Md. Code Regs. 10.09.15.01

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

Section 10.09.15.01 - Definitions

A. In this chapter, the following terms have the meanings indicated.

B. Terms Defined.

(1) "Ambulatory surgical center" means any distinct, Medicare-certified entity that operates exclusively for the purpose of providing surgical services to patients not requiring hospitalization.

(2) "Board" means the State Board of Podiatric Medical Examiners.

(3) "Department" means the State Department of Health and Mental Hygiene, the single State agency designated to administer the Maryland Medical Assistance Program under Title XIX of the Social Security Act, 42 U.S.C. 1396 et seq.

(4) "Emergency services" means treatment for traumatic injury or infection other than athlete's foot or chronic mycotic infection of the nail bed.

(5) "Hospital" means an institution which falls within the jurisdiction of Health-General Article, Title 19, Subtitle 3, Annotated Code of Maryland, and is licensed pursuant to COMAR 10.07.01, or other applicable standards established by the state in which the service is provided.

(6) "Medical Assistance Program" means a program of comprehensive medical and other health-related care for indigent and medically indigent persons.

(7) "Medically necessary" has the meaning stated in COMAR 10.09.36.01A.

(8) "Medicare" means the insurance program administered by the Federal Government under Title XVIII of the Social Security Act, 42 U.S.C. 1395 et seq.

(9) "Nursing facility" means a skilled nursing facility certified for participation pursuant to Title XVIII or Title XIX of the Social Security Act, or an intermediate care facility certified for participation pursuant to Title XIX of the Social Security Act, which has entered into a provider agreement with the Department.

(10) "Participant" means an individual who is certified as eligible for, and is receiving, Medical Assistance benefits.

(11) "Personal hygiene care" means routine hygienic care in the absence of pathology.

(12) "Podiatrist" means a Doctor of Podiatry (D.P.M.) who is licensed to practice podiatry by the Board or by the state in which the service is rendered.

(13) Practice Podiatry.

(a) "Practice podiatry" means to diagnose or surgically, medically, or mechanically treat any ailment of the:

(i) Human foot or ankle;

(ii) Anatomical structures that attach to the human foot; or

(iii) Soft tissue below the midcalf.

(b) "Practice podiatry" does not include:

(i) Surgical treatment of acute ankle fracture; or

(ii) Administration of an anesthetic, other than a local anesthetic.

(14) "Preauthorization" means an approval required from the Department or its designee before rendering services.

(15) "Program" means the Maryland Medical Assistance Program.

(16) "Provider" means an individual, association, partnership, or an incorporated or unincorporated group of podiatrists, duly licensed to provide services for participants, and who, through appropriate agreement with the Department, has been identified as a Program provider by the issuance of an individual account number.

(17) "Routine care" means the cutting or removing of corns and calluses, and the trimming, cutting, clipping, or debriding of toenails.

(18) "Utilization control agent" means the organization responsible for reviewing the use of medical services to determine medical necessity and lengths of stay according to professional standards.

Md. Code Regs. 10.09.15.01

Regulation .01 amended effective June 14, 1999 (26:12 Md. R. 925)
Regulation .01B amended effective January 2, 2006 (32:26 Md. R. 1997); August 27, 2007 (34:17 Md. R. 1507)
Regulation .01P adopted effective February 15, 1982 (9:3 Md. R. 221); amended effective 45:14 Md. R. 696, eff. 7/16/2018