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10.09.15.00.htm 10.09.15.00. Title 10 MARYLAND DEPARTMENT OF HEALTH Subtitle 09 MEDICAL CARE PROGRAMS Chapter 15 Podiatry Services Authority: Health-General Article, §2-104(b) 15-103, and 15-105, Annotated Code of Maryland
10.09.15.01.htm 10.09.15.01. 01 Definitions.. A. In this chapter, the following terms have the meanings indicated.. B. Terms Defined.. 1) "Ambulatory surgical center" means any distinct, Medicare-certified entity that operates exclusively for the purpose of providing surgical services to patients not requiring hospitalization.2) "Board" means the State Board of Podiatric Medical Examiners.. 3) "Department" means the Maryland Department of Health, the single State agency designated to admin
10.09.15.02.htm 10.09.15.02. 02 License Requirements.. A. The Provider shall meet all license requirements as set forth in COMAR 10.09.36.02.. B. In order to participate in the Program a podiatrist shall be licensed to practice podiatry in the state in which service is provided.C. The provider shall ensure that Clinical Laboratory Improvement Amendments (CLIA) certification exists for all clinical laboratory services performed, and:1) If located in Maryland, comply with requirements of Health-General Artic
10.09.15.03.htm 10.09.15.03. 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 podiatry services provider require that the provider:1) Ensure that all X-ray or other radiological equipment is inspected and meets the standards established by COMAR 10.14.03, or other applicable standards established by the s
10.09.15.04.htm 10.09.15.04. 04 Covered Services. The Program covers the following services:. A. Medically necessary services, when these services are:. 1) Rendered to a recipient in the podiatrist's office, the recipient's home, a hospital, nursing facility, a free standing clinic, or elsewhere;2) Performed by the podiatrist or another licensed podiatrist in his employ;. 3) Clearly related to the recipient's individual medical needs as diagnostic, curative, palliative, or rehabilitative services;
10.09.15.05.htm 10.09.15.05. 05 Limitations.. A. The Program does not cover the following under this chapter:. 1) Services which are not medically necessary;. 2) Investigational or experimental drugs or procedures;. 3) Services prohibited by the Maryland Podiatry Act or the State Board of Podiatric Medical Examiners;4) Services denied by Medicare as not medically justified;. 5) Drugs and supplies which are acquired by the podiatrist at no cost;. 6) Injections and visits solely for the administra
10.09.15.06.htm 10.09.15.06. 06 Preauthorization.. A. Preauthorization is required for any procedure not included in the current fee schedule.. B. Preauthorization is issued when:. 1) Program procedures are met;. 2) The provider submits to the Department adequate documentation demonstrating that the service to be preauthorized is medically necessary.C. Preauthorization is valid only for services rendered or initiated within 60 days of the date issued.D. Preauthorization normally required by the Progr
10.09.15.07.htm 10.09.15.07. 07 Payment Procedures.. A. The provider shall submit his request for payment on the form designated by the Department including all required documentation.B. The Department reserves the right to return to the provider, before payment, all invoices not properly signed and completed.C. The provider shall bill the provider’s customary fees, but may not bill a fee in excess of that charged the general public for similar services, except for injectable drugs and dispensed medical su
10.09.15.08.htm 10.09.15.08. 08 Recovery and Reimbursement.. A. 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 Medical Assistance Program, the provider may submit a claim to the Program. The provider shall submit a co
10.09.15.09.htm 10.09.15.09. 09 Cause for Suspension or Removal and Imposition of Sanctions.. A. If the Department determines that a provider, podiatrist, any agent or employee of the provider, or any person with an ownership interest in the provider has failed to comply with 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 of payment by the Program;.
10.09.15.10.htm 10.09.15.10. 10 Appeal Procedures.. Providers filing appeals from administrative decisions made in connection with these regulations shall do so according to COMAR 10.09.36.09.
10.09.15.11.htm 10.09.15.11. 11 Interpretive Regulation.. Except when the language of a specific regulation indicates an intent by the Department to provide reimbursement for covered services to Program recipients without regard to the availability of federal financial participation, State regulations shall be interpreted in conformity with applicable federal statutes and regulations.
10.09.15.9999.htm 10.09.15.9999. Administrative History Effective date: January 1, 1976 (2:29 Md. R. 1741). Chapter revised September 14, 1977 (4:19 Md. R. 1470). Regulation .01 amended effective June 14, 1999 (26:12 Md. R. 925). Regulation .01B amended effective January 2, 2006 (32:26 Md. R. 1997) August 27, 2007 (34:17 Md. R. 1507)Regulation .01P adopted effective February 15, 1982 (9:3 Md. R. 221). Regulations .02 and .03 amended as an emergency provision effective September 16, 1992 (19:20 Md. R.
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