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10.09.12.00.htm 10.09.12.00. Title 10 DEPARTMENT OF HEALTH AND MENTAL HYGIENE Subtitle 09 MEDICAL CARE PROGRAMS Chapter 12 Disposable Medical Supplies and Durable Medical Equipment Authority: Health-General Article, §2-104(b) 15-103, 15-105, and 15-129, Annotated Code of Maryland
10.09.12.01.htm 10.09.12.01. 01 Definitions.. A. In this chapter, the following terms have the meanings indicated.. B. Terms Defined.. 1) "Customary charge" means the uniform amount that the provider charges in the majority of cases for a specific supply or piece of equipment, excluding token charges for charity patients and substandard charges for welfare and other low income patients.2) "Customized equipment" means durable medical equipment which is uniquely constructed or substantially modified by the prov
10.09.12.02.htm 10.09.12.02. 02 License Requirements.. Providers of services shall meet the licensing requirements as set forth in COMAR 10.09.36.02..
10.09.12.03.htm 10.09.12.03. 03 Conditions for Participation.. To participate in the Program, the provider:. A. Shall, unless exempt from Medicare accreditation requirements:. 1) Be accredited by a Medicare-approved accreditation organization;. 2) Effective November 1, 2011, provide documentation of:. a) Accreditation; or. b) Having submitted an application for accreditation; and. 3) Effective April 1, 2012, be accredited or terminated from the Program;.
10.09.12.04.htm 10.09.12.04. 04 Covered Services.. A. The following medically necessary items are covered when ordered by a prescriber:. 1) Disposable medical supplies;. 2) Durable medical equipment;. 3) Repairs to purchased durable medical equipment;. 4) All disposable medical supplies and durable medical equipment for home kidney dialysis purchased or rented for Medical Assistance recipients;5) Prosthetic devices which include:. a) Artificial eyes;. b) Breast prostheses, including surgical brassiere; and.
10.09.12.05.htm 10.09.12.05. 05 Limitations.. The Program does not cover:. A. Incontinency pants and disposable underpads unless the following conditions are met:. 1) The incontinence supplies are medically necessary for medical conditions associated with prolonged urinary or bowel incontinence;2) For pull-on underwear type garments, the recipient is capable of independently putting on and removing the garment; and
10.09.12.06.htm 10.09.12.06. 06 Prepayment Authorization Requirements.. A. Prepayment authorization is required for:. 1) Disposable medical supplies with a charge exceeding $500, except as specified in §B(1) and (4) of this regulation and durable medical equipment on the approved list of items as individual consideration (I/C)2) All incontinency pants for recipients 3 through 15 years old in excess of 240 in any 30-day period, and disposable underpads for recipients 3 through 15 years old in excess
10.09.12.07.htm 10.09.12.07. 07 Payment Procedures.. A. Payment procedures shall be as set forth in COMAR 10.09.36.04.. B. The provider’s billed charges to the Program may not exceed the provider’s customary charge. If the item is free to individuals not covered by Medicaid:1) The provider:. a) May charge the Program; and. b) Shall be reimbursed in accordance with the provisions of this regulation; and. 2) The provider’s reimbursement is not limited to the provider’s customary charge.. C. The provider shall giv
10.09.12.08.htm 10.09.12.08. 08 Recovery and Reimbursement.. Recovery and reimbursement shall be as set forth in COMAR 10.09.36.07..
10.09.12.09.htm 10.09.12.09. 09 Cause for Suspension or Removal and Imposition of Sanctions.. Cause for suspension or removal and imposition of sanctions shall be as set forth in COMAR 10.09.36.08.
10.09.12.10.htm 10.09.12.10. 10 Appeal Procedures.. Appeal procedures shall be as set forth in COMAR 10.09.36.09..
10.09.12.11.htm 10.09.12.11. 11 Interpretive Regulation.. State Regulations shall be interpreted as set forth in COMAR 10.09.36.10..
10.09.12.9999.htm 10.09.12.9999. Administrative History Effective date: January 1, 1976 (2:29 Md. R. 1740). Regulation .04A amended effective February 8, 1980 (7:3 Md. R. 264). Regulation .05 amended effective February 8, 1980 (7:3 Md. R. 264) and April 4, 1980 (7:7 Md. R. 708) ―Chapter revised effective June 26, 1981 (8:13 Md. R. 1139). Regulation .01B amended effective July 11, 1988 (15:13 Md. R. 1553). Regulation .03J adopted effective January 6, 1983 (9:26 Md. R. 2572) May 29, 1989 (16:10 Md. R. 1108)
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