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10.09.77.00.htm 10.09.77.00. Title 10 DEPARTMENT OF HEALTH AND MENTAL HYGIENE Subtitle 09 MEDICAL CARE PROGRAMS Chapter 77 Urgent Care Centers Authority: Health-General Article, §2-104(b) 15-103, and 15-105, Annotated Code of Maryland
10.09.77.01.htm 10.09.77.01. 01 Definitions.. A. In this chapter, the following terms have the meanings indicated.. B. Terms Defined.. 1) "Department" means the State Department of Health and Mental Hygiene, the single State agency designated to administer the Medical Assistance Program under Title XIX of the Social Security Act, 42 U.S.C. §1396 et seq.2) "Free-standing clinic" means a health care facility that is not licensed as a hospital, part of a hospital, or nursing home and is not administrati
10.09.77.02.htm 10.09.77.02. 02 License Requirements.. A. License requirements under this chapter are found 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 Environment Article, Title 8, Subtitle 3, Annotated Code of Maryland.C. Urgent care services may be performed only by health care practitioners who are licensed to perform these procedures within the state in which the center is located.
10.09.77.03.htm 10.09.77.03. 03 Conditions for Participation.. A. The 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. The specific requirements for participation in the Program as a free-standing urgent care center include the following:1) Have clearly defined, written, patient care policies;. 2) Define the center's hours of operation and clearly communicate those hours of operation to the pu
10.09.77.04.htm 10.09.77.04. 04 Covered Services.. The Program covers the following medically necessary services rendered to recipients in a free-standing urgent care center:A. Acute illnesses with a sudden onset;. B. Minor trauma;. C. Diagnostic, preventive, curative, palliative, rehabilitative, or ameliorative services, when clearly related to the recipient's individual needs;D. Physician services rendered in free-standing urgent care centers, when the services are performed by a physician or one of
10.09.77.05.htm 10.09.77.05. 05 Limitations.. The Program does not cover the following:. A. Services not medically necessary;. B. Investigational and experimental drugs and procedures;. C. Services denied by Medicare as not medically necessary;. D. Services which do not involve direct patient contact (face-to-face). E. Laboratory or x-ray services performed by another facility;. F. Immunizations;. G. Visits only to accomplish one or more of the following:. 1) Collection of specimens for laboratory procedures;.
10.09.77.06.htm 10.09.77.06. 06 Payment Procedures.. A. Payment for free-standing urgent care centers is as follows:. 1) Urgent care centers are reimbursed a facility fee, which is determined by the Program;. 2) In addition to the facility fee, the Program shall reimburse for services rendered by the physician during the visit at the free-standing urgent care center when performed by a physician, or by other authorized personnel under that physician’s supervision; and
10.09.77.07.htm 10.09.77.07. 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, 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 a claim to the Program. The provider shall submit a copy of the insura
10.09.77.08.htm 10.09.77.08. 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.
10.09.77.09.htm 10.09.77.09. 09 Appeal Procedures.. Providers filing appeals from administrative decisions made in connection with this chapter shall do so according to COMAR 10.09.36.09.
10.09.77.10.htm 10.09.77.10. 10 Interpretive Regulation.. Except when the language of a specific regulation indicates 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.
10.09.77.9999.htm 10.09.77.9999. Administrative History Effective date: April 21, 2008 (35:8 Md. R. 805). Regulation .06A, C, H amended effective July 4, 2016 (43:13 Md. R. 712). Regulation .06G amended effective April 4, 2011 (38:7 Md. R. 430). Regulation .09 amended effective January 24, 2011 (38:2 Md. R. 84).
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