Title 10 — Subtitle 04. Fiscal

In this chapter, the following terms have the meanings indicated.

Terms Defined.

For fiscal year 2013 and each subsequent fiscal year, each subdivision shall receive, at a minimum, the amount of State matching funds distributed in fiscal year 2012 for local health services.

The annual formula adjustment and any other adjustments for local health services shall be allocated to each subdivision based on each subdivision's percentage share of State funds distributed in the previous fiscal year, and to address a substantial change in community health need, if any, as determined in the discretion of the Secretary after consultation with local health officers.

As to appropriations referenced in Health-General Article, §2-302, Annotated Code of Maryland, local matching funds shall be required as a condition of any distribution to a subdivision.

The local match percentage for each subdivision shall equal the percentage required for each subdivision for fiscal year 1996.

An operating budget to implement each local health department's projects for the next fiscal year, funded partially or wholly from funds provided through local health services, shall be prepared in sufficient detail and submitted to the Department for the Secretary to determine the acceptability of the budget.

The format, content, and submission date of the budget shall be as set forth in the annual local health department budget instructions available on the Department's website or as otherwise determined by the Secretary.

Each position shall be accounted for in only one project; however, funding for a position may be split among several projects.

An agreement form signed by the county executive authority and the health officer of the subdivision shall be transmitted to the Department by a date established by the Secretary for the upcoming State fiscal year. The agreement shall include, but is not limited to, the following:

If the subdivision elects to make an audit as described in §D(3) of this regulation, the audit shall be done within 3 years after the close of the fiscal year that is the subject of the audit.

On approval by the Secretary, the budget containing State and federal funds and the required local matching funds shall be used as the basis of operation by the health officer for State-supported services.

Any substantive change in local health projects during the fiscal year is subject to Departmental review and approval, as set forth in the annual local health department budget instructions.

Cash Transactions.

Purpose of Expenditure. State funds and local matching funds may only be expended if the activity to be funded is:

Procurement. If authorized by the principal executive or legislative authority of the subdivision's government in accordance with local ordinance, a local health department may use either the State procurement system or the procurement system of the subdivision in which the local health department is located. In the absence of such authorization, a local health department shall use the State procurement system in accordance with State Finance and Procurement Article, Annotated Code of Maryland, and COMAR Title 21.

Expense Accounts. Amounts spent to reimburse personnel for travel expenses in accordance with COMAR 23.02.01 are eligible for State matching funds.

Employee Fringe Benefits. The employer's payments for Social Security, retirement systems, health insurance, and unemployment insurance are eligible for State matching funds.

Revenues. Amounts collected in accordance with COMAR 10.02.01 as the result of services rendered as part of local health services shall be treated as a reduction of expenditures for the corresponding project. Amounts collected by subdivisions shall be reported monthly to the Department.

Interest. A subdivision shall:

Prohibited Expenditures.

Insurance, Repair, and Maintenance of Physical Assets. The cost of insuring, repairing, or maintaining physical assets, the provision of which under this chapter is the responsibility of the subdivision, is not eligible for State matching funds.

Reimbursement for Injuries. Amounts paid as compensation for injury incurred in the line of duty, and injury other than as a result of malpractice occurring on the premises of a facility of a local health department, as well as the cost of insuring for this liability, are eligible for State matching funds.

Audits.

“Adjusted gross monthly income” means gross monthly income less allowable deductions as set forth in Regulation .04C(5), of this chapter.

“Assets” means all accumulated personal wealth over which a person has the authority or power to liquidate his interest, including but not limited to cash savings, savings accounts, certificates of deposit, money market certificates, checking accounts, stocks, bonds, real property, personal property, mortgages, and mutual funds.

“Chargeable person” means:

“Collectively” means pertaining to any combination of one or more responsible relatives.

“College expenses” means tuition cost for undergraduate studies.

“Department” means Maryland Department of Health.

“Dependent” means any person who qualifies as a dependent under the dependency test of the Internal Revenue Service.

“Gross monthly income” means total annual gross income divided by 12.

“Income” means a recurrent money benefit from any source.

“Individually” means pertaining to one sponsor.

“In-patient” means a person admitted to a State-operated facility.

“In-patient day.” The number of days of service received by a patient for in-patient services is always in units of full days; a day begins at midnight and ends 24 hours later. The midnight method is to be used for billing days of care of patients. A part of a day, including the day of admission, counts as a full day, however, the day of discharge, the day of death, or a day on which a patient begins a leave of absence is not counted as a day. If admission and discharge or admission and death occur the same day, the day is considered a day of admission and counts as one in-patient day.

“Monthly rate” means the charge as developed under Regulation .04C(9)(a) of this chapter.

“Patient” means in-patient.

“Payroll taxes” means Social Security, federal, State, and local income taxes.

“Rate” means monthly rate.

“Recipient of services” means an individual who receives care, maintenance, treatment, and support in a facility or program that is operated or funded wholly or partly by the Department.

“Responsible relative” means the:

“Secretary” means Secretary of Health.

“Sponsor” means responsible relative.

“State-operated facility” means those hospitals and centers as set forth in Health-General Article, §§7-305, 10-406, and 19-502, Annotated Code of Maryland.

“Total lifetime hospitalization” means the sum total of all periods of inpatient hospitalization for a recipient of services in any State hospital or facility whether these periods are intermittent or continuous.

“Treatment” means any process by which professional care or attention is given to a patient in a State-operated facility.

A recipient of services' primary liability-to-pay in-patient charges established in accordance with COMAR 10.02.01.04 shall be determined by conducting a financial investigation of the individual's income, assets, and expenses.

