Md. Code Regs. 10.09.18.03

Current through Register Vol. 51, No. 22, November 1, 2024

Section 10.09.18.03 - Conditions for Participation

To participate in the Program, the provider shall:

A. Unless exempt from Medicare accreditation requirements:

(1) Be accredited by a Medicare-approved accreditation organization;

(2) Effective November 1, 2011, provide documentation of:

(a) Accreditation; or

(b) Having submitted an application for accreditation; and

(3) Effective April 1, 2012, be accredited or terminated from the Program;

B. Apply for participation in the Program using the application form designated by the Department;

C. If located more than 25 miles from the border of Maryland, shall provide to the Program documentation demonstrating that the enrollment and screening requirements of 42 CFR Part 455, Subpart E have been performed within the 12 months preceding the application for initial enrollment or revalidation of enrollment by:

(1) A Medicare contractor; or

(2) The Medicaid agency or the Children's Health Insurance Program of another state;

D. Be approved for participation by the Department;

E. Verify the recipient's eligibility;

F. Maintain for a minimum of 6 years adequate records which are sufficient in detail to support the invoices submitted for payment, and make these records available upon request to the Department or its designee;

G. Provide service without discrimination as to race, creed, color, age, sex, national origin, marital status, or physical or mental handicap;

H. Not knowingly employ a former Medicaid provider, or a former employee of a Medicaid provider, to provide service to Medical Assistance patients after that provider or employee has been disqualified from the Program, unless prior approval has been received from the Department;

I. Accept payment by the Department as payment in full for services rendered, and make no additional charge to any person for covered services;

J. Agree that if the Program denies payment or requests repayment on the basis that an otherwise covered service was not medically necessary or preauthorized, the provider may not seek payment for that service from the recipient;

K. Agree that if the Program denies payment due to late billing, he may not seek payment from the recipient;

L. Place no restriction on a recipient's right to select providers of the recipient's choice;

M. Have emergency services available on a 24 hour-a-day basis;

N. Be prepared to furnish necessary maintenance and repairs to oxygen and related respiratory equipment;

O. Insure on every visit to the patient that all oxygen and related respiratory equipment functions properly;

P. Provide suitable identification, including a recent photograph, which employees who visit patients at home will carry on their person and display on request;

Q. Agree to discontinue billing or remove equipment promptly, if the patient dies, is institutionalized, or otherwise ceases to require the oxygen;

R. Provide an ancillary source of oxygen to last at least 24 hours when the primary source is a concentrator.

Md. Code Regs. 10.09.18.03

Regulation .03 amended effective April 16, 2012 (39:7 Md. R. 491)
Regulation .03D amended effective April 5, 2010 (37:7 Md. R. 570)
Regulation .03H amended effective May 29, 1989 (16:10 Md. R. 1109)
Regulation .03P amended effective November 5, 1984 (11:22 Md. R. 1899)
Regulations .03 amended effective 42:7 Md. R. 568, eff.4/13/2015