<?xml version='1.0' encoding='utf-8'?>
<regulation prefix="Regulation" num=".03" citation="COMAR 10.09.04.03" title_num="10" subtitle_num="09" chapter_num="04" heading="Conditions for Participation.">
  <paragraph num="A.">
    <text>To be a provider, a home health agency shall be a participating home health agency under Medicare.</text>
  </paragraph>
  <paragraph num="B.">
    <text>To participate in the Program, the home health agency shall:</text>
    <paragraph num="(1)">
      <text>Apply for participation in the Program using the form designated by the Department;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Be approved for participation by the Department;</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Have in effect a provider agreement with the Department;</text>
    </paragraph>
    <paragraph num="(4)">
      <text>Accept payment by the Department as payment in full for covered services rendered and make no additional charge to any person for covered services;</text>
    </paragraph>
    <paragraph num="(5)">
      <text>Provide verification to the Department, in the manner prescribed by the Department, of all changes in the provider's charges within 10 days of the occurrence of the changes;</text>
    </paragraph>
    <paragraph num="(6)">
      <text>Maintain all patient care, medical supply, timesheets, official agency recipient or witness signature records, and billing records for a minimum of 6 years after completion of an audit by the Department and make them available, upon request, to the appropriate State and federal personnel or their designees during office hours;</text>
    </paragraph>
    <paragraph num="(7)">
      <text>Secure from the participant's physician, physician assistant, certified nurse midwife, or certified nurse practitioner a written plan of treatment which relates the items and services to the participant's medical condition;</text>
    </paragraph>
    <paragraph num="(8)">
      <text>Maintain a participant's plan of care based on the physician's, physician assistant's, certified nurse midwife's, or certified nurse practitioner's plan of treatment for the participant;</text>
    </paragraph>
    <paragraph num="(9)">
      <text>Provide services without regard to race, color, age, sex, national origin, marital status, or physical or mental handicap;</text>
    </paragraph>
    <paragraph num="(10)">
      <text>Verify the participant's eligibility;</text>
    </paragraph>
    <paragraph num="(11)">
      <text>Place no restriction on a participant's right to select his choice of providers under this subtitle;</text>
    </paragraph>
    <paragraph num="(12)">
      <text>Agree that if the Program denies payment or requests repayment on the basis that an otherwise covered service was not medically necessary, the provider may not seek payment for that service from the participant;</text>
    </paragraph>
    <paragraph num="(13)">
      <text>Agree that if the Program denies payment due to late billing, the provider may not seek payment from the participant;</text>
    </paragraph>
    <paragraph num="(14)">
      <text>Provide services in person unless expressly authorized by the Department to render services via telehealth; and</text>
    </paragraph>
    <paragraph num="(15)">
      <text>If not rendering services in person, comply with COMAR 10.09.49 and any subregulatory guidance issued by the Department.</text>
    </paragraph>
  </paragraph>
  <paragraph num="C.">
    <text>Plan of Treatment.</text>
    <paragraph num="(1)">
      <text>The plan of treatment under §B(8) shall include:</text>
      <paragraph num="(a)">
        <text>Prognosis;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Diagnoses;</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Treatment goals;</text>
      </paragraph>
      <paragraph num="(d)">
        <text>Frequency of visits for each type of service ordered;</text>
      </paragraph>
      <paragraph num="(e)">
        <text>Duration of treatment of each type of service ordered;</text>
      </paragraph>
      <paragraph num="(f)">
        <text>Rehabilitation potential;</text>
      </paragraph>
      <paragraph num="(g)">
        <text>Functional limitations;</text>
      </paragraph>
      <paragraph num="(h)">
        <text>Permitted and prohibited activities;</text>
      </paragraph>
      <paragraph num="(i)">
        <text>Diet;</text>
      </paragraph>
      <paragraph num="(j)">
        <text>Medications;</text>
      </paragraph>
      <paragraph num="(k)">
        <text>Treatments;</text>
      </paragraph>
      <paragraph num="(l)">
        <text>Mental status;</text>
      </paragraph>
      <paragraph num="(m)">
        <text>Medical supplies;</text>
      </paragraph>
      <paragraph num="(n)">
        <text>Durable medical equipment;</text>
      </paragraph>
      <paragraph num="(o)">
        <text>Safety measures to protect against injury; and</text>
      </paragraph>
      <paragraph num="(p)">
        <text>Other appropriate items.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(2)">
      <text>The plan of treatment shall be reviewed, updated, and signed at least every 60 days by the participant's physician, physician assistant, certified nurse midwife, or certified nurse practitioner, in consultation with the registered nurse or the case coordinator.</text>
    </paragraph>
    <paragraph num="(3)">
      <text>The physician, physician assistant, certified nurse midwife, or certified nurse practitioner shall:</text>
      <paragraph num="(a)">
        <text>Sign and date the initial plan of treatment; and</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Document that the physician or nonphysician practitioner, who is not employed by the home health agency, has had a face-to-face encounter with the participant no more than 90 days before the home health start of care date or within 30 days of the start of the home health care, including the date of the encounter.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(4)">
      <text>For participants admitted immediately to home health upon discharge from a hospital or post-acute setting, the attending acute or post-acute physician shall document the clinical findings of the face-to-face encounter.</text>
    </paragraph>
    <paragraph num="(5)">
      <text>The plan of treatment shall be part of the provider's permanent record for the participant.</text>
    </paragraph>
  </paragraph>
  <paragraph num="D.">
    <text>Plan of Care.</text>
    <paragraph num="(1)">
      <text>For each type of service ordered, the plan of care under §C(9) shall, at a minimum, include:</text>
      <paragraph num="(a)">
        <text>Goals of treatment;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Actions or procedures needed to meet the goals;</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Dates the goals are expected to be achieved;</text>
      </paragraph>
      <paragraph num="(d)">
        <text>Problems encountered, if any;</text>
      </paragraph>
      <paragraph num="(e)">
        <text>Revision of goals and actions or procedures, whenever necessary; and</text>
      </paragraph>
      <paragraph num="(f)">
        <text>Appropriate discharge activities.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(2)">
      <text>The plan of care shall be reviewed, dated, and signed at least every 60 days by the registered nurse or the case coordinator upon consultation with the appropriate health team.</text>
    </paragraph>
    <paragraph num="(3)">
      <text>The plan of care is a part of the provider's permanent record for the participant.</text>
    </paragraph>
  </paragraph>
</regulation>