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10.09.76.00.htm 10.09.76.00. Title 10 DEPARTMENT OF HEALTH AND MENTAL HYGIENE Subtitle 09 MEDICAL CARE PROGRAMS Chapter 76 School-Based Health Centers (SBHC) Authority: Health-General Article, §2-104(b) 15-103, and 15-105, Annotated Code of Maryland
10.09.76.01.htm 10.09.76.01. 01 Definitions.. A. The following terms have the meanings indicated.. B. Terms Defined.. 1) “Department” means the Maryland Department of Health and Mental Hygiene, the State agency designated to administer the Maryland Medical Assistance Program under Title XIX of the Social Security Act, 42 U.S.C. §1396 et seq.2) “Early and periodic screening, diagnosis and treatment (EPSDT) means the provision of preventive health care, including medical and dental services
10.09.76.02.htm 10.09.76.02. 02 License Requirements.. A. The provider shall meet all license requirements as set forth in COMAR 10.09.36.02.. B. A physician, nurse practitioner, or physician assistant providing services in an SBHC shall be licensed and legally authorized to practice in the state in which the service is provided.C. A dentist or dental hygienist providing services in an SBHC shall be licensed and legally authorized to practice in the state in which the service is provided.
10.09.76.03.htm 10.09.76.03. 03 Conditions for Participation.. A. General requirements for participation in the Program are that a provider shall meet the:. 1) Conditions for participation as set forth in COMAR 10.09.36.03; and. 2) General requirements for participation as a free-standing clinic as set forth in COMAR 10.09.08.03B.B. Specific requirements for participation in the Program as an SBHC are that a provider shall:. 1) Be approved by the Maryland State Department of Education (MSDE) as an SBHC;.
10.09.76.04.htm 10.09.76.04. 04 Covered Services.. An SBHC, designated by the Department as meeting the criteria specified in Regulation .03 of this chapter, is eligible for reimbursement by the Program for the following services:A. Comprehensive well-child care, including the administration of vaccines in accordance with the Maryland Healthy Kids Preventive Health Schedule, when:1) Performed by EPSDT certified providers; and. 2) Rendered according to EPSDT standards set forth in COMAR 10.09.23.03;.
10.09.76.05.htm 10.09.76.05. 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. Basic school health services as defined in COMAR 13A.05.05.05―15;. E. Services to individuals who are not enrolled in the school system;. F. Nursing or other health services provided as part of a participant’s individualized educational program (IEP) as defined i
10.09.76.06.htm 10.09.76.06. 06 Reimbursement Methodology.. A. The provider shall charge the Program the provider’s customary charge to the general public for similar services and charge the provider’s acquisition cost for injectable drugs or dispensed medical supplies.B. If the service is free to individuals not covered by Medicaid:. 1) The provider:. a) May charge the Program; and. b) Shall be reimbursed in accordance with §B of this regulation; and.
10.09.76.07.htm 10.09.76.07. 07 Payment Procedures.. A. The provider shall submit a completed request for payment in the format designated by the Department or HealthChoice MCO, including required documentation.B. The dental provider shall submit a request for payment in the format designated by the Department and in accordance with COMAR 10.09.05.07.C. The Program reserves the right to return to the provider, before payment, all invoices not properly completed.D. Unless the service is free to individuals not c
10.09.76.08.htm 10.09.76.08. 08 Recovery and Reimbursement.. Recovery and reimbursement are as set forth in COMAR 10.09.36.07..
10.09.76.09.htm 10.09.76.09. 09 Cause for Suspension or Removal and Imposition of Sanctions.. Cause for suspension or removal and imposition of sanctions are as set forth in COMAR 10.09.36.08..
10.09.76.10.htm 10.09.76.10. 10 Appeal Procedures.. Providers filing appeals from administrative decisions made in connection with this chapter shall do so according to COMAR 10.09.36.09.
10.09.76.11.htm 10.09.76.11. 11 Interpretive Regulation.. State regulations shall be interpreted in conformity with COMAR 10.09.36.10..
10.09.76.9999.htm 10.09.76.9999. Administrative History Effective date: April 10, 2017 (44:7 Md. R. 355).
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