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10.09.95.00.htm 10.09.95.00. Title 10 DEPARTMENT OF HEALTH AND MENTAL HYGIENE Subtitle 09 MEDICAL CARE PROGRAMS Chapter 95 Special Psychiatric Hospitals Authority: Health-General Article, §2-104(b) 15-102.8, 15-103, and 15-105, Annotated Code of Maryland
10.09.95.01.htm 10.09.95.01. 01 Definitions.. A. In this chapter, the following terms have the meanings indicated.. B. Terms Defined.. 1) “Administrative day” means a day of medical services delivered to a participant who no longer requires the level of care which the provider is licensed to deliver and is awaiting placement in a nursing home or residential care facility.2) “Admission” means the formal acceptance by a specialty psychiatric hospital of a patient who is to be provided with room,
10.09.95.02.htm 10.09.95.02. 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 specialty psychiatric hospital; and2) Obtain other licenses, as set forth in COMAR 10.07.01.. B. A provider shall ensure that Clinical Laboratory Improvement Amendments (CLIA) certification exists for all clinical laboratory services performed, and:
10.09.95.03.htm 10.09.95.03. 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 a special psychiatric 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) Meet the following staffing requirements 24 hours per day, 7 days per week:.
10.09.95.04.htm 10.09.95.04. 04 Covered Services.. A. The Program covers the following inpatient special psychiatric hospital services:. 1) Medically necessary services for the number of days, per admission, including days certified by the Department or its designee;2) Medically necessary mental health services authorized in accordance with COMAR 10.09.59.08 and as set forth in Regulation .05B(4) of this chapter;3) Medically necessary services when these services are:.
10.09.95.05.htm 10.09.95.05. 05 Limitations.. A. There are limitations placed on the coverage of some special psychiatric hospital inpatient and outpatient services.B. The Program does not cover:. 1) Special psychiatric hospital services, procedures, drugs or admissions that are investigational or experimental;2) Services identified by the Department or its designee as not medically necessary;. 3) Elective inpatient admissions without preauthorization;. 4) Inpatient admissions or outpatient visits solel
10.09.95.06.htm 10.09.95.06. 06 Utilization Review Requirements.. A. Elective Inpatient Preauthorization Reviews.. 1) The special psychiatric 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 a special psychiatric hospital.. 2) The special psychiatric hospital shall obtain preauthorization for elective inpatient admissions from the Department or it
10.09.95.07.htm 10.09.95.07. 07 Payment Procedures.. A. Reimbursement Principles.. 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) The Department shall compare the current rates with the projected upper payment limit for inpatient days of service on or after July 1, 2012, in freestanding private psychi
10.09.95.08.htm 10.09.95.08. 08 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.
10.09.95.09.htm 10.09.95.09. 09 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.
10.09.95.10.htm 10.09.95.10. 10 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.
10.09.95.11.htm 10.09.95.11. 11 Submitting Cost Reports.. 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 reimbursed according to Medicare s
10.09.95.12.htm 10.09.95.12. 12 Cost Settlement.. A. The Department or its designee shall notify each provider participating in the Program of the results of the final settlement under Regulation .07 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 request review of the settlement under Regulation .07 o
10.09.95.13.htm 10.09.95.13. 13 Interpretive Regulation.. General policies governing the interpretive regulations applicable to all providers are set forth in COMAR 10.09.36.10.
10.09.95.9999.htm 10.09.95.9999. Administrative History Effective date: April 10, 2017 (44:7 Md. R. 354).
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