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10.09.42.00.htm 10.09.42.00. Title 10 MARYLAND DEPARTMENT OF HEALTH Subtitle 09 MEDICAL CARE PROGRAMS Chapter 42 Free-Standing Medicare-Certified Ambulatory Surgical Centers Authority: Health-General Article, §2-104(b) 15-103, and 15-105, Annotated Code of Maryland
10.09.42.01.htm 10.09.42.01. 01 Definitions.. A. In this chapter, the following terms have the meanings indicated.. B. Terms Defined.. 1) "Covered surgical procedures" means those surgical and other medical procedures which meet the criteria specified in 42 CFR Part 416, Subpart F, §416.166(a) and (b) and which are published by the Centers for Medicare and Medicaid Services (CMS) in the Federal Register.2) “Dental Benefits Administrator (DBA) means an entity that administers the dental program for theM
10.09.42.02.htm 10.09.42.02. 02 License Requirements.. A. License requirements under this chapter are referenced in COMAR 10.09.36.02.. B. The provider shall ensure that all X-ray and other radiological equipment is maintained and inspected in compliance with the requirements of the Maryland Radiation Act, Environment Article, Title 8, Subtitle 3, Annotated Code of Maryland, and meets the standards established by COMAR 26.12.01 and COMAR 26.12.02 or other applicable standards established by the state in wh
10.09.42.03.htm 10.09.42.03. 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 and 42 CFR, Part 416, Subpart B.B. Specific requirements for participation in the Program are that the provider shall meet all specific conditions for participation as set forth in 42 CFR, Part 416, Subpart C, to include the following:1) Be approved by Medicare to furnish ambulatory s
10.09.42.04.htm 10.09.42.04. 04 Covered Services.. The Program covers the following:. A. Medically necessary facility services rendered to recipients in a free-standing Medicare-certified ambulatory surgical center;B. Diagnostic, curative, palliative, or rehabilitative services, when clearly related to the recipient's individual needs;C. Surgical procedures which meet the standards described in 42 CFR Part 416, Subpart D, §416.65, and as published by the Centers for Medicare and Medicaid Services; and
10.09.42.05.htm 10.09.42.05. 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 justified;. E. Separate billing of services which are included in the composite Medicare rate for an ambulatory surgical center;F. Surgical procedures which:. 1) Generally result in extensive blood loss;.
10.09.42.06.htm 10.09.42.06. 06 Payment Procedures.. A. The Program reimburses a facility fee when the free-standing Medicare certified ambulatory surgery center provides a covered surgical procedure, in accordance with 42 CFR 416.166 to an eligible Medicaid recipient. Reimbursement for the facility fee includes, but is not limited to the following:1) Nursing, technician, and related services;. 2) Use of the facility;. 3) Drugs, biologicals, surgical dressings, supplies, splints, casts, and ap
10.09.42.07.htm 10.09.42.07. 07 Recovery and Reimbursement.. Recovery and reimbursement under this chapter are set forth in COMAR 10.09.36.07..
10.09.42.08.htm 10.09.42.08. 08 Cause for Suspension or Removal and Imposition of Sanctions.. Causes for suspension or removal and imposition of sanctions under this chapter are set forth in COMAR 10.09.36.08.
10.09.42.09.htm 10.09.42.09. 09 Appeal Procedures.. Appeal procedures under this chapter are set forth in COMAR 10.09.36.09..
10.09.42.10.htm 10.09.42.10. 10 Interpretive Regulation.. Interpretive regulations under this chapter are set forth in COMAR 10.09.36.10..
10.09.42.9999.htm 10.09.42.9999. Administrative History Effective date: September 2, 1991 (18:17 Md. R. 1918). Regulation .01B amended effective September 29, 2003 (30:19 Md. R. 1332) April 5, 2010 (37:7 Md. R. 571) March 16, 2015 (42:5 Md. R. 485)Regulation .02B amended effective March 16, 2015 (42:5 Md. R. 485). Regulation .02C 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)
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