Md. Code Regs. 10.09.94.03

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

Section 10.09.94.03 - Conditions for Participation

A. A provider shall meet all conditions for participation as set forth in COMAR 10.09.36.

B. To participate in the Program as a special pediatric hospital services provider, the provider shall:

(1) Meet the requirements of Title XLX of the Social Security Act for participation as a hospital, as issued by the U.S. Department of Health and Human Services;

(2) Directly provide, or make available through contractual arrangements or transfer agreements, medically necessary covered services;

(3) Accept payment by the Program as payment in full for the covered services;

(4) Make available to the Department or its designee the participant's medical record for review and certification of medical necessity for admission and continuation of stay; and

(5) Maintain documentation of each contact with the participant as part of the complete medical record, which, at a minimum, includes:

(a) Date of service;

(b) The participant's chief medical complaint or reason for admission or outpatient visit;

(c) A description of the services provided, including:

(i) Progress notes;

(ii) Imaging studies;

(iii) Laboratory results;

(iv) Medication administration records; and

(v) Discharge summary; and

(d) A signature, electronic or handwritten, along with the printed or typed name of the individual providing care, with the appropriate title.

C. If an out-of-State or District of Columbia hospital, the hospital shall:

(1) Have in effect a utilization review plan applicable to all participants who receive Medical Assistance under Title XIX of the Social Security Act which meets the requirements of § 1861(k) of the Social Security Act unless a waiver has been granted by the Secretary of Health and Human Services; and

(2) Allow HealthChoice managed care organizations to pay no more and no less than the reimbursement rates established in Regulation .07 of this chapter unless the parties mutually agree to an alternative arrangement in a contract either on or after July 1, 2011.

Md. Code Regs. 10.09.94.03

Regulation .03 adopted effective 44:7 Md. R. 354, eff. 4/10/2017