Md. Code Regs. 10.14.02.06

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

Section 10.14.02.06 - Nurse Anesthetist Services

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

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

(2) Be currently collaborating with an anesthesiologist or other physician who is licensed to practice medicine in Maryland or a jurisdiction bordering Maryland in the manner prescribed by COMAR 10.27.06 or by the jurisdiction in which the service is provided;

(3) Agree to accept, for each covered 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 who has insurance that does not provide coverage for a reimbursed procedure or service;

(b) The reimbursement rate approved by the insurer plus the payment of the deductible and the 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 reimbursement for a covered 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), (9), and (10) of this chapter.

B. An eligible health care provider may be a certified nurse anesthetist.

C. The reimbursed medical procedure is anesthesia required for the diagnosis and treatment of breast cancer or cervical cancer.

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

E. The participating nurse anesthetist provider shall accept the responsibilities pursuant to Regulation .04E(1)-(5), F, and G of this chapter.

Md. Code Regs. 10.14.02.06

Regulations .06 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 .06 adopted effective December 5, 1994 (21:24 Md. R. 1988)
Regulations .06 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