Md. Code Regs. 10.09.57.01

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

Section 10.09.57.01 - Definitions

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

B. Terms Defined.

(1) "Applicant" means an entity which submits an application to become a partially capitated provider.

(2) "Capitation payment" means the sum of money paid by the Program on behalf of an enrollee on a regular periodic per capita basis for capitated services.

(3) "Capitated services" means a service provided by a PCP or one of its subcontractors for which the Department has agreed to pay a capitation payment to the PCP.

(4) "Department" means the 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.

(5) "Enrollee" means a recipient who has entered into an agreement to receive certain Medical Assistance services from or through a PCP.

(6) "Medical Assistance Program" has the meaning stated in COMAR 10.09.36.01B.

(7) "Partially capitated provider (PCP)" means a public or private legal entity which is organized for the purpose of providing or arranging for the provision of medical and health-related services which meets the conditions for participation in Regulations .02 and .03 of this chapter for enrollment and which is eligible to enter into a contract with the Department to receive a capitated payment for a limited number of services.

(8) "Program" means the Maryland Medical Assistance Program as defined in COMAR 10.09.36.01B.

(9) "Provider" means a partially capitated provider.

(10) "Provider agreement" means the agreement between the Department and the partially capitated provider which specifies the terms of the relationship between the Department and the provider, and includes the amount of the capitation payment and the specific services to be provided for the capitation payment.

(11) "Recipient" has the meaning stated in COMAR 10.09.36.01B.

Md. Code Regs. 10.09.57.01

Regulations .01 adopted as an emergency provision effective June 14, 1995 (22:14 Md. R. 1051); adopted permanently effective October 23, 1995 (22:21 Md. R. 1616)