Md. Code Regs. 10.18.06.07

Current through Register Vol. 51, No. 12, June 14, 2024

Section 10.18.06.07 - Payment Procedures

A. Except as provided in §§B and C of this regulation, the Department shall pay a pharmacy in accordance with the procedures of the Medical Assistance Pharmacy Services Program set forth at COMAR 10.09.03.07.

B. If the Department or the recipient tells the pharmacy that the recipient has or may have third-party insurance coverage to offset some or all of the cost for services provided under MADAP, the pharmacy shall:

(1) Bill the third-party payer the pharmacy's usual and customary charge for the services provided; and

(2) Bill the Department for the difference between the pharmacy's usual and customary charge and the anticipated third-party receipts.

C. If the recipient has third-party insurance coverage, the Department shall pay the pharmacy the difference between the pharmacy's usual and customary charge and the anticipated third-party insurance receipts, not to exceed the amount permitted under COMAR 10.09.03.07F and G.

D. The Department shall make payments related to MADAP in accordance with any applicable policies and procedures for the administration of federal funds issued pursuant to the Ryan White HIV/AIDS Treatment Extension Act of 2009, and any subsequent modifications to the Act.

Md. Code Regs. 10.18.06.07

Regulations .07 adopted as an emergency provision effective November 27, 2002 (29:25 Md. R. 1979); adopted permanently effective February 17, 2003 (30:3 Md. R. 180); amended effective 43:6 Md. R. 408, eff.3/28/2016