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10.09.22.00.htm 10.09.22.00. Title 10 DEPARTMENT OF HEALTH AND MENTAL HYGIENE Subtitle 09 MEDICAL CARE PROGRAMS Chapter 22 Free-Standing Dialysis Facility Services Authority: Health-General Article, §2-104(b) 15-103, and 15-105, Annotated Code of Maryland
10.09.22.01.htm 10.09.22.01. 01 Definitions.. A. The following terms have the meanings indicated.. B. Terms Defined.. 1) “CMS” means Centers for Medicare and Medicaid Services.. 2) “Continuous ambulatory peritoneal dialysis (CAPD) means a dialysis treatment method performed manually during the day by patient in which the patient’s peritoneal membrane is used as a dialyzer.3) “Continuous cycling peritoneal dialysis (CCPD) means a dialysis treatment method performed automatically during the night
10.09.22.02.htm 10.09.22.02. 02 License Requirements.. A. The provider shall meet all license requirements as set forth in COMAR 10.09.36.02.. B. A physician providing services in a free-standing dialysis facility 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 is maintained and inspected in compliance with the requirements of Environment Article, Title 8, S
10.09.22.03.htm 10.09.22.03. 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 free-standing dialysis facility include all of the following:1) Be approved by Medicare to furnish dialysis service to kidney disease patients and maintain documentation of certification by the Division of Surve
10.09.22.04.htm 10.09.22.04. 04 Covered Services.. A. The Program covers medically necessary services described in §B of this regulation, rendered to recipients in a free-standing dialysis facility, when these services are:1) Performed by a physician or by one of the following:. a) Certified registered physician's assistant;. b) Licensed certified nurse practitioner;. c) Licensed registered nurse;. d) Licensed practical nurse;. e) A licensed social worker;. f) A dietician who is in compliance with Medicare
10.09.22.05.htm 10.09.22.05. 05 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. Services denied by Medicare as not medically necessary..
10.09.22.06.htm 10.09.22.06. 06 Pre-authorization Requirements.. Reserved..
10.09.22.07.htm 10.09.22.07. 07 Payment Procedures.. A. Reimbursement Principles.. 1) Reimbursement by the Program is for services provided at a free-standing dialysis facility which has been approved for Medicare by the Division of Survey and Certification of CMS. Reimbursement shall be consistent with the rates established by the Maryland Medical Assistance Program for those services which are approved by Medicare.2) Physician services are not reimbursed under this regulation. Reimburseme
10.09.22.08.htm 10.09.22.08. 08 Recovery and Reimbursement.. A. If the recipient has insurance or if any other person is obligated either legally or contractually to pay for, or to reimburse for, any service covered by this chapter, the provider shall seek payment from that source. If payment is made by both the Program and by the insurance or other source, the provider shall refund to the Department, within 60 days of receipt, the amount paid by the Program, or by the insurance or other source, whichever
10.09.22.09.htm 10.09.22.09. 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 all applicable federal or State laws or regulations, the Department may initiate one or more of the following actions against the responsible party:1) Recovery of overpayments as specified in Regulation .08 of this chapter;.
10.09.22.10.htm 10.09.22.10. 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.
10.09.22.11.htm 10.09.22.11. 11 Interpretive Regulation.. Except when the language of a specific regulation indicates an intent by the Department to provide reimbursement for covered services which are provided without regard to the availability of federal financial participation, State regulations shall be interpreted in conformity with applicable federal statutes and regulations.
10.09.22.9999.htm 10.09.22.9999. Administrative History Effective date: December 2, 1985 (12:24 Md. R. 2348). Regulation .01B amended effective February 17, 2014 (41:3 Md. R. 201). Regulations .02 and .03 amended as an emergency provision effective September 16, 1992 (19:20 Md. R. 1812) amended permanently effective January 1, 1993 (19:25 Md. R. 2205)Regulation .03B amended effective February 17, 2014 (41:3 Md. R. 201). Regulation .04B amended effective February 17, 2014 (41:3 Md. R. 201).
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