Md. Code Regs. 10.14.02.22

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

Section 10.14.02.22 - Maryland Health Insurance Plan Coverage

A. In lieu of providing direct reimbursement to participating health care providers, the Program may pay MHIP, if available, to provide health coverage for individuals enrolled in the Program who are also eligible for MHIP.

B. The Program may pay MHIP, if available, for health coverage for eligible patients, including:

(1) MHIP premiums;

(2) Pre-existing condition buy-downs; and

(3) Any MHIP fees.

C. The Program may not pay any amount to MHIP, if available, for an eligible patient's spouse, children, or other family members enrolled in MHIP.

D. Fees Reimbursable to Participating Providers.

(1) The Program may reimburse participating health care providers for a bill the provider submits to the Department for patient contribution amounts and deductibles for services directly related to the treatment of breast and cervical cancer for individuals enrolled in MHIP through the Program, if funding is available for the payment of patient contribution amounts and deductibles under this section.

(2) The Program's decision regarding whether to pay for patient contribution amounts and deductibles shall be based solely on the availability of funding and may not be contingent upon any other factor.

(3) If MHIP does not provide coverage for a service covered by this chapter, the Program shall reimburse the participating health care provider as otherwise provided by this chapter.

(4) To obtain reimbursement, the participating health care provider shall submit to the Program:

(a) The bill for the service on the form designated by the Department; and

(b) A copy of the explanation of benefits or denial from MHIP.

E. Payment to MHIP.

(1) The Department shall submit timely payments to MHIP for premiums, pre-existing condition buy-downs, and any MHIP fees for individuals enrolled in MHIP through the Program.

(2) The Department shall work with the designated MHIP staff to assure timely payments of MHIP invoices for individuals enrolled in MHIP through the Program to:

(a) Preserve MHIP coverage; and

(b) Resolve any existing issues related to the payment of MHIP premiums.

Md. Code Regs. 10.14.02.22

Regulation .22 amended as an emergency provision effective 41:2 Md. R. 88, eff.1/1/2014 ; amended permanently effective 41:9 Md. R. 521, eff.5/12/2014 ; amended effective 47:10 Md. R. 515, eff. 5/18/2020