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10.09.93.00.htm 10.09.93.00. Title 10 MARYLAND DEPARTMENT OF HEALTH Subtitle 09 MEDICAL CARE PROGRAMS Chapter 93 Chronic Hospitals Authority: Health-General Article, §2-104(b) 15-102.8, 15-103, and 15-105, Annotated Code of Maryland
10.09.93.01.htm 10.09.93.01. 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) “Administrative day” means a day of medical services delivered to a participant who no longer requires the level of care that the provider is licensed to deliver.3) “Admission” means the formal acceptance by a hospital of a participant who is to be provided with
10.09.93.02.htm 10.09.93.02. 02 License Requirements.. A. In order to participate in the Program, a provider shall:. 1) Be licensed by the Department pursuant to Health-General Article, Title 19, Subtitle 3, Annotated Code of Maryland, as a hospital; and2) Obtain any other licenses required by COMAR 10.07.01.. B. The provider shall ensure that Clinical Laboratory Improvement Amendments (CLIA) certification exists for all clinical laboratory services performed, and:
10.09.93.03.htm 10.09.93.03. 03 Conditions for Participation ― General.. 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 a chronic 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 U.S. Department of Health and Human Services;2) 24 hours per day, 7 days per week, meet the following staffing requirements:.
10.09.93.04.htm 10.09.93.04. 04 Specific Conditions for Provider Participation ― Brain Injury Community Integration Program.. A. To participate in the Program as a provider operating a brain injury community integration program, the provider shall be:1) Accredited by the Commission on Accreditation of Rehabilitation Facilities; and. 2) Approved by the Department to provide the Program.. B. Staff Requirements. In addition to the requirements in Regulation .03 of this chapter, a brain injury community integratio
10.09.93.05.htm 10.09.93.05. 05 Covered Services.. A. Chronic hospitals shall provide the following services:. 1) Complex respiratory care services;. 2) Complex wound care services;. 3) Services for participants with multiple co-morbidities, including but not limited to services necessary to care for:a) Ventilator-assisted individuals who have been ventilator dependent for less than 6 months and who need further medical stabilization or are candidates for weaning from ventilator assistance;
10.09.93.06.htm 10.09.93.06. 06 Limitations.. The Program does not cover:. A. Services for individuals who are not eligible for Medicaid;. B. Services for individuals who are not medically eligible for chronic hospital services;. C. Services identified by the Department or its designee as not medically necessary;. D. Hospital services, procedures, drugs, or hospital admissions that are investigational or experimental;E. Duplicated care or services;. F. Interpretation of laboratory tests or panels;.
10.09.93.07.htm 10.09.93.07. 07 Medical Eligibility.. A. General Requirements.. 1) An admission to a chronic hospital is medically necessary for a participant whose:. a) Medical condition is not stabilized subsequent to a course of treatment at an acute hospital, or whose deteriorating medical condition resulted in a readmission to an acute hospital from a nursing facility or community setting; andb) Service and care needs require active and continuing medical treatment at an intensity and freque
10.09.93.08.htm 10.09.93.08. 08 Utilization Review.. A. Admission and Prior Approval.. 1) For participants and individuals who have applied for Medical Assistance, the provider shall request a determination from the Department or its designee at the time of admission, or at the time of application for Medical Assistance, that the individual meets the medical eligibility criteria set forth in Regulation .07A of this chapter.2) For a participant to be preauthorized for services in a brain injury com
10.09.93.09.htm 10.09.93.09. 09 Payment Procedures.. A. Reimbursement of Maryland Chronic Hospitals.. 1) In-State chronic hospitals shall be reimbursed according to:. a) Rates approved by the HSCRC pursuant to COMAR 10.37.03; or. b) The administrative day rate as follows:. i) For a participant who is not ventilator-dependent, payment for approved administrative days shall be the estimated Statewide average Medicaid nursing facility payment rate as determined by the Department; andii) For a participant who
10.09.93.10.htm 10.09.93.10. 10 Cost Reporting ― State-Operated Chronic 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 granted, and who are reimburse
10.09.93.11.htm 10.09.93.11. 11 Cost Settlement ― State-operated Chronic Hospitals.. A. Final settlement for services in the provider’s fiscal year shall be determined based on Medicare retrospective cost principles found at 42 CFR §413, adjusted for Program allowable costs. Allowable costs specific to the Program shall be limited to a base year cost per discharge increased by the applicable federal rate of increase times the number of Program discharges for that fiscal year.B. Base Year. For purpose
10.09.93.12.htm 10.09.93.12. 12 Cost Settlement for State-operated Chronic Hospitals ― Payments and Appeals.. A. The Department or its designee shall notify each provider participating in the Program of the results of the final settlement under Regulation .11 of this chapter.B. Within 60 days after the provider receives the notification described in §A of this regulation, the Department shall pay the amount due to the provider regardless of whether the provider files an appeal.C. The provider may reque
10.09.93.13.htm 10.09.93.13. 13 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.
10.09.93.14.htm 10.09.93.14. 14 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.
10.09.93.15.htm 10.09.93.15. 15 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.
10.09.93.16.htm 10.09.93.16. 16 Interpretive Regulation.. General policies governing the interpretive regulations applicable to all providers are set forth in COMAR 10.09.36.10.
10.09.93.9999.htm 10.09.93.9999. Administrative History Effective date: April 10, 2017 (44:7 Md. R. 354).
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