Md. Code Regs. 10.09.42.01

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

Section 10.09.42.01 - Definitions

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

B. Terms Defined.

(1) "Covered surgical procedures" means those surgical and other medical procedures which meet the criteria specified in 42 CFR Part 416, Subpart F, § 416.166(a) and (b), and which are published by the Centers for Medicare and Medicaid Services (CMS) in the Federal Register.

(2) "Dental Benefits Administrator (DBA)" means an entity that administers the dental program for the Department of Health and Mental Hygiene.

(3) "Dental services" means emergency, preventive, or therapeutic services for oral diseases which are administered by or under the general supervision of a dentist in the practice of the profession.

(4) "Department" means the Department as defined in COMAR 10.09.36.01A.

(5) "Free-standing Ambulatory Surgery Center (ASC)" means an entity capable of providing ambulatory surgical services, which is not located in a hospital setting, and which is Medicare-certified to furnish ambulatory surgical services.

(6) "Hospital" means any 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.

(7) "Medical Assistance Program" means the Medical Assistance Program as defined in COMAR 10.09.36.01A.

(8) "Medicare" means Medicare as defined in COMAR 10.09.36.01A.

(9) "Medicare-certified facility" means a facility which:

(a) Is certified for Medicare by the regional office of the Centers for Medicare and Medicaid Services (CMS) to furnish ambulatory surgical services directly to patients;

(b) Has an agreement with (CMS) under Medicare to participate as an ASC; and

(c) Meets the conditions set forth by (CMS) in 42 CFR Part 416, Subparts B, C, and F, § 416.163.

(10) "Patient" means a recipient awaiting or undergoing health care or treatment.

(11) "Physician" means an individual legally licensed to practice medicine in the state in which the physician's practice is located.

(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) "Program" means Program as defined in COMAR 10.09.36.

(14) "Provider" means a free-standing ambulatory surgical center which, through appropriate agreement with the Department, has been identified as a Program provider by the issuance of a provider account number.

(15) "Recipient" means recipient as defined in COMAR 10.09.36.01A.

Md. Code Regs. 10.09.42.01

Regulation .01B amended effective September 29, 2003 (30:19 Md. R. 1332); April 5, 2010 (37:7 Md. R. 571)
Regulation .01 amended effective 42:5 Md. R. 485, eff.3/16/2015