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10.09.36.00.htm 10.09.36.00. Title 10 DEPARTMENT OF HEALTH AND MENTAL HYGIENE Subtitle 09 MEDICAL CARE PROGRAMS Chapter 36 General Medical Assistance Provider Participation Criteria Authority: Health-General Article, §2-104(b) 15-103, and 15-105, Annotated Code of Maryland
10.09.36.01.htm 10.09.36.01. 01 Definitions.. A. The following terms apply to Medical Assistance providers. Additional defined terms, unique to Medical Assistance provided services, are found in Medical Assistance service-specific chapters.B. Terms Defined.. 1) “Abandoned” means failing to appear for a hearing on the established date without good cause.. 2) “Administrative law judge” means an individual appointed by the Chief Administrative Law Judge under State Government Article, §9-1604, Annotated C
10.09.36.02.htm 10.09.36.02. 02 License Requirements.. Providers of Medical Assistance Program services shall, to the extent required by law, be licensed and legally authorized to practice or deliver services in the state in which the service is provided.
10.09.36.03.htm 10.09.36.03. 03 Conditions for Participation.. A. To participate in the Program, the provider shall comply with the following criteria:. 1) Ensure compliance with all the Medical Assistance provisions listed in the Code of Maryland Regulations (COMAR) designated for their provider type;2) Apply for participation in the Program using the application form designated by the Department;. 3) Be approved for participation by the Department;. 4) Allow the Department or its agents to conduct u
10.09.36.04.htm 10.09.36.04. 04 Payment Procedures.. A. The provider shall submit the request for payment of services rendered according to procedures established by the Department and in the form designated by the Department.B. The Department reserves the right to return to the provider, before payment, all invoices not properly signed, completed, and accompanied by properly completed forms required by the Department.C. Payment advances are not made routinely..
10.09.36.05.htm 10.09.36.05. 05 Cost Reporting.. A. Providers who are reimbursed on the basis of cost reports shall submit to the Department or its designee, in the form prescribed, financial and statistical data within 3 months after the end of the provider's fiscal year unless the Department grants the provider an extension or the provider discontinues participation in the Program.B. If a provider discontinues participation, financial and statistical data shall be submitted to the Department within 45 da
10.09.36.06.htm 10.09.36.06. 06 Billing Time Limitations.. A. Definition.. 1) In this regulation, the following term has the meaning indicated.. 2) Term Defined. “Received” means:. a) The Program taking delivery of a claim after the Program signs a certified mail, return receipt requested parcel from the United States Postal Service; orb) The claim is reported on the provider’s remittance advice.. B. Unless specified in Regulation .03A(1) of this chapter, the following apply:. 1) The Department may not
10.09.36.07.htm 10.09.36.07. 07 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, covered services, 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 Program shall pay the difference between
10.09.36.08.htm 10.09.36.08. 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 or related party of 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;.
10.09.36.09.htm 10.09.36.09. 09 Filing Appeal.. A. Source of Appeals.. 1) A provider may file an appeal from a proposed Program action to:. a) Suspend the provider from the Program;. b) Withhold payment by the Program;. c) Remove the provider from the Program; or. d) Disqualify the provider from future participation in the Program, either as a provider or as a person providing services for which Program payment will be claimed.2) A provider shall submit an appeal according to:. a) COMAR 10.01.03;.
10.09.36.10.htm 10.09.36.10. 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.
10.09.36.11.htm 10.09.36.11. 11 Provider Rights.. Providers participating in the Program shall have the right to:. A. Be treated professionally with courtesy, dignity, and respect regardless of the individual’s:. 1) Race;. 2) Color;. 3) Religion;. 4) Gender;. 5) Sexual orientation;. 6) National origin;. 7) Political affiliation;. 8) Disability;. 9) Marital status;. 10) Age; or. 11) Union affiliation;. B. File a complaint with the appropriate State agency when the provider believes that the provider h
10.09.36.9999.htm 10.09.36.9999. Administrative History Effective date:. Regulations .01―10 adopted as an emergency provision effective July 1, 1990 (17:15 Md. R. 1851) adopted permanently effective October 1, 1990 (17:18 Md. R. 2201)Regulations .01A and .03A amended, and .03D adopted as an emergency provision effective February 27, 1992 (19:6 Md. R. 669) adopted permanently effective June 22, 1992 (19:11 Md. R. 1015)Regulations .01A, .06A, B amended, and .06C―E adopted as an emergency provi
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