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10.21.15.00.htm 10.21.15.00. Title 10 MARYLAND DEPARTMENT OF HEALTH Subtitle 21 MENTAL HYGIENE REGULATIONS Chapter 15 Petition for Emergency Evaluation ― Payment for Services Authority: Health-General Article, §10-628, Annotated Code of Maryland
10.21.15.01.htm 10.21.15.01. 01 Scope.. These regulations govern payment for specific emergency services, as defined in Health-General Article, §10-628, Annotated Code of Maryland, rendered as a direct consequence of a petition for emergency evaluation.
10.21.15.02.htm 10.21.15.02. 02 Definitions.. A. In this chapter, the following terms have the meanings indicated.. B. Terms Defined.. 1) "Consultant" means a physician, licensed by the State, who is not a salaried staff member of the emergency facility and who is authorized by the emergency facility to perform an examination of an emergency evaluee.2) "Department" means the Maryland Department of Health.. 3) "Designated emergency facility" means a health care organization currently identified by the Depa
10.21.15.03.htm 10.21.15.03. 03 Conditions for Payment.. The Department shall pay for emergency service only if:. A. As determined according to Health-General Article, §16-202, Annotated Code of Maryland, the emergency evaluee cannot pay the charge for the service; andB. The emergency evaluee does not have health insurance, including Medicare or Medical Assistance, that covers the allowable payment for the service.
10.21.15.04.htm 10.21.15.04. 04 Payable Services.. The Department shall limit services payable under this chapter to the following emergency services:. A. The basic emergency room fee in a designated emergency facility;. B. The initial examination performed in the emergency room of a designated psychiatric emergency facility by a consultant physician; andC. Transportation for the emergency evaluee in an emergency vehicle:.
10.21.15.05.htm 10.21.15.05. 05 Billing Procedures.. A. The provider shall submit the following documents:. 1) A request for payment on a form designated by the Department;. 2) A bill that specifies the:. a) Name of the emergency evaluee;. b) Date of service; and. c) Description of service;. 3) A copy of the current petition for emergency evaluation;. 4) If the bill is for an examination by a consultant physician, a copy of the consultant physician's evaluation that is signed by the examining consul
10.21.15.06.htm 10.21.15.06. 06 Payment Rates.. The Department shall pay:. A. Hospitals, at rates approved by the Health Services Cost Review Commission;. B. Physicians, the lesser of the:. 1) Amount billed; or. 2) The Statewide average of prevailing charges for an examination by a physician consultant based on Medicare's 75th percentile as determined according to 42 CFR § 405.504; andC. Transportation providers, if transportation is by:. 1) Ambulance, the lesser of the:. a) Amount billed; or.
10.21.15.07.htm 10.21.15.07. 07 Subrogation by the Department.. A. Before billing the Department, the provider shall:. 1) Take all reasonable steps to collect the charge from the emergency evaluee and, if applicable, from insurers, including Medicare and Medical Assistance; or2) Make and document a determination of the evaluee's inability to pay, according to the provisions of Regulation .03 of this chapter.B. A provider:. 1) Shall accept as payment in full the maximum payment amount allowable und
10.21.15.08.htm 10.21.15.08. 08 Patients' Rights.. A. Access to Care. Providers of emergency services shall give an emergency evaluee equal access to treatment and services that are available or medically indicated, regardless of diagnosis, handicap status, race, age, sex, national origin, religious or political opinions or affiliations, or sources of payment for care.B. Providers of emergency services shall recognize and respect an emergency evaluee's dignity in the provision of care and treatment.
10.21.15.9999.htm 10.21.15.9999. Administrative History Effective date: May 9, 1994 (21:9 Md. R. 751).
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