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10.09.68.00.htm 10.09.68.00. Title 10 MARYLAND DEPARTMENT OF HEALTH Subtitle 09 MEDICAL CARE PROGRAMS Chapter 68 Maryland Medicaid Managed Care Program: Program Integrity Authority: Health-General Article, Title 15, Subtitle 1, Annotated Code of Maryland
10.09.68.01.htm 10.09.68.01. 01 Requirements to Detect and Prevent Fraud, Waste, and Abuse.. A. An MCO or its responsible subcontractor shall implement and maintain arrangements or procedures that are designed to detect and prevent fraud, waste, and abuse, which includes a compliance program that has, at a minimum, the following elements:1) Written policies, procedures, and standards of conduct that include the MCO’s commitment to comply with all applicable:
10.09.68.02.htm 10.09.68.02. 02 Access to Information.. A. An MCO, its subcontractors, and its subcontractor’s subcontractors shall permit the following organizations or their designees to inspect, evaluate, or audit books, records, contracts, computer or other electronic systems, premises, and facilities that pertain to the MCO’s Medicaid enrollees, and any aspect of services and activities performed, or determination of amounts payable under, the MCO’s contract with the Depa1) The Department and its agents;.
10.09.68.03.htm 10.09.68.03. 03 Reporting.. A. An MCO shall submit to the Department the following:. 1) Encounter data in the form and manner described in COMAR 10.09.65.15B, 42 CFR §438.242(c) and 42 CFR §438.818.2) Data required by the Department in order to certify the actuarial soundness of capitation rates to an MCO, under 42 CFR §438.3, including base data described in 42 CFR §438.5(c) that is generated by the MCO.3) Data required by the Department to determine compliance of the MCO with
10.09.68.9999.htm 10.09.68.9999. Administrative History Effective date: February 26, 2018 (45:4 Md. R. 205).
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