Md. Code Regs. 10.14.02.05

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

Section 10.14.02.05 - Nurse Practitioner Services

A. To be considered a participating nurse practitioner in the Program, the provider shall:

(1) Be a certified nurse practitioner in Maryland or a jurisdiction bordering Maryland;

(2) Have a current written attestation with a physician who is licensed to practice medicine in Maryland or a jurisdiction bordering 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 for an eligible patient who is uninsured or has insurance that does not provide coverage for a certain procedure or service;

(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 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 certified nurse practitioner.

C. The reimbursed medical procedure includes but is not limited to:

(1) Colposcopically directed cervical or vaginal biopsy or both;

(2) Colposcopy;

(3) Cyst aspiration;

(4) Endocervical curettage; and

(5) Endometrial biopsy if the patient has taken Tamoxifen for the treatment of breast cancer or if cervical cancer has been documented.

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 nurse practitioner shall accept the responsibilities pursuant to Regulation .04E, F, and G of this chapter.

Md. Code Regs. 10.14.02.05

Regulations .05 under new Chapter, Reimbursement for Breast and Cervical Cancer Diagnosis and Treatment, adopted as an emergency provision effective March 31, 1993 (20:8 Md. R. 715);
Regulations .05 adopted effective December 5, 1994 (21:24 Md. R. 1988)
Regulation .05A amended effective August 20, 2012 (39:16 Md. R. 1080)
Regulations .05 amended effective 42:7 Md. R. 569, eff.4/13/2015; amended effective 45:13 Md. R. 666, eff. 7/2/2018; amended effective 47:10 Md. R. 515, eff. 5/18/2020