) "Attending physician" means a person who is licensed to practice medicine in the jurisdiction in which the service is provided and who establishes the plan of treatment and certifies the necessity for home health services for a recipient.
10.09.04.02.htm 10.09.04.02. 02 License Requirements.. A home health agency shall be licensed pursuant to Health-General Article, §19-401—19-408, Annotated Code of Maryland, or shall be part of a hospital or related institution licensed pursuant to Health-General Article, §19-301—19-359, Annotated Code of Maryland, or shall be legally authorized to provide home health services in the jurisdiction in which the service is provided.
10.09.04.03.htm 10.09.04.03. 03 Conditions for Participation.. A. To be a provider, a home health agency shall be a participating home health agency under Medicare.B. To participate in the Program, the home health agency shall:. 1) Apply for participation in the Program using the form designated by the Department;. 2) Be approved for participation by the Department;. 3) Have in effect a provider agreement with the Department;. 4) Accept payment by the Department as payment in full for covered services
10.09.04.04.htm 10.09.04.04. 04 Covered Services.. A. The Program covers the services listed in §B and C of this regulation when the services are:. 1) Provided upon the written order of the attending physician and furnished under the current plan of treatment;2) Consistent with the current diagnosis and treatment of the recipient's condition;. 3) In accordance with accepted standards of medical practice;. 4) Required by the medical condition rather than the convenience or preference of the recipient;.
10.09.04.05.htm 10.09.04.05. 05 Limitations.. The Program does not cover the following:. A. Nonskilled services rendered by licensed nurses, physical therapists, occupational therapists and speech pathologists;B. Services and medical supplies that are not medically necessary and appropriate;. C. Durable medical equipment except as covered under COMAR 10.09.12;. D. Services primarily for the purpose of housekeeping, including but not limited to:. 1) Cleaning of floor and furniture;. E. Home health aide servi
10.09.04.06.htm 10.09.04.06. 06 Preauthorization Requirements.. A. Preauthorization is required for:. 1) More than one visit per type of service per day;. 2) Any service or combination of services specified in Regulation .04 of this chapter and rendered during any 30-day period for which the provider anticipates payments from the program in excess of the Medicaid average nursing facility rate;3) Four or more hours of care per day whether the 4-hour limit is reached in one visit or in several
10.09.04.07.htm 10.09.04.07. 07 Payment Procedures.. A. The provider shall submit his request for payment on the form designated by the Department.. B. The provider shall submit requests for payment for supplies on the same invoice which requests payment for the visit during which the supplies were used.C. The Department reserves the right to return to the provider, before payment, all invoices not properly completed.D. Payment Rates.. 1) The provider shall be paid the lesser of:. a) The provider’s customa
10.09.04.08.htm 10.09.04.08. 08 Recovery and Reimbursement.. Recovery and reimbursement regulations are set forth in COMAR 10.09.36..
10.09.04.09.htm 10.09.04.09. 09 Cause for Suspension or Removal and Imposition of Sanctions.. Cause for suspension or removal and imposition of sanctions are set forth in COMAR 10.09.36..
10.09.04.10.htm 10.09.04.10. 10 Appeal Procedures.. Appeal procedures are set forth in COMAR 10.09.36..
10.09.04.11.htm 10.09.04.11. 11 Interpretive Rule.. State regulations are interpreted as set forth in COMAR 10.09.36..
10.09.04.9999.htm 10.09.04.9999. Administrative History Effective date: July 1, 1985 (12:11 Md. R. 1048). Regulations .01B and .05L amended, and .05M adopted as an emergency provision effective July 17, 1990 (17:16 Md. R. 1984) adopted permanently effective November 1, 1990 (17:20 Md. R. 2427)Regulation .01B amended effective November 12, 1990 (17:22 Md. R. 2656). Regulation .03C amended effective November 12, 1990 (17:22 Md. R. 2656). Regulation .04B amended effective April 4, 1988 (15:7 Md. R. 849) November
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