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10.09.96.00.htm 10.09.96.00. Title 10 MARYLAND DEPARTMENT OF HEALTH Subtitle 09 MEDICAL CARE PROGRAMS Chapter 96 Remote Patient Monitoring Authority: Health-General Article, §15-103(b) Annotated Code of Maryland
10.09.96.01.htm 10.09.96.01. 01 Purpose and Scope.. A. This chapter applies to remote patient monitoring services reimbursed by the Maryland Medical Assistance Program effective January 1, 2018.B. The purpose of providing medically necessary services via remote patient monitoring is to assist participants in managing and controlling their chronic conditions in order to reduce readmissions and emergency department visits and to improve quality of careC. The target populations are high-risk, chronical
10.09.96.02.htm 10.09.96.02. 02 Definitions.. A. In this chapter, the following terms have the meanings indicated.. B. Terms Defined.. 1) “Certified nurse practitioner” means an individual who meets the licensure and conditions of participation set forth in COMAR 10.09.01.2) “Department” means the Maryland Department of Health, which is the single State agency designated to administer the remote patient monitoring program.3) “Episode” means the span of treatment during which remote patient monito
10.09.96.03.htm 10.09.96.03. 03 License Requirements.. A. The provider shall:. 1) Meet all license requirements as set forth in COMAR 10.09.36.02; and. 2) Be licensed in the state in which the participant resides.. B. A home health agency shall be:. 1) Licensed pursuant to Health-General Article, §19-401―19-408, Annotated Code of Maryland;. 2) Part of a hospital or related institution licensed pursuant to Health-General Article, §19-301―19-359, Annotated Code of Maryland; or3) Legally authorized to
10.09.96.04.htm 10.09.96.04. 04 Provider Conditions for Participation.. A. To provide remote patient monitoring, the provider shall:. 1) Be enrolled with an active status as a Maryland Medical Assistance Program provider on the date the service is rendered;2) Be a:. a) Physician;. b) Physician assistant;. c) Certified nurse practitioner; or. d) Home health agency when remote patient monitoring services are prescribed by a physician; and. 3) Meet the requirements for participation in the
10.09.96.05.htm 10.09.96.05. 05 Participant Eligibility for Services.. A. A participant is eligible to receive remote patient monitoring services if:. 1) The participant is enrolled in the Maryland Medical Assistance Program on the date the service is rendered;2) The participant consents to remote patient monitoring services and has the capability to utilize the monitoring tools and take actions to improve self-management of the chronic disease;
10.09.96.06.htm 10.09.96.06. 06 Covered Services.. A. Remote patient monitoring services include:. 1) Installation;. 2) Education for the participant in the use of the equipment; and. 3) Daily monitoring of vital signs and other medical statistics.. B. The remote patient monitoring provider shall establish an intervention process to address abnormal data measurements in an effort to prevent avoidable hospital utilization.C. Physician, nurse practitioner, and physician assistant providers who est
10.09.96.07.htm 10.09.96.07. 07 Limitations.. A. Remote patient monitoring services are only covered for participants who meet the eligibility criteria specified in Regulation .05 of this chapter.B. The Program does not cover:. 1) Remote patient monitoring equipment;. 2) Upgrades to remote patient monitoring equipment;. 3) The internet connections necessary to transmit the results of remote patient monitoring services to the provider’s officesa) 2 months of remote patient monitoring services per episode; and.
10.09.96.08.htm 10.09.96.08. 08 Preauthorization Requirements.. The Department may preauthorize services when the provider submits to the Department adequate documentation demonstrating the:A. Participant’s condition meets the criteria listed in Regulation .05 of this chapter; and. B. Participant has not already been preauthorized for two episodes during the past rolling calendar year.
10.09.96.09.htm 10.09.96.09. 09 Payment Methodology.. A. After providing the services outlined in Regulation .06 of this chapter, the remote patient monitoring provider shall submit the request for payment using the format designated by the Department.B. Home health agencies shall:. 1) Bill on a UB04; and. 2) Be paid a monthly rate.. C. Physicians, nurse practitioners, and physician assistants who provide remote patient monitoring shall:1) Bill using a CMS 1500 or an 837P; and. D. Professionals followin
10.09.96.10.htm 10.09.96.10. 10 Recovery and Reimbursement.. Recovery and reimbursement shall be in accordance with COMAR 10.09.36.07..
10.09.96.11.htm 10.09.96.11. 11 Cause for Suspension or Removal and Imposition of Sanctions.. Cause for suspension or removal and imposition of sanctions shall be in accordance with COMAR 10.09.36.08.
10.09.96.12.htm 10.09.96.12. 12 Appeal Procedures.. Providers filing appeals from administrative decisions made in connection with these regulations shall do so in accordance with COMAR 10.09.36.09.
10.09.96.13.htm 10.09.96.13. 13 Interpretive Regulation.. Except when the language of a specific regulation indicates an 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.
10.09.96.9999.htm 10.09.96.9999. Administrative History Effective date: January 1, 2018 (44:26 Md. R. 1215).
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