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10.09.29.00.htm 10.09.29.00. Title 10 MARYLAND DEPARTMENT OF HEALTH Subtitle 09 MEDICAL CARE PROGRAMS Chapter 29 Residential Treatment Center Services Authority: Health-General Article, §2-104(b) 15-103, and 15-105, Annotated Code of Maryland
10.09.29.01.htm 10.09.29.01. 01 Definitions.. A. In this chapter, the following terms have the meanings indicated.. B. Terms Defined.. 1) "Active treatment" means inpatient psychiatric services which involve implementation of a professionally developed and supervised individual plan of care described in 42 CFR §441.155, that is:a) Developed and implemented not later than 14 days after admission; and. b) Designed to achieve the recipient's discharge from inpatient status at the earliest possible time.
10.09.29.02.htm 10.09.29.02. 02 Licensure Requirements.. A. In order to participate in the Program a provider shall:. 1) Be licensed by the Department in accordance with requirements of Health-General Article, §19-308, Annotated Code of Maryland;2) Meet the standards established by COMAR 10.07.04; and. 3) Obtain other licenses as may be required by applicable State and local laws.. B. A physician providing services in a residential treatment center shall be licensed and legally authorized to practice medi
10.09.29.03.htm 10.09.29.03. 03 General Conditions for Participation.. To participate in the Program as a residential treatment center for emotionally disturbed children and adolescents, a provider shall:A. Meet the requirements for participation as defined in 42 CFR §440.160 (inpatient psychiatric services for individuals under 21 years old) and have acute psychiatric services that meet the requirements of 42 CFR Part 441, Subpart D (inpatient psychiatric services for individuals under 21 years old
10.09.29.04.htm 10.09.29.04. 04 Covered Services.. The Program covers inpatient psychiatric services for the diagnosis, active treatment, and care of recipients under 21 years old with mental disease when the services are:A. Medically necessary;. B. Performed under the direction of a physician;. C. Certified as necessary by an admissions team before the recipient's admission to the residential treatment center;D. In the case of a recipient already residing in the residential treatment center, certified as nec
10.09.29.05.htm 10.09.29.05. 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. A day of inpatient care solely for the purpose of performing diagnostic tests that can be performed on an outpatient basis;E. Admissions with a primary diagnosis of alcoholism, drug addiction, or severe brain damage, or the following diagnoses in the ICD-9-CM,
10.09.29.06.htm 10.09.29.06. 06 Preauthorization Requirements.. The following procedures or services require preauthorization:. A. Out-of-State admissions. Adequate documentation shall be provided demonstrating that the placement meets one of the conditions as follows:1) Effective services at an in-State facility are not available;. 2) For similar services, an inpatient placement is not currently available in Maryland; or. 3) The recipient resides out-of-State and the cost for the out-of-State ser
10.09.29.07.htm 10.09.29.07. 07 Payment Procedures.. A. Reimbursement Principles.. 1) The Department will make no direct reimbursement to any State-operated residential treatment center for recipients. The Department will claim federal fund recoveries from the Department of Health and Human Services for services to federally eligible Title XIX patients in these residential treatment centers.2) The Department will pay the residential treatment center the lesser of the provider’s customary c
10.09.29.08.htm 10.09.29.08. 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, the recipient for any services covered by this chapter, the provider shall seek payment from that source. If payment is made by both the Program and the insurance or other source, the provider shall report, within 15 days after the close of each month, on a form designated by the Department, the amount paid by the Pr
10.09.29.09.htm 10.09.29.09. 09 Cause for Suspension or Removal and Imposition of Sanctions.. A. If the Department determines that a provider, 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;. 3) Removal from the Program;.
10.09.29.10.htm 10.09.29.10. 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.
10.09.29.11.htm 10.09.29.11. 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.
10.09.29.12.htm 10.09.29.12. 12 Cost Reporting.. A. The provider shall:. 1) Include, for purposes of cost finding, direct and indirect costs applicable to recipient care;. 2) In the cost report, specifically identify costs associated with related organizations;. 3) Maintain adequate financial records and statistical data, according to generally accepted accounting principles and procedures, which shall provide, as a minimum:a) Maintenance of:. i) A chronological cash receipts and disbursements
10.09.29.13.htm 10.09.29.13. 13 Interim Rates.. A. A provider shall have its interim rate updated annually.. B. A provider's interim rate shall be adjusted at the beginning of each fiscal year, by applying the Centers for Medicare and Medicaid Services' published federal fiscal year market basket index relating to hospitals excluded from the prospective payment system, subject to the limitations in Regulation .07A of this chapter, to the provider's interim rate in effect on the last day of the preceding
10.09.29.14.htm 10.09.29.14. 14 Field Verification.. A. The Department or its designee shall:. 1) Conduct a field verification, at least every 3 years, of the reported costs of each facility participating in the Program, if the amount of the facility's reimbursement would justify the expense of a field verification;2) Desk review the reported costs of the facility in those years when a field verification is not conducted;3) Notify each provider participating in the Program of the results of the
10.09.29.15.htm 10.09.29.15. 15 Change of Ownership.. A. The current owner of a residential treatment center shall:. 1) Notify the Program of the contemplated sale of a facility or controlling interest in it not less than 30 days before the date of the change of ownership; and2) Before the date of the change of ownership, post an indemnity bond or standby letter of credit, or provide some assurance satisfactory to the Program that the purchaser will assume and be responsible for all financial obli
10.09.29.9999.htm 10.09.29.9999. Administrative History Effective date:. Regulations .01―11 adopted as an emergency provision effective July 1, 1986 (13:13 Md. R. 1474) adopted permanently effective December 1, 1986 (13:24 Md. R. 2559)Regulation .01 amended as an emergency provision effective July 1, 1997 (24:16 Md. R. 1150) amended permanently effective December 29, 1997 (24:26 Md. R. 1758)Regulation .01B amended effective April 5, 2010 (37:7 Md. R. 571).
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