Md. Code Regs. 10.09.08.05

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

Section 10.09.08.05 - Federally Qualified Health Center Services

A. To participate as a federally qualified health center, the provider shall meet the requirements of Regulations .03 and .04B of this chapter and shall:

(1) Meet the conditions for coverage in accordance with 42 CFR § 491, Subpart A;

(2) Be enrolled in the EPSDT/Healthy Kids Program as provided in COMAR 10.09.23 and provide EPSDT/Healthy Kids services to participants who are eligible to receive them;

(3) Supply the Department with financial and other information as requested;

(4) Meet one of the following conditions:

(a) Meet all of the requirements for receiving a grant under §329, 330, or 340 of the Public Health Service Act, 42 U.S.C. § 254(c), as determined by the Secretary of the United States Department of Health and Human Services, and in accordance with 42 CFR § 405.2401;

(b) Receive a waiver from the Secretary of the United States Department of Health and Human Services of one or more of the requirements for receiving a grant pursuant to §329, 330, or 340 of the Public Health Service Act; or

(c) Be an outpatient health program or facility operated by a tribe or tribal organization under the Indian Self-Determination Act or by an Urban Indian organization receiving funds under Title V of the Indian Health Care Improvement Act;

(5) Comply with the requirements contained in COMAR 10.09.59 if delivering mental health services and COMAR 10.09.80 when providing substance use disorder services; and

(6) Comply with the requirements contained in COMAR 10.09.05, if rendering dental services.

B. Covered services are the same as those authorized to be provided by rural health clinics as described in 42 CFR § 440.20(b), rural health clinic services, and 42 CFR § 440.20(c), other ambulatory services furnished by a rural health clinic.

C. In the event that the provider elects to institute a scope of services change, the provider shall:

(1) Notify the Department of its intent to institute the scope of services change:

(a) Not later than 30 days before it begins to deliver services under the scope of services change; or

(b) Within 30 days after the adoption of this section; and

(2) Provide the Department with any information the Department needs to:

(a) Assure continuity of care for enrollees;

(b) Arrange for the processing and payment of claims; or

(c) Otherwise administer services to Medical Assistance participants under the provider's scope of services change.

D. Rate Revisions for FQHCs Due to Scope of Services Change or Extraordinary One-Time Circumstance.

(1) If an FQHC implements a change in the FQHC's scope of services or if the FQHC experiences an extraordinary one-time circumstance, the FQHC or the Department may request a revision of the FQHC's prospective rate of reimbursement.

(2) The FQHC shall provide the Department with written notification no later than 30 days after the implementation of the scope of services change or the occurrence of the one-time circumstance.

(3) After receiving notification from an FQHC that the FQHC plans to institute a scope of services change, the Department shall notify the FQHC within 30 days if the Department wishes to request a revision to an FQHC's rate.

(4) An FQHC or the Department may not request more than one rate revision per FQHC per calendar year under this regulation.

(5) When an FQHC or the Department requests a rate revision based on §D(1) of this regulation, the FQHC shall submit to the Department or its designee a cost report and supporting documentation.

(6) The cost report and supporting documentation required under §D(5) of this regulation shall:

(a) Be submitted within 90 days after the end of the first 1-year period immediately following the implementation of the scope of service change or the occurrence of the extraordinary one-time circumstance;

(b) Reflect the change in costs relating to the rate revision request for the center's operations for the first 1-year period immediately following the implementation of the scope of service change or the occurrence of the extraordinary one-time circumstance;

(c) Conform with the standards described in §C of this regulation and instructions issued by the Department or its designee;

(d) Contain an explanation of the scope of services change or extraordinary one-time circumstance and schedules to support the calculation of the change in the cost-per-visit rate; and

(e) Be subject to verification and adjustment by the Department or its designee.

(7) Rate revisions granted under this section shall be effective the date the change of scope was approved by the Health Resources and Services Administration (HRSA) or the occurrence of the extraordinary onetime circumstance.

(8) The revised rate granted under this section shall be the rate referenced in §A(3) of this regulation.

E. Rates of reimbursement established according to this regulation shall be for:

(1) Payment of covered services rendered to participants; and

(2) Determining supplemental payments under COMAR 10.09.65.21A.

Md. Code Regs. 10.09.08.05

Regulations .05 repealed effective October 1, 1985 (12:19 Md. R. 1849)
Regulations .05 adopted effective October 1, 1985 (12:19 Md. R. 1849)
Regulation .05 amended effective February 6, 1989 (16:2 Md. R. 159)
Regulation .05E amended effective June 26, 2000 (27:12 Md. R. 1139)
Regulations .05A amended as an emergency provision effective July 1, 1997 (24:16 Md. R. 1148); amended permanently effective December 29, 1997 (24:26 Md. R. 1758)
Regulations .05C amended as an emergency provision effective December 23, 1995 (23:2 Md. R. 93); adopted permanently effective April 8, 1996 (23:7 Md. R. 552)
Regulation .05 amended effective November 20, 1995 (22:23 Md. R. 1801); August 4, 2003 (30:15 Md. R. 991)
Regulation .05C amended as an emergency provision effective October 15, 1992 (19:22 Md. R. 1979); amended permanently effective February 1, 1992 (20:2 Md. R. 112)
Regulation .05E adopted effective June 26, 2000 (27:12 Md. R. 1139)
Regulation .05-1 adopted effective August 4, 2003 (30:15 Md. R. 991)
Regulation .05-1B, C amended effective August 15, 2005 (32:16 Md. R. 1392)
Regulation .05 adopted effective 42:6 Md. R. 512, eff.4/1/2015; amended effective 46:10 Md. R. 485, eff. 5/20/2019; amended effective 50:20 Md. R. 886, eff. 10/16/2023