Md. Code Regs. 10.09.77.01

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

Section 10.09.77.01 - Definitions

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

B. Terms Defined.

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

(2) "Free-standing clinic" means a health care facility that is not licensed as a hospital, part of a hospital, or nursing home and is not administratively part of a physician's, dentist's, or osteopath's office, but which has a separate staff functioning under the direction of a clinic administrator or health officer and is organized and operated to provide ambulatory health services.

(3) "Free-standing urgent care center" means a location, distinct from a hospital emergency room, a physician's office, or a free-standing clinic, whose purpose is to diagnose and treat illness or injury for unscheduled, ambulatory patients seeking immediate medical attention.

(4) "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.

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

(6) "Medically necessary" means that the service or benefit is:

(a) Directly related to diagnostic, preventive, curative, palliative, rehabilitative, or ameliorative treatment of an illness, injury, disability, or health condition;

(b) Consistent with currently accepted standards of good medical practice;

(c) The most cost efficient service that can be provided without sacrificing effectiveness or access to care; and

(d) Not primarily for the convenience of the consumer, family, or provider.

(7) "Medicare" means the insurance program administered by the federal government under Title XVIII of the Social Security Act, U.S.C. §1395 et seq.

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

(9) "Patient" means a participant awaiting or undergoing health care or treatment.

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

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

(12) "Provider" means a free-standing urgent care center which, through appropriate agreement with the Department, has been identified as a Program provider by the issuance of a Medical Assistance provider number.

(13) "Urgent care" means the delivery of ambulatory care, such as for acute illnesses or minor traumas, in a facility dedicated to the delivery of unscheduled, walk-in care outside of a hospital emergency department, a free-standing clinic, or a physician's office.

Md. Code Regs. 10.09.77.01

Regulation .01 amended effective 50:13 Md. R. 512, eff. 7/10/2023