Md. Code Regs. 10.09.54.04

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

Section 10.09.54.04 - Conditions for Provider Participation - General Requirements

A. To participate as a provider of a service covered under this chapter, a provider shall:

(1) Meet all of the conditions for participation as a Maryland Medical Assistance Program provider as set forth in COMAR 10.09.36, except as otherwise specified in this chapter;

(2) Verify the qualifications of all individuals who render services on the provider's behalf, and provide a copy of the current license or credentials upon request;

(3) Implement the reporting and follow-up of incidents and complaints in accordance with the Department's established reportable events policy;

(4) Agree to cooperate with required inspections, reviews, and audits by authorized governmental representatives;

(5) Agree to provide services, and to subsequently bill the Department in accordance with the reimbursement methodology specified in this chapter for only those services covered under this chapter which have been:

(a) Pre-approved in the participant's plan of service;

(b) Provided in a manner consistent with the participant's plan of service; and

(c) Identified in the provider agreement as within the scope of the provider's Medicaid participation;

(6) Agree to maintain and have available written documentation of services, including dates and hours of services provided to participants, for a period of 6 years, in a manner approved by the Department;

(7) Agree not to suspend, terminate, increase, or reduce services for an individual without authorization from the Department and with consultation and agreement by the participant or a participant's representative when applicable;

(8) Submit a transition plan to the case manager and participant or participant's representative when applicable when suspending or terminating services;

(9) Verify Medicaid eligibility at the beginning of each month that services will be rendered;

(10) Not be a Medicaid provider or principal of a Medicaid provider that has overpayments that remain due to the Department;

(11) Notify the Department in writing at least 45 days in advance of any:

(a) Voluntary closure;

(b) Change of ownership;

(c) Change of location;

(d) Sale of the business;

(e) Change in the name under which the provider is doing business; or

(f) Change in provider tax identification number;

(12) Include in the notice to the Department regarding any change of status under §A(11) of this regulation, the method for informing waiver participants and representatives of its intent to close, change ownership, change location, or sell its business;

(13) Apply for a new license if applicable, whenever ownership is to be transferred from the person or organization named on the license to another person or organization in time to assure continuity of waiver services;

(14) Submit a Medicaid provider application to the Department if the new owner chooses to participate in the waiver program;

(15) Render services in person, except as expressly authorized by the Department in the regulation governing that service type; and

(16) If rendering services via telehealth, comply with COMAR 10.09.49 and any subregulatory guidance issued by the Department.

B. To participate as a provider of a service covered under this chapter, a provider or its principals may not, within the past 24 months, have:

(1) Had a license or certificate suspended or revoked as a health care provider, health care facility, or provider of direct care services;

(2) Undergone the imposition of sanctions under COMAR 10.09.36.08;

(3) Been subject to disciplinary action, including actions by the licensing board, that indicate behavior which is potentially harmful to participants;

(4) Been cited by a State agency for deficiencies which affect participants' health and safety; or

(5) Experienced a termination of a Medicaid provider agreement or been barred from work or participation by a public or private agency due to:

(a) Failure to meet contractual obligations; or

(b) Fraudulent billing practices.

C. A provider who renders health-related services to participants shall agree to:

(1) Periodically indicate the condition of a participant in accordance with the procedures and forms designated by the Department; and

(2) Share and discuss the documented information at the request of the participant.

Md. Code Regs. 10.09.54.04

Regulations .04 adopted as an emergency provision effective July 22, 1993 (20:16 Md. R. 1275); adopted permanently effective October 26, 1993 (20:21 Md. R. 1654)
Regulations .04 adopted effective 41:8 Md. R. 471, eff.4/28/2014 ; amended effective 50:23 Md. R. 1004, eff. 11/27/2023