Md. Code Regs. 10.14.02.04-1

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

Section 10.14.02.04-1 - Physician Assistant Services

A. To be considered a participating physician assistant in the Program, the provider shall:

(1) Be licensed to practice as a physician assistant in Maryland or a jurisdiction bordering Maryland;

(2) Have a current written executed delegation agreement with a licensed supervising physician who is licensed to practice medicine in Maryland or a jurisdiction bordering on Maryland, if required by that jurisdiction;

(3) Agree to accept, for each reimbursed medical procedure performed or service provided, the following reimbursement including, if applicable, a medical management fee as described in Regulation .15 of this chapter:

(a) The current Medical Assistance approved rate in the State of an eligible patient who is uninsured or has insurance that does not provide coverage for a certain procedure or services;

(b) The reimbursement rate approved by the insurer plus the payment of the deductible and patient contribution amount by the Department for an eligible patient who has insurance, other than Medicare, that provides coverage for a certain procedure or service;

(c) The reimbursement rate approved by Medicare plus the payment of the deductible and patient contribution amount by the Department for an eligible patient who is covered by Medicare only; or

(d) For an eligible patient who has insurance that provides coverage for a reimbursed procedure or service that is less than the current Medical Assistance approved rate, the reimbursement rate approved by the insurer plus the difference between the reimbursement rate approved by the insurer, and the Medical Assistance approved rate in the State plus the payment of the deductible and patient contribution amount by the Department;

(4) Agree to abide by the provisions set forth in this section by signing and sending to the Department the designated Departmental form; and

(5) Agree to the medical, financial, and reporting requirements of the Program pursuant to Regulation .04A(5), (6), (7)(a)-(e), and (8)-(10) of this chapter.

B. An eligible health care provider may be a physician assistant.

C. The reimbursed medical services include services related to breast and cervical cancer rendered to participants in accordance with:

(1) The functions allowed under:

(a) The Physician Assistant's Practice Act;

(b) COMAR 10.32.03; and

(c) The physician assistant's written delegation agreement with a physician; or

(2) If out-of-State, the functions authorized in the state in which the services are provided.

D. Non-reimbursed medical procedures and services include a procedure or service not related to the diagnosis and treatment of breast and cervical cancer.

E. The participating physician assistant shall accept the responsibilities pursuant to Regulation .04E-G of this chapter.

Md. Code Regs. 10.14.02.04-1

Regulations .04-1 adopted effective 47:10 Md. R. 515, eff. 5/18/2020