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10.20.01.00.htm 10.20.01.00. Title 10 MARYLAND DEPARTMENT OF HEALTH Subtitle 20 KIDNEY DISEASE PROGRAM Chapter 01 General Regulations Authority: Health-General Article, §13-301―13-315 and 16-204, Annotated Code of Maryland
10.20.01.01.htm 10.20.01.01. 01 Definitions.. A. In this chapter, the following terms have the meanings indicated.. B. Terms Defined.. 1) "Applicant" means an individual who has applied for, or is in the process of applying for, Kidney Disease Program enrollment and has not yet been certified as an eligible recipient.2) "Certification period" means the 12-month period during which an individual is certified as eligible to receive Kidney Disease Program benefits.3) "Certified facility" means a hospital, dialysis
10.20.01.02.htm 10.20.01.02. 02 Program Application Process.. A. A Maryland resident diagnosed with end-stage renal disease may apply for certification with the Program.B. An applicant, or the applicant's representative, shall complete a written application on the form designated by the Program.C. Application Supporting Documents.. 1) The Program may require the following as part of the application form or in addition to the application form:a) Copies of the previous year's federal income ta
10.20.01.03.htm 10.20.01.03. 03 Recipient Eligibility and Certification for Program Participation.. A. To be eligible for enrollment in the Program an applicant shall:. 1) Be a resident of Maryland and one of the following:. a) A citizen of the United States,. b) A qualified alien, as specified in §C of this regulation, who is eligible in accordance with the requirements related to the 5-year bar specified at §D of this regulation; orc) An alien who is:.
10.20.01.04.htm 10.20.01.04. 04 Program Participation Fee.. A. A recipient whose family income exceeds 175 percent of the poverty income guidelines or whose family liquid assets exceed 200 percent of the poverty income guidelines, or both, at the time of initial application or reapplication is required to pay an annual Program participation fee.B. Family income for purposes of this regulation includes the adjusted gross income, as defined in the Internal Revenue Code for federal income tax pu
10.20.01.05.htm 10.20.01.05. 05 Preauthorization.. A. The following procedures or services require preauthorization:. 1) Treatment that is provided outside of Maryland;. 2) Pre-renal transplant dental services;. 3) Ancillary supplies for home intravenous antibiotic therapy;. 4) Durable medical equipment and disposable medical supplies used in the home; and. 5) One pair of eyeglasses, one time only.. B. The Program may preauthorize services when the provider submits to the Program adequate documenta
10.20.01.06.htm 10.20.01.06. 06 License Requirements.. A. A pharmacy may not qualify as a provider without first having obtained a permit from the Department pursuant to Health Occupations Article, Title 12, Annotated Code of Maryland, or from the appropriate agency in the state in which the pharmacy is located.B. A pharmacy that provides compounded prescriptions for home intravenous therapy shall be licensed under the provisions of COMAR 10.34.19.C. A doctor of medicine or osteopathy shall be lic
10.20.01.07.htm 10.20.01.07. 07 Provider Reimbursement.. A. To qualify as a provider, a pharmacy shall:. 1) Maintain a permit from the Department pursuant to Health Occupations Article, Title 12, Annotated Code of Maryland, or from the appropriate agency in the state in which the pharmacy is located;2) To the extent required by law, be licensed and legally authorized to practice or deliver services in the state in which the service is provided; and3) Be a provider in the Maryland Medical Assistance Program..
10.20.01.08.htm 10.20.01.08. 08 Limitations.. A. The Program does not cover a drug if:. 1) The manufacturer has not provided the same rebate to the Kidney Disease Program as that provided for State-Only Pharmacy Assistance recipients’ purchases of drugs as is required under §1927(c) of Title XIX of the Social Security Act (42 U.S.C. §1396r-8(c)2) The Program has provided notice to the manufacturer of the manufacturer’s failure to provide adequate rebates and its opportunity to request a waiv
10.20.01.09.htm 10.20.01.09. 09 Payment Procedures.. A. A provider shall submit the request for Program payment for services rendered to a recipient according to procedures established by the Program and in the form designated by the Program.B. The Program reserves the right to return to the provider, before payment, all invoices not properly signed, completed, and accompanied by properly completed forms required by the Program.C. Billing Time Limits.. 1) The Program may not make payments for an invoic
10.20.01.10.htm 10.20.01.10. 10 Informal Reconsiderations and Hearings.. A. Informal Reconsideration.. 1) An applicant, recipient, or provider dissatisfied with a decision, action, or inaction of the Department under this chapter shall be granted an opportunity for an informal reconsideration of the matter.2) The informal reconsideration shall include:. a) Written notice to the applicant, recipient, or provider of the decision or action taken by the Department and the basis for the decision or action;
10.20.01.11.htm 10.20.01.11. 11 Program Recovery and Reimbursement.. A. The Department shall seek recovery in all cases when Program benefits have been incorrectly paid.. B. The Department shall accept reimbursement when voluntarily offered by a current or former recipient or someone acting on the recipient's behalf.C. The Department may institute any proceedings that the Department considers necessary to require collection of uncollected fees.D. The Program shall refer to the Central Collecti
10.20.01.12.htm 10.20.01.12. 12 Conflict with Regulations of the Kidney Disease Commission.. Pursuant to Health-General Article, §13-308(e) Annotated Code of Maryland, the Department is authorized, after consulting with the Commission, to adopt these regulations. Accordingly, these regulations supersede any regulations issued by the Commission that concern nonmedical issues.
10.20.01.9999.htm 10.20.01.9999. Administrative History Effective date:. Chapter, Control of Noise Pollution, transferred to Title 26 Department of the Environment, June, 1988 ―Regulations .01―10, General Regulations (Kidney Disease Program) adopted as an emergency provision effective November 1, 1991 (18:23 Md. R. 2481) emergency status expired March 30, 1992Regulations .01―10 adopted effective March 31, 1992 (19:3 Md. R. 304) ―. Chapter revised as an emergency provision effective November 29, 1999 (26:2
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