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10.18.06.00.htm 10.18.06.00. Title 10 DEPARTMENT OF HEALTH AND MENTAL HYGIENE Subtitle 18 HUMAN IMMUNODEFICIENCY VIRUS (HIV) INFECTION AND ACQUIRED IMMUNODEFICIENCY SYNDROME (AIDS) Chapter 06 Maryland AIDS Drug Assistance Program: Pharmacy Services Authority: Health General Article, §2-104(b) and (i) 2-105(a) and (b) and 18-102(a) Annotated Code of Maryland
10.18.06.01.htm 10.18.06.01. 01 Definitions.. A. In this chapter, the following terms have the meanings indicated.. B. Terms Defined.. 1) “Acquired Immunodeficiency Syndrome (AIDS) means the medical condition caused by the Human Immunodeficiency Virus.2) “Department” means the Department of Health and Mental Hygiene.. 3) “Drug” means an article intended for use in the diagnosis, cure, mitigation, treatment, or prevention of disease licensed by the U.S. Food and Drug Administration and cover
10.18.06.02.htm 10.18.06.02. 02 License Requirements.. The license requirements for participation in MADAP are the same as those for the Medical Assistance Pharmacy Services Program set forth at COMAR 10.09.03.02.
10.18.06.03.htm 10.18.06.03. 03 Conditions for Participation.. A. To participate in MADAP, a pharmacy shall:. 1) Be enrolled in Medical Assistance or submit a request for exception to, and receive approval from, the Department;2) Accept payment by MADAP as payment in full for the professional services rendered and make no additional charges to the recipient or the recipient’s family;3) Maintain records in accordance with standards established by Medical Assistance;. 4) Maintain prescriptions
10.18.06.04.htm 10.18.06.04. 04 Covered Services.. A. The recipient shall obtain a prescription for each drug or other product ordered for the recipient.B. The Department shall pay for a prescription drug or other product on the formulary within the limits established by the Department if the prescription is ordered and signed by a health care practitioner for the recipient.
10.18.06.04-1.htm 10.18.06.04-1. 04-1 Formulary.. The Department shall:. A. Maintain an updated formulary that is available electronically;. B. Make available copies of the formulary; and. C. Consider the recommendations of the MADAP Advisory Board in revising the formulary, in accordance with Regulation .04-2G of this chapter.
10.18.06.04-2.htm 10.18.06.04-2. 04-2 Advisory Board.. A. The Department may establish a MADAP Advisory Board (Board). B. The Board shall consist of a maximum of 18 members as follows:. 1) Nine members shall be clinicians including physicians, physician assistants, certified nurse practitioners, registered nurses, and pharmacists; and2) Nine members shall be community representatives including representatives from community-based organizations, community advocates, and MADAP consumC. Each Board member shall:.
10.18.06.05.htm 10.18.06.05. 05 Limitations on Covered Services.. A. A pharmacist may not dispense more than a 100-day supply of a prescribed drug or other product.. B. The Department may not pay for:. 1) A drug or other product prescribed as part of a recipient’s care in a correctional institution, inpatient hospital, nursing home, or long-term care setting; or2) Drugs or other products indicated as restricted on the formulary, unless the:.
10.18.06.06.htm 10.18.06.06. 06 Preauthorization Requirement.. A pharmacist shall obtain preauthorization for each prescription or refill before dispensing a drug or other product marked as restricted.
10.18.06.07.htm 10.18.06.07. 07 Payment Procedures.. A. Except as provided in §B and C of this regulation, the Department shall pay a pharmacy in accordance with the procedures of the Medical Assistance Pharmacy Services Program set forth at COMAR 10.09.03.07.B. If the Department or the recipient tells the pharmacy that the recipient has or may have third-party insurance coverage to offset some or all of the cost for services provided under MADAP, the pharmacy shall:1) Bill the third-party p
10.18.06.08.htm 10.18.06.08. 08 Recovery and Reimbursement.. The Department shall follow the same procedures for recovery and reimbursement as the Medical Assistance Pharmacy Services Program in COMAR 10.09.03.08.
10.18.06.09.htm 10.18.06.09. 09 Cause for Suspension or Removal and Imposition of Sanctions.. A. If the Department determines that a pharmacy or the pharmacy’s employee, or both, has failed to comply with federal or State laws and regulations, the Department may:1) Suspend the pharmacy from MADAP;. 2) Withhold payment to the pharmacy by MADAP; or. 3) Both.. B. Removal of a pharmacy or a pharmacy’s employee from Medical Assistance shall result in removal from MADAP.C. The Department:.
10.18.06.10.htm 10.18.06.10. 10 Appeal Procedures.. A pharmacy filing an appeal shall do so in accordance with the Medical Assistance Pharmacy Services Program as set forth at COMAR 10.09.03.10.
10.18.06.11.htm 10.18.06.11. 11 Confidentiality.. Unless otherwise authorized by law, the Department:. A. Shall keep all applicant and recipient personal information confidential;. B. May not disclose personal information kept on an applicant or recipient without written consent of the:1) Applicant;. 2) Recipient;. 3) Applicant’s parent or legal guardian; or. 4) Recipient’s parent or legal guardian;. C. Shall comply with the laws and regulations concerning the privacy and security of protected healt
10.18.06.12.htm 10.18.06.12. 12 Availability of Funding and Program Termination.. A. If sufficient monies are not available to fund MADAP, the Department shall take the action necessary to eliminate a deficit which may include MADAP termination.B. If MADAP is terminated, the Department shall provide benefits for each current recipient in accordance with COMAR 10.18.05.09B.
10.18.06.9999.htm 10.18.06.9999. Administrative History Effective date:. Regulations .01―12 adopted as an emergency provision effective November 27, 2002 (29:25 Md. R. 1979) adopted permanently effective February 17, 2003 (30:3 Md. R. 180)Regulation .01B amended as an emergency provision effective August 11, 2004 (31:18 Md. R. 1348) amended permanently effective October 11, 2004 (31:20 Md. R. 1485)Regulation .01B amended effective March 16, 2015 (42:5 Md. R. 486). Regulation .04 repealed a
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