Notwithstanding any other provision of law to the contrary, the Department or its designated financial agent may obtain and use financial information and, if and when necessary, a summary of medical and psychological diagnoses regarding a recipient of services. If the obtaining and use of this information is connected to the Department's billing and collection functions under Health-General Article, Title 16, Annotated Code of Maryland:

If the financial information is connected to the treatment or care of a recipient of services, the Department or its designated financial agent may disclose the financial information to a designated clinical representative of a facility.

The Department may set the amount of payments retroactively:

The Department shall make a claim against all available income or assets, or both, of a recipient of services.

Health insurance coverage and other third party reimbursements correctly paid, or to be paid, for services provided by the Department shall be considered available for billing purposes.

For purposes of determining a recipient of services' financial capacity to contribute towards the cost of his or her care, the Department shall consider all of the recipient of services' assets and income to be available for billing purposes subject to certain billing reductions. In recognition of an individual's ongoing financial needs, the Department shall consider a reduction in a recipient of services' billing by permitting the income allowances, asset exemptions, and allowable expenses indicated below. A billing reduction may not be permitted unless and until the recipient of services submits appropriate written documentation demonstrating his or her entitlement to the billing reduction. Permitted billing reductions are as follows:

Monthly Rate. If a combined income is available, the monthly rate charged to the recipient of services and spouse will be computed according to Regulation .04, of this chapter.

Investigation of Financial Condition.

A maximum monthly charge for which responsible relatives may be held liable, within the scope of these regulations, will be developed by the Department in the following manner:

Procedure to be Followed for Computation of Monthly Rate.

This chapter shall apply to all contracts and grants made by the Maryland Department of Health with private vendors, grantees, and local health departments for which an audit is provided as described in State Finance and Procurement Article, §7-404, Annotated Code of Maryland.

The audit shall determine whether funds were spent in accordance with the contract or grant agreement.

The auditor shall review expenditures and revenues to determine if they are consistent with the approved budget and supported by documentation in accordance with the contract or grant agreement and generally accepted accounting principles.

The audit shall establish amounts due to or from the State by comparison of budgeted, reported, and audited expenditures net of revenues and funded amounts.

The audit findings shall be the basis for making a final settlement of the grant or contract.

The following terms have the meanings indicated.

Terms Defined.

The Secretary of Health shall provide for a periodic examination of the accounts and records of grantees and local health departments receiving funds under contracts and grants with the Department. In addition, periodic audits shall be conducted of the accounts and records of vendors providing purchase of care services for children, juveniles, and adults in non-governmental facilities. The purpose of the audit is to determine if the expenses incurred for which reimbursement was received were in accordance with allowable cost guidelines of the grant award and contractual agreement.

The Audit Division of the Maryland Department of Health shall be responsible for auditing the accounts and records of all grantees, local health departments, and vendors providing purchase of care services under grants and contracts with the Department, except for those grants and contracts with local governments for which audits have been conducted in accordance with the Single Audit Act of 1984. If these audits are not conducted, or are conducted but do not satisfy the information requirements of the Department, the Audit Division shall be responsible for such further auditing as it deems necessary under the circumstances.

The audits shall be conducted in accordance with the terms of the grant or contract, or both, and in accordance with allowable cost guidelines of the Maryland Department of Health and its various administrations.

The Audit Division of the Maryland Department of Health may audit a subgrantee, notwithstanding the responsibility of the primary grantee when it is in the interest of the State to do so. The Department, when it elects to audit a subgrantee, shall inform the primary grantee, in writing, that the primary grantee is absolved of the responsibility stated in Regulation .05C, of this chapter.

The Audit Division shall conduct an exit conference upon the conclusion of the audit. Before the exit conference the grantee, vendor, or local health department shall be given a draft audit report containing all findings, exceptions, and recommendations of the auditors. In addition, the draft report shall provide detailed information pertaining to amounts due to or from the State resulting from the audit.

The Audit Division, after consideration and evaluation of additional information and evidence presented subsequent to the promulgation of the draft audit report, shall issue a final audit report.

The final audit report shall be distributed to the:

The Audit Division in the final audit report shall:

The audits shall be performed at the intervals and in the manner approved and determined by the Secretary of Health or Director of the appropriate program administration, after consultation with the Chief of the Audit Division.

The grantee, provider, and local health departments shall provide full disclosure of all accounting, financial, and other records as needed, to the Audit Division during regular business hours of the audited organization.

The grantee, provider, and local health department shall retain all accounts and records of the grant or contract for a period of 5 years following the close of each fiscal year for audit by the Department.

Each primary grantee shall be responsible for auditing subgrantees in accordance with the chapter.

Each grantee shall maintain detailed accounting records as to receipts and expenditures of grant funds pertaining to the direct administration of the program. Each subgrantee is accountable to the primary grantee, who is responsible directly to the Division of Program Cost and Analysis of the Maryland Department of Health.

Revenues collected as a result of sale of goods and services rendered by persons or facilities receiving grant funds shall be credited to the grant program, and be applied as a reduction of the gross expenditures of the program. These revenues shall include fee collections, third-party payments, and proceeds from sales of goods obtained or manufactured with labor and materials paid for with grant funds. Revenues shall also include interest earned on deposited grant funds and contributions, with the exception of those contributions which are undesignated.

The grantee, provider, or local health department shall have the right to present additional information and evidence to support its position relative to the audit findings. This information and evidence may be presented at the exit conference or at any time before the issuance of the final audit report.

The following terms have the meanings indicated.

Terms Defined.

The Department may enter into an agreement with a vendor to provide human services.

The agreement shall specify that the Department and the vendor comply with requirements and procedures set forth in the “Human Services Agreements Manual”, which is incorporated by reference.

The Department shall supply each vendor with a copy of the “Human Services Agreements Manual”.