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10.09.39.00.htm 10.09.39.00. Title 10 DEPARTMENT OF HEALTH AND MENTAL HYGIENE Subtitle 09 MEDICAL CARE PROGRAMS Chapter 39 Nurse Anesthetist Services Authority: Health-General Article, §2-104(b) 15-103, and 15-105, Annotated Code of Maryland
10.09.39.01.htm 10.09.39.01. 01 Definitions.. A. The following terms have the meanings indicated.. B. Terms Defined.. 1) "Anesthesiologist" means a licensed physician who:. a) Has had special training in the field of anesthesiology;. b) Administers anesthesia on a regular basis; and. c) Devotes a substantial portion of the medical practice to the practice of anesthesiology.. 2) "Certified registered nurse anesthetist" means a registered nurse who:. a) By reason of certification under COMAR 10.27.06
10.09.39.02.htm 10.09.39.02. 02 License Requirements.. A. The provider shall meet all license requirements as set forth in COMAR 10.09.36.02.. B. A certified registered nurse anesthetist applying for provider status shall meet the:. 1) Requirements of the Nursing Board as set forth in COMAR 10.27.06.03; or. 2) Nurse anesthetist regulatory requirements of the jurisdiction in which the services are provided.. C. An anesthesiologist or other physician collaborating with a nurse anesthetist shall be licensed t
10.09.39.03.htm 10.09.39.03. 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 nurse anesthetist provider require that the provider:1) Meet the licensure and practice requirements as described in Regulation .02A of this chapter;. 2) Collaborate with an anesthesiologist, other licensed physician, or denti
10.09.39.04.htm 10.09.39.04. 04 Covered Services.. The Program covers medically necessary services rendered to recipients by a provider who engages in the practice of nurse anesthesia. These services shall be clearly related to the recipient's medical needs and adequately described in the recipient's medical record.
10.09.39.05.htm 10.09.39.05. 05 Limitations.. The Program does not cover the following under these regulations:. A. Services not encompassed by the definition of the practice of nurse anesthesia;. B. Services not medically necessary;. C. Services prohibited by the Maryland Nurse Practice Act or by COMAR 10.27.06;. D. Services prohibited in the jurisdiction in which the services are provided; and. E. Nurse anesthetist services provided to HMO-MA enrollees..
10.09.39.06.htm 10.09.39.06. 06 Payment Procedures.. A. The provider shall submit the request for payment on 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 any properly completed forms required by the Department.C. The provider shall charge the Program the provider’s customary charge to the general public for similar services. If the service is free to individ
10.09.39.07.htm 10.09.39.07. 07 Recovery and Reimbursement.. A. The provider shall reimburse the Department for any overpayment.. B. 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 services 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 Program, the provider may submit
10.09.39.08.htm 10.09.39.08. 08 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) Suspension from the Program;. 2) Withholding part or all of the payment by the Program;.
10.09.39.09.htm 10.09.39.09. 09 Appeal Procedures.. Providers filing appeals of administrative decisions made in connection with these regulations shall do so according to COMAR 10.09.36.09.
10.09.39.10.htm 10.09.39.10. 10 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.
10.09.39.9999.htm 10.09.39.9999. Administrative History Effective date:. Regulations .01―10 adopted as an emergency provision effective July 1, 1989 (16:14 Md. R. 1565) extended at 16:24 Md. R. 2615; adopted permanently effective November 27, 1989 (16:23 Md. R. 2506)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 .06 amended as an emergency provision effective January 28, 1991
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