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10.09.92.00.htm 10.09.92.00. Title 10 DEPARTMENT OF HEALTH AND MENTAL HYGIENE Subtitle 09 MEDICAL CARE PROGRAMS Chapter 92 Acute Hospitals Authority: Health-General Article, §2-104(b) 15-102.8, 15-103, and 15-105, Annotated Code of Maryland
10.09.92.01.htm 10.09.92.01. 01 Definitions.. A. In this chapter, the following terms have the meanings indicated.. B. Terms Defined.. 1) “Acute hospital” means an institution that provides active, short-term medical diagnosis, treatment, and care.2) “Acute level of care” means care in which a patient is treated:. a) For a brief but severe episode of illness, for conditions that are the result of disease or trauma; andb) During recovery from surgery.. 3) “Acute rehabilitation hospital” means an instit
10.09.92.02.htm 10.09.92.02. 02 License Requirements.. A. In order to participate in the Program, a provider shall:. 1) Be licensed as a hospital by the Department pursuant to Health-General Article, Title 19, Subtitle 3, Annotated Code of Maryland; and2) Obtain other licenses, as set forth in COMAR 10.07.01.. B. The provider shall ensure that Clinical Laboratory Improvement Amendments (CLIA) certification exists for all clinical laboratory services performed, and:
10.09.92.03.htm 10.09.92.03. 03 Conditions for Participation.. A. A provider shall meet all conditions for participation as set forth in COMAR 10.09.36.03.. B. To participate in the Program as an acute hospital services provider, the provider shall:. 1) Meet the requirements of Title XIX of the Social Security Act for participation as a hospital, as issued by the Department of Health and Human Services;2) Directly provide or make available through contractual arrangements or transfer agreements, medic
10.09.92.04.htm 10.09.92.04. 04 Covered Services.. A. The Program covers the services listed in §B of this regulation according to the conditions and requirements indicated.B. The Program covers the following hospital services:. 1) Medically necessary emergency services as defined in COMAR 10.09.36.01, including triage, related ancillary services, and when necessary, observation stays of a participant who presents to a hospital emergency department;
10.09.92.05.htm 10.09.92.05. 05 Limitations.. The Program does not cover:. A. Hospital services, procedures, drugs, or hospital admissions that are investigational or experimental;B. Hospital services denied by Medicare as not medically necessary;. C. Inpatient admissions or outpatient visits solely for the administration of injections, unless medical necessity and the participant’s inability to take appropriate oral medications is documented in the participant’s medical record;
10.09.92.06.htm 10.09.92.06. 06 Utilization Review.. A. Elective Inpatient Preauthorization Reviews.. 1) The hospital shall only request preauthorization for inpatient stays when such services:. a) Cannot be provided on an outpatient basis; or. b) Can only be provided in a facility that is licensed as an acute hospital.. 2) The hospital shall obtain preauthorization for elective inpatient admissions from the Department or its designee, before the participant is admitted, by providing the follo
10.09.92.07.htm 10.09.92.07. 07 Payment Procedures.. A. Reimbursement Principles for Acute Hospitals Located in Maryland.. 1) The Department will make no direct reimbursement to any State-operated hospital. The Department will claim federal fund recoveries from the U.S. Department of Health and Human Services for services to participants in State-operated hospitals.2) Acute hospitals located in Maryland that participate in the Program, shall charge the rates approved by the HSCRC and be r
10.09.92.08.htm 10.09.92.08. 08 District of Columbia Hospital Reimbursement.. A. Inpatient Services Rate Calculation.. 1) A hospital in the District of Columbia shall:. a) Bill its usual and customary charges; and. b) Be reimbursed for covered services the lesser of its percentage of charges as calculated in §A(2) of this regulation or its charges.2) The percentage of charges in §A(1) of this regulation is the product of the following:. a) The cost-to-charges percentage using only those costs of the hospital re
10.09.92.09.htm 10.09.92.09. 09 Submitting Cost Reports for Freestanding Acute Rehabilitation Hospitals.. A. The provider shall submit to the Department or its designee, in the form prescribed, financial and statistical data within 5 months after the end of the provider’s fiscal year unless the Department grants the provider an extension or the provider discontinues participation in the Program.B. For hospitals who do not submit reports within 5 months, for whom an extension has not been grant
10.09.92.10.htm 10.09.92.10. 10 Cost Settlement for Freestanding Acute Rehabilitation Hospitals.. A. Retrospective Cost Reimbursement for Freestanding Acute Rehabilitation Hospitals.. 1) An acute rehabilitation hospital not approved by the Program for reimbursement according to HSCRC rates shall be reimbursed according to Medicare standards and principles for retrospective cost reimbursement described in 42 CFR §413, or on the basis of charges if less than reasonable cost.2) In calculating retrosp
10.09.92.11.htm 10.09.92.11. 11 Recovery and Reimbursement.. A. General policies governing recovery and reimbursement procedures applicable to all providers are set forth in COMAR 10.09.36.07.B. If refund of a payment as specified in §A of this regulation is not made, the Department shall reduce its current payment to the provider by the amount of the duplicate payment, overpayment, or third-party payment.
10.09.92.12.htm 10.09.92.12. 12 Cause for Suspension or Removal and Imposition of Sanctions.. Causes for suspension or removal and imposition of sanctions shall be as set forth in COMAR 10.09.36.08.
10.09.92.13.htm 10.09.92.13. 13 Appeal Procedures.. A provider filing an appeal from an administrative decision made in connection with these regulations shall do so according to COMAR 10.09.36.09.
10.09.92.14.htm 10.09.92.14. 14 Interpretive Regulation.. General policies governing the interpretive regulations applicable to all providers are set forth in COMAR 10.09.36.10.
10.09.92.9999.htm 10.09.92.9999. Administrative History Effective date: April 10, 2017 (44:7 Md. R. 354).
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