Md. Code Regs. 10.09.04.03

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

Section 10.09.04.03 - Conditions for Participation

A. To be a provider, a home health agency shall be a participating home health agency under Medicare.

B. To participate in the Program, the home health agency shall:

(1) Apply for participation in the Program using the form designated by the Department;

(2) Be approved for participation by the Department;

(3) Have in effect a provider agreement with the Department;

(4) Accept payment by the Department as payment in full for covered services rendered and make no additional charge to any person for covered services;

(5) Provide verification to the Department, in the manner prescribed by the Department, of all changes in the provider's charges within 10 days of the occurrence of the changes;

(6) Maintain all patient care, medical supply, timesheets, official agency recipient or witness signature records, and billing records for a minimum of 6 years after completion of an audit by the Department and make them available, upon request, to the appropriate State and federal personnel or their designees during office hours;

(7) Secure from the participant's physician, physician assistant, certified nurse midwife, or certified nurse practitioner a written plan of treatment which relates the items and services to the participant's medical condition;

(8) Maintain a participant's plan of care based on the physician's, physician assistant's, certified nurse midwife's or certified nurse practitioner's plan of treatment for the participant;

(9) Provide services without regard to race, color, age, sex, national origin, marital status, or physical or mental handicap;

(10) Verify the participant's eligibility;

(11) Place no restriction on a participant's right to select his choice of providers under this subtitle;

(12) Agree that if the Program denies payment or requests repayment on the basis that an otherwise covered service was not medically necessary, the provider may not seek payment for that service from the participant;

(13) Agree that if the Program denies payment due to late billing, the provider may not seek payment from the participant;

(14) Provide services in person unless expressly authorized by the Department to render services via telehealth; and

(15) If not rendering services in person, comply with COMAR 10.09.49 and any subregulatory guidance issued by the Department.

C. Plan of Treatment.

(1) The plan of treatment under §B(8) shall include:

(a) Prognosis;

(b) Diagnoses;

(c) Treatment goals;

(d) Frequency of visits for each type of service ordered;

(e) Duration of treatment of each type of service ordered;

(f) Rehabilitation potential;

(g) Functional limitations;

(h) Permitted and prohibited activities;

(i) Diet;

(j) Medications;

(k) Treatments;

(l) Mental status;

(m) Medical supplies;

(n) Durable medical equipment;

(o) Safety measures to protect against injury; and

(p) Other appropriate items.

(2) The plan of treatment shall be reviewed, updated, and signed at least every 60 days by the participant's physician, physician assistant, certified nurse midwife, or certified nurse practitioner, in consultation with the registered nurse or the case coordinator.

(3) The physician, physician assistant, certified nurse midwife, or certified nurse practitioner shall:

(a) Sign and date the initial plan of treatment; and

(b) Document that the physician or nonphysician practitioner, who is not employed by the home health agency, has had a face-to-face encounter with the participant no more than 90 days before the home health start of care date or within 30 days of the start of the home health care, including the date of the encounter.

(4) For participants admitted immediately to home health upon discharge from a hospital or post-acute setting, the attending acute or post-acute physician shall document the clinical findings of the face-to-face encounter.

(5) The plan of treatment shall be part of the provider's permanent record for the participant.

D. Plan of Care.

(1) For each type of service ordered, the plan of care under §C(9) shall, at a minimum, include:

(a) Goals of treatment;

(b) Actions or procedures needed to meet the goals;

(c) Dates the goals are expected to be achieved;

(d) Problems encountered, if any;

(e) Revision of goals and actions or procedures, whenever necessary; and

(f) Appropriate discharge activities.

(2) The plan of care shall be reviewed, dated, and signed at least every 60 days by the registered nurse or the case coordinator upon consultation with the appropriate health team.

(3) The plan of care is a part of the provider's permanent record for the participant.

Md. Code Regs. 10.09.04.03

Regulation .03C amended effective November 12, 1990 (17:22 Md. R. 2656)
Regulation .03 amended effective December 27, 2010 (37:26 Md. R. 1787)
Regulation .03C amended effective 40:19 Md. R. 1544, eff.9/30/2013 ; amended effective 48:12 Md. R. 470, eff. 6/14/2021; amended effective 50:23 Md. R. 1004, eff. 11/27/2023