Md. Code Regs. 10.09.92.03

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

Section 10.09.92.03 - Conditions for Participation

A. A provider shall meet all conditions for participation as set forth in COMAR 10.09.36.03.

B. To participate in the Program as an acute hospital services provider, the provider shall:

(1) Meet the requirements of Title XLX of the Social Security Act for participation as a hospital, as issued by the Department of Health and Human Services;

(2) Directly provide or make available through contractual arrangements or transfer agreements, medically necessary covered services;

(3) Accept payment by the Program as payment in full for the covered service;

(4) Make available to the Department or its designee the participant's medical record for review and certification of medical necessity for admission and continuation of stay;

(5) Maintain documentation of each contact with the participant as part of the complete medical record, which, at a minimum, includes:

(a) Date of service;

(b) The participant's chief medical complaint or reason for visit;

(c) A description of the services provided, including:

(i) Progress notes;

(ii) Imaging studies;

(iii) Laboratory results;

(iv) Medication administration records; and

(v) Discharge summary; and

(d) A signature, electronic or handwritten, along with the printed or typed name of the individual providing care, with the appropriate title; and

(6) If the hospital provider is the only hospital within the county, participate with each participating HealthChoice Managed Care Organization in the county.

C. If an out-of-State or District of Columbia hospital, the hospital shall:

(1) Unless a waiver has been granted by the Secretary of Health and Human Services, have in effect a utilization review plan applicable to all participants who receive Medical Assistance under Title XVII of the Social Security Act which meets the requirements of § 1861(k) of the Social Security Act; and

(2) Comply with applicable regulations of this chapter and COMAR 10.09.36.

Md. Code Regs. 10.09.92.03

Regulation .03 adopted effective 44:7 Md. R. 354, eff. 4/10/2017