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10.09.18.00.htm 10.09.18.00. Title 10 DEPARTMENT OF HEALTH AND MENTAL HYGIENE Subtitle 09 MEDICAL CARE PROGRAMS Chapter 18 Oxygen and Related Respiratory Equipment Services Authority: Health-General Article, §2-104(b) 15-103, 15-105, and 15-129, Annotated Code of Maryland
10.09.18.01.htm 10.09.18.01. 01 Definitions.. A. The following terms have the meanings indicated.. B. Terms Defined.. 1) "Concentrator" means a device which removes nitrogen from ambient air, thus increasing the percentage of oxygen, and delivers the resulting oxygen-enhanced air to the patient.2) "Current stable arterial blood gas results" means stable arterial blood gas results on room air within 1 month before the requested date of submission of the form designated by the Department.3) "Demurrage" means a ch
10.09.18.02.htm 10.09.18.02. 02 (Reserved).
10.09.18.03.htm 10.09.18.03. 03 Conditions for Participation.. To participate in the Program, the provider shall:. A. 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;.
10.09.18.04.htm 10.09.18.04. 04 Covered Services.. A. The following medically necessary items and services are covered for pulmonary use in the patient's home or nursing facility pursuant to §B, C, D, and E of this regulation:1) Rental or purchase for use in patient's home or nursing facility of:. a) Oxygen, gaseous (tank contained). b) Oxygen, liquid.. 2) Rental of concentrators.. 3) Rental or purchase of the following related respiratory equipment:. a) Rental of equipment included in complete oxygen set-up:.
10.09.18.05.htm 10.09.18.05. 05 Limitations.. A. The Program does not cover:. 1) Any service or items not identified in Regulation .04 of this chapter;. 2) Demurrage;. 3) Charges for delivery;. 4) Equipment prescribed primarily to provide comfort or convenience, including, but not limited to, air conditioners and room humidifiers;5) Items which are investigational or experimental in nature;. 6) Oxygen and related equipment not for pulmonary use;. 7) Pre-set oxygen for emergency use;. 8) Trach string or tape..
10.09.18.06.htm 10.09.18.06. 06 Prepayment Authorization Requirements.. A. The following items require a written prepayment authorization:. 1) Nasal continuous positive pressure (NCPAP) system;. 2) Custom made tracheostomy tubes; and. 3) Intermittent positive pressure breathing (IPPB) machine.. B. Prepayment authorization is issued when:. 1) Program procedures are met;. 2) Program limitations are met; and. 3) The Prescriber submits to the Department adequate documentation demonstrating that the service to
10.09.18.07.htm 10.09.18.07. 07 Payment Procedures.. A. The provider shall submit request for payment on the forms designated by the Department, with attachments when applicable.B. The Department reserves the right to return to the provider, before payment, all invoices not properly signed and completed and those submitted without required documentation.C. The provider shall charge the Program the provider’s customary charge to the general public for similar items. If the item is free to individuals n
10.09.18.08.htm 10.09.18.08. 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 any service 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 c
10.09.18.09.htm 10.09.18.09. 09 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 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 Department;.
10.09.18.10.htm 10.09.18.10. 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.
10.09.18.11.htm 10.09.18.11. 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.
10.09.18.9999.htm 10.09.18.9999. Administrative History Effective date: January 1, 1984 (10:25 Md. R. 2268). Regulation .01B amended effective November 5, 1984 (11:22 Md. R. 1899) May 2, 1988 (15:9 Md. R. 1108) May 29, 1989 (16:10 Md. R. 1109) April 5, 2010 (37:7 Md. R. 570)Regulation .03 amended effective April 16, 2012 (39:7 Md. R. 491) April 13, 2015 (42:7 Md. R. 568). Regulation .03D amended effective April 5, 2010 (37:7 Md. R. 570). Regulation .03H amended effective May 29, 1989 (16:10 Md. R. 1109).
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