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10.09.30.00.htm 10.09.30.00. Title 10 MARYLAND DEPARTMENT OF HEALTH Subtitle 09 MEDICAL CARE PROGRAMS Chapter 30 Statewide Evaluation and Planning Services Authority: Health-General Article, §2-104(b) 15-103, and 15-105, Annotated Code of Maryland
10.09.30.01.htm 10.09.30.01. 01 Definitions.. A. The following terms have the meanings indicated.. B. Terms Defined.. 1) "Case management" means a service which will assist recipients in gaining access to:. a) The full range of Medical Assistance services for which the individual is qualified; and. b) Other needed support services such as medical, social, housing, financial, adult day care, in-home aide, and counseling.2) "Case manager" means a licensed registered nurse or licensed social work
10.09.30.02.htm 10.09.30.02. 02 Licensing Requirements.. A. Nurses performing STEPS shall be licensed pursuant to Health Occupations Article, §7-101 and 7-301―7-315, Annotated Code of Maryland.B. Social workers performing STEPS services shall be licensed pursuant to Health Occupations Article, §18-205, Annotated Code of Maryland.C. Under this chapter, licensed registered nurses shall:. 1) Have 2 years of community health nursing experience; or. 2) Be directly supervised by a licensed registered
10.09.30.03.htm 10.09.30.03. 03 Conditions for Participation.. A. General requirements for participation in the Medical Assistance Program are that providers shall:1) Ensure that employees performing STEPS meet the licensure requirements as provided in Regulation .02 of this chapter;2) Apply for participation in the Program using the application form designated by the Department;. 3) Be approved for participation by the Department;. 4) Have a provider agreement in effect;. 5) Verify the licenses an
10.09.30.04.htm 10.09.30.04. 04 Covered Services.. A. The Program reimburses for completed STEPS comprehensive evaluations and multidisciplinary assessments, which include:1) Performance of a comprehensive evaluation by a nurse or social worker, or both, not more than 5 working days after the date of an appropriate referral, unless the client is not medically stable, except as specified in Regulation .03B(5) of this chapter; and2) Completion of the multidisciplinary assessment not more than 10 working
10.09.30.05.htm 10.09.30.05. 05 Limitations.. A. STEPS is advisory in nature and is designed to assist individuals in identifying and using appropriate long term care services.B. A restriction may not be placed on the qualified recipient's option to receive the STEPS multidisciplinary assessment or case management services.C. STEPS does not restrict or otherwise affect:. 1) Eligibility for Title XIX benefits or other available benefits or programs;. 2) The freedom of a recipient to select from all a
10.09.30.06.htm 10.09.30.06. 06 Payment Procedures.. A. Request for Payment.. 1) Requests for payment of services rendered shall be submitted according to procedures established by the Department. Payment requests which are not properly prepared or submitted may not be processed, but shall be returned unpaid to the provider.2) Requests for payment shall be submitted on the form specified by the Department.. 3) STEPS providers shall bill the Program the fee specified in §C of this regulation..
10.09.30.07.htm 10.09.30.07. 07 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 service covered by this chapter, the provider shall seek payment from that source first. 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 th
10.09.30.08.htm 10.09.30.08. 08 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 the 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;.
10.09.30.09.htm 10.09.30.09. 09 Appeal Procedures.. Providers filing appeals from administrative decisions made in connection with these regulations shall do so according to COMAR 10.09.36.09.
10.09.30.10.htm 10.09.30.10. 10 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.
10.09.30.9999.htm 10.09.30.9999. Administrative History Effective date:. Regulations .01―11 adopted as an emergency provision effective October 21, 1986 (13:23 Md. R. 2477) emergency status extended at 14:2 Md. R. 125; adopted permanently effective January 27, 1987 (14:2 Md. R. 129)Regulation .01B amended effective July 12, 1987 (14:14 Md. R. 1571) January 9, 1989 (15:27 Md. R. 3129)Regulation .02 amended effective July 12, 1987 (14:14 Md. R. 1571) January 9, 1989 (15:27 Md. R. 3129)Regulation .03 amended ef
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