Md. Code Regs. 10.12.02.05

Current through Register Vol. 51, No. 21, October 18, 2024

Section 10.12.02.05 - Reimbursements

A. Restrictions. A provider:

(1) May not charge the victim or the victim's family of an alleged rape, sexual offense, or child sexual abuse for a physical examination or an initial assessment for the purpose of establishing and gathering information and evidence as to the alleged crime or for emergency hospital treatment and follow-up medical testing performed up to 90 days after the initial physical examination;

(2) May not bill a victim of an alleged rape, sexual offense, or child sexual abuse, or the victim's family or private insurance, for any difference between charges and Department reimbursement; and

(3) Shall accept the Department's reimbursement as payment in full.

B. Physicians Providing Services to Victims of Alleged Rape or Sexual Offense.

(1) The Department shall pay a physician the physician's usual and customary fee not to exceed $80 for examination and collection of evidence, if the following are submitted to the Department of Health and Mental Hygiene, Center for Health Promotion, 300 West Preston Street, Suite # 410, Baltimore, MD 21201:

(a) The forms found in the Maryland State Police sexual assault kit, or comparable evidence collection kit, which are:

(i) Filled out completely;

(ii) Typed or legibly written;

(iii) Signed and dated by the examining physician; and

(iv) Bearing the police central complaint number or a similar police case identifier or a property-held number in accordance with Regulation .03B(1)(b) of this chapter; and

(b) A completed DHMH form 2923, as developed by the Department, containing the signature of the victim or the victim's representative, indicating informed consent for medical examination, collection of evidence, and release of information.

(2) The Department shall pay the physician's usual and customary fee for consultation and for rendering emergency hospital treatment and necessary follow-up medical testing obtained within 90 days of the initial physical examination, for injuries sustained as a result of alleged rape or sexual assault.

(3) If there is a physician's fee component in the emergency room rate as established by the Health Services Cost Review Commission, there is no additional payment for the physician.

C. Physicians Providing Services to Victims of Alleged Child Sexual Abuse.

(1) The Department shall pay a physician the physician's usual and customary fee or the customary fee of those individuals under the physician's supervision, qualified to participate in the gathering of information and evidence through an initial assessment as defined under Regulation .02B of this chapter, not to exceed $80 per hour for up to 5 hours. The Department shall pay a physician only if a report:

(a) Is filled out completely as to the assessment done;

(b) Is typed or legibly written;

(c) Is signed and dated by the physician or cosigned by the physician and other qualified professionals providing services;

(d) Includes the police central complaint number, a property-held number, or other case identifier; and

(e) Includes either a completed DHMH Form 2923 or 4456, as developed by the Department.

(2) If there is a physician's fee component in the emergency room or outpatient clinic rate as established by the Health Services Cost Review Commission, there is no additional payment for the physician.

D. Hospital. The Department shall pay the established rate as determined by the Health Services Cost Review Commission for the use of the emergency room or outpatient clinic and the daily in-hospital rate in case of hospitalization for physical injuries directly resulting from the alleged sexual assault or abuse.

E. Laboratory. The Department shall pay the established rate as defined by the Health Services Cost Review Commission for laboratory tests necessary to establish and gather information and evidence of the crime, and for screening of the victim for pregnancy and sexually transmitted infections.

F. Billing.

(1) Except as provided in §F(3) of this regulation, in order to get paid a provider shall submit itemized bills to the Department within 90 days of the rendering of care.

(2) If a provider submits a bill more than 90 days but less than 180 days after the initial physical examination, the provider shall submit a written request for payment stating the specific reasons why the itemized bills were not timely submitted in accordance with §F(1) of this regulation.

(3) The Department may pay bills received more than 90 days but less than 180 days after the initial physical examination if the Department determines that the provider has set forth a legitimate explanation for not submitting the bill within 90 days of rendering care.

(4) To identify the alleged sexual offense, a bill submitted by a provider under this chapter shall contain:

(a) A police central complaint number or other case identifier; or

(b) A property-held number assigned in accordance with Regulation .03B(1)(b)(ii) of this chapter when there is no police central complaint number or similar police case identifier because a criminal prosecution is not being pursued.

(5) The provider of services shall secure signed informed consent for examination and collection of evidence in cases of alleged rape or sexual offense with authorization for release of information on such forms (DHMH form 2923 or form 4456) as are developed by the Department. The providers shall supply the Department with any information requested concerning services rendered.

G. Payment under this chapter is contingent on the availability of funds according to State Finance and Procurement Article, §§7-234 and 7-235, Annotated Code of Maryland.

Md. Code Regs. 10.12.02.05

Regulation .05B, F amended effective December 29, 2008 (35:26 Md. R. 2249)