Md. Code Regs. 10.09.23.03

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

Section 10.09.23.03 - Conditions for Participation

A. In order to receive payments as a Medicaid provider, providers shall meet the following general requirements:

(1) All conditions for participation set forth in COMAR 10.09.36;

(2) If delivering services via telehealth, comply with COMAR 10.09.49 and any subregulatory guidance issued by the Department;

(3) The licensure and provider qualification requirements in Regulation .02 of this chapter; and

(4) Verify the licenses and credentials of all professionals employed or contracted by the provider, and keep on file documentation of how that verification was completed.

B. To be certified to participate in the Healthy Kids Program as an EPSDT screening provider, a provider shall agree to:

(1) Provide EPSDT comprehensive well-child services as outlined in the EPSDT periodicity schedule and in a manner prescribed by the Department;

(2) Provide or arrange for referral, diagnosis, treatment, and follow-up when the screening indicates a need for additional services;

(3) Inform the parent or guardian of the next preventive health care visit, and assist with scheduling;

(4) Cooperate with Departmental efforts to assure that children receive needed follow-up and treatment services;

(5) Conform to the equipment, facilities, and procedural standards set by the Department;

(6) Maintain a patient record system that is sufficiently detailed and current to allow another physician who is unfamiliar with the patient to properly continue treatment in the absence of the initial provider;

(7) Participate in the Vaccines for Children Program;

(8) Permit periodic on-site quality assurance visits by the Department or its designee following a protocol established by the Department to:

(a) Assure that the equipment necessary to perform required procedures is available;

(b) Review the charts of participants to assure delivery of EPSDT screens;

(c) Determine that required procedures are being performed correctly and that appropriate follow-up is provided; and

(d) Assess the need for any follow-up provider training, staff training, technical assistance, or in-service training; and

(9) Maintain a minimum score of 80 percent on all Healthy Kids Program quality assurance reviews.

C. An MCO that has contracted with the Department shall ensure its enrollees have access to EPSDT comprehensive well-child services in accordance with COMAR 10.09.66.05A(3).

Md. Code Regs. 10.09.23.03

Regulations .03 adopted effective March 22, 2010 (37:6 Md. R. 477); amended effective 44:4 Md. R. 253, eff. 2/27/2017; amended effective 50:15 Md. R. 681, eff. 8/7/2023