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10.09.82.00.htm 10.09.82.00. Title 10 DEPARTMENT OF HEALTH AND MENTAL HYGIENE Subtitle 09 MEDICAL CARE PROGRAMS Chapter 82 Provider-Based Outpatient Oncology Facilities Authority: Health-General Article, §2-104, 15-103, and 15-105, Annotated Code of Maryland
10.09.82.01.htm 10.09.82.01. 01 Definitions.. A. In this chapter, the following terms have the meanings indicated.. B. Terms Defined.. 1) "Department" means the Department of Health and Mental Hygiene, the single 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) “Healthcare Common Procedure Coding System (HCPCS) means a set of health care procedure codes based on the American Medical Association's Current P
10.09.82.02.htm 10.09.82.02. 02 License Requirements.. In order to participate in the Program, the provider shall:. A. Meet all requirements as set forth in COMAR 10.09.36.02; and. B. Ensure that Clinical Laboratory Improvement Amendments (CLIA) certification exists for all clinical laboratory services performed and if located:1) In Maryland, comply with requirements of Health-General Article, Title 17, Subtitles 2 and 3, Annotated Code of Maryland, and COMAR 10.10.06; or2) Out-of-State, comply w
10.09.82.03.htm 10.09.82.03. 03 Conditions for Participation.. A. To participate in the Program, a provider shall meet all conditions for participation as set forth in COMAR 10.09.36.03.B. Specific requirements for participation with the Department as a provider-based outpatient oncology facility require that the provider shall:1) Be a Medicare-certified facility;. 2) Have clearly defined, written patient care policies; and. 3) Maintain adequate documentation of each recipient visit as part of the p
10.09.82.04.htm 10.09.82.04. 04 Covered Services.. The Program covers the following services when medically necessary:. A. Radiation therapy;. B. Chemotherapy;. C. IV Infusion;. D. Blood transfusions;. E. Medical supplies;. F. Drugs; and. G. Bone marrow biopsies..
10.09.82.05.htm 10.09.82.05. 05 Limitations.. The following services are not covered:. A. Any service or treatment that is not medically necessary;. B. Experimental or investigational services;. C. Services that are specifically included as part of another service; and. D. Professional fees provided by physicians billed separately from the facility’s charges..
10.09.82.06.htm 10.09.82.06. 06 Payment Procedures.. A. General policies for payment procedures that are applicable to all providers are set forth in COMAR 10.09.36.04.B. Specific Payment Procedures for a Provider-Based Outpatient Oncology Facility.. 1) The provider shall submit a request for payment on the form designated by the Department for dates of service on or after July 1, 2012.2) Except for drugs which shall be billed to the Program using the National Drug Code (NDC) and appropriate the HCPCS, the De
10.09.82.07.htm 10.09.82.07. 07 Recovery and Reimbursement.. A. If the recipient has insurance, or if any other person is obligated either legally or contractually to pay for or to reimburse for any service 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 Medical Assistance Program, the provider may submit a claim to the Department. The provider shall submit a copy of the insurance carrier’
10.09.82.08.htm 10.09.82.08. 08 Cause for Suspension or Removal and Imposition of Sanctions.. General policies governing cause for suspension or removal and imposing sanctions that are applicable to all providers are set forth in COMAR 10.09.36.08.
10.09.82.09.htm 10.09.82.09. 09 Appeal Procedures.. General policies governing appeal procedures that are applicable to all providers are set forth in COMAR 10.09.36.09.
10.09.82.10.htm 10.09.82.10. 10 Interpretive Regulation.. General policies governing the interpretive regulations that are applicable to all providers are set forth in COMAR 10.09.36.10.
10.09.82.9999.htm 10.09.82.9999. Administrative History Effective date: September 17, 2012 (39:18 Md. R. 1196). Regulation .06B amended effective July 4, 2016 (43:13 Md. R. 712).
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