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10.09.08.00.htm 10.09.08.00. Title 10 MARYLAND DEPARTMENT OF HEALTH Subtitle 09 MEDICAL CARE PROGRAMS Chapter 08 Freestanding Clinics Authority: Health-General Article, §2-104(b) 15-103, and 15-105, Annotated Code of Maryland
10.09.08.01.htm 10.09.08.01. 01 Definitions.. A. In this chapter, the following terms have the meanings indicated.. B. Terms Defined.. 1) "All-inclusive cost-per-visit rate" means the rate that is established for Federally Qualified Health Centers (FQHCs) which includes all services that are rendered to a participant on a given date of service.2) "Clinic services" means preventive, diagnostic, therapeutic, rehabilitative or palliative items or services furnished by or under the direction of
10.09.08.02.htm 10.09.08.02. 02 License Requirements.. A. The provider shall meet all license requirements as set forth in COMAR 10.09.36.02.. B. A physician or osteopath providing services in a freestanding clinic shall be licensed and legally authorized to practice medicine in the state in which the service is provided.C. The provider shall ensure that all X-ray and other radiological equipment:. 1) Is maintained and inspected in compliance with the requirements of the Maryland Radiation Act, En
10.09.08.03.htm 10.09.08.03. 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 freestanding clinic provider require that the provider:1) Meet the applicable standards and requirements of Regulation .04 of this chapter;. 2) Verify the licenses and credentials of all professionals employed by or
10.09.08.04.htm 10.09.08.04. 04 Covered Services.. A. The Program covers the services listed in §B―E of this regulation according to the conditions and requirements indicated.B. Medically Necessary Services. The program covers medically necessary services as described in §C, D, and E of this regulation and in Regulation .05 of this chapter, rendered to participants by a freestanding clinic, when these services are performed by a physician or by:1) A registered nurse, a psychologist, or a social
10.09.08.05.htm 10.09.08.05. 05 Federally Qualified Health Center Services.. A. To participate as a federally qualified health center, the provider shall meet the requirements of Regulations .03 and .04B of this chapter and shall:1) Meet the conditions for coverage in accordance with 42 CFR §491, Subpart A;. 2) Be enrolled in the EPSDT/Healthy Kids Program as provided in COMAR 10.09.23 and provide EPSDT/Healthy Kids services to recipients who are eligible to receive them;
10.09.08.06.htm 10.09.08.06. 06 Limitations.. The Program does not cover the following:. A. Services not specified in Regulation .04 of this chapter;. B. Services not medically necessary;. C. Investigational and experimental drugs and procedures;. D. Procedures solely for cosmetic purposes;. E. Services denied by Medicare as not medically justified;. F. Freestanding clinic services for inpatient recipients in State-operated facilities serving individuals with intellectual disabilities;
10.09.08.07.htm 10.09.08.07. 07 Freestanding Clinic Reimbursement Methodology.. A. Reimbursement for Family Planning Clinics. The Department shall pay the family planning clinic the lesser of the provider’s customary charge or the provider’s acquisition cost, but no more than the maximum reimbursement allowed for similar procedures or services required in COMAR 10.09.02.07D. If the service is free to individuals not covered by Medicaid:1) The provider:. a) May charge the Program; and.
10.09.08.08.htm 10.09.08.08. 08 Reimbursement Methodology for FQHC Services.. A. Federally qualified health centers shall be reimbursed for covered services once the provider is in compliance with all federal and State requirements.B. The only well-child visits that are eligible for Program reimbursement are those that are billed as EPSDT screens.C. Payment of Allowable Costs.. 1) Federally qualified health centers shall be paid 100 percent of the FQHC’s allowable costs, subject to the limitations con
10.09.08.09.htm 10.09.08.09. 09 Preauthorization Requirements.. A. The following procedures or services require preauthorization:. 1) Vision care according to COMAR 10.09.14.06 and COMAR 10.09.23;. 2) Mental health services which shall comply with the requirements of COMAR 10.09.59;. 3) Substance use disorder services which shall comply with the requirements of COMAR 10.09.80; and. 4) Dental services which shall comply with the requirements of COMAR 10.09.05.. B. The Department or it’s designee shall preauthor
10.09.08.10.htm 10.09.08.10. 10 Payment Procedures.. A. The provider shall submit a completed request for payment in the format designated by the Department with any required documentation.B. The Program reserves the right to return to the provider, before payment, all invoices not properly completed with a diagnosis, procedure code, and description of the services provided.C. The provider shall bill the Program the provider’s customary charge to the general public for similar services. If the ser
10.09.08.11.htm 10.09.08.11. 11 Recovery and Reimbursement.. Recovery and reimbursement are as set forth in COMAR 10.09.36.07..
10.09.08.12.htm 10.09.08.12. 12 Cause for Suspension or Removal and Imposition of Sanctions.. Cause for suspension or removal and imposition of sanctions are as set forth in COMAR 10.09.36.08..
10.09.08.13.htm 10.09.08.13. 13 Appeal Procedures.. Providers filing appeals from administrative decisions made in connection with this chapter shall do so according to COMAR 10.09.36.09.
10.09.08.14.htm 10.09.08.14. 14 Interpretive Regulation.. State regulations shall be interpreted in conformity with COMAR 10.09.36.10..
10.09.08.9999.htm 10.09.08.9999. Administrative History Effective date: September 14, 1981 (8:18 Md. R. 1479). Regulations .03A and .04A amended effective November 23, 1981 (8:23 Md. R. 1856). Regulation .03A amended effective January 6, 1983 (9:26 Md. R. 2572) January 30, 1984 (11:2 Md. R. 113)Regulation .07D, F amended as an emergency provision effective July 1, 1985 (12:14 Md. R. 1426). Regulation .07D―H amended as an emergency provision effective July 1, 1982 (9:13 Md. R. 1348) adopted permanently effective N
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