Md. Code Regs. 10.09.81.04

Current through Register Vol. 51, No. 25, December 13, 2024

Section 10.09.81.04 - Conditions for Provider Participation - General Requirements

A. To participate as a provider of a service covered under Regulations .22-.37 of this chapter, a provider shall:

(1) Meet all of the conditions for participation as a Maryland Medical Assistance Program provider as set forth in COMAR 10.09.36, except as otherwise specified in this chapter;

(2) Meet the licensure and certification requirements specified in this chapter, if applicable;

(3) Meet the applicable conditions for provider participation in this chapter;

(4) Apply in accordance with the conditions of participation under Regulations .05-.20 of this chapter, by completing the application forms designated by the Maryland Medical Assistance Program;

(5) Have a signed provider agreement in effect with the Maryland Medical Assistance Program;

(6) Verify the qualifications of all individuals who render ICS services on the provider's behalf, and provide a copy of the current license or credentials of these individuals upon request;

(7) Provide services in accordance with:

(a) A participant's plan of service;

(b) The provider agreement;

(c) The ICS Program; and

(d) All relevant federal, State, and local laws and regulations;

(8) Agree to inform the case manager within 24 hours, and within 7 calendar days file a written report on a form designated by the Department, in the case of any threat to the health, safety, or welfare of the participant such as:

(a) Potential eviction;

(b) Suspected abuse or neglect; or

(c) Significant interruption of service;

(9) Immediately notify the Adult Protective Services office at the local department of social services and law enforcement if the provider believes that the participant has been subjected to abuse, neglect, self-neglect, or exploitation in the community, in accordance with COMAR 07.06.14.04D;

(10) Agree to cooperate with required inspections, reviews, and audits by authorized governmental representatives;

(11) Agree to provide services, and to subsequently bill the Department in accordance with the payment procedures specified at Regulation .40 of this chapter for only covered services which have been:

(a) Preapproved in the participant's plan of service;

(b) Provided in a manner consistent with the participant's plan of service; and

(c) Authorized in the provider agreement as within the scope of the provider's Medicaid participation;

(12) Agree to maintain and have available written documentation of ICS services, including dates and hours of services provided to participants for a period of 6 years, in a manner approved by the Department;

(13) Agree not to suspend, terminate, increase, or reduce services for a participant without authorization from the participant's case manager; and

(14) Agree to comply with the requirements in the Department's quality plan for the ICS Program.

B. To participate as a provider of a service covered under this chapter, a provider or its principals may not, within the past 24 months, have:

(1) Been subject to sanctions under COMAR 10.09.36.08D;

(2) Had a license or certificate suspended or revoked as a health care provider, health care facility, or provider of direct care services;

(3) Been subject to a disciplinary action by a licensing board;

(4) Been cited by a State agency for deficiencies which affect recipients' health and safety; or

(5) Been terminated under a reimbursement agreement with or been barred from work or participation by a public or private agency due to:

(a) Failure to meet contractual obligations; or

(b) Fraudulent billing practices.

C. A provider who renders health-related services to participants, including attendants, participant trainers, occupational therapists, speech and language therapists, physical therapists, nutritionists, dietitians, medical day care centers, and registered nurses, shall agree to:

(1) Periodically indicate the condition of a participant in accordance with the procedures and forms designated by the Department; and

(2) Share and discuss the documented information at the request of the participant.

Md. Code Regs. 10.09.81.04