<?xml version='1.0' encoding='utf-8'?>
<regulation prefix="Regulation" num=".05" citation="COMAR 10.09.08.05" title_num="10" subtitle_num="09" chapter_num="08" heading="Federally Qualified Health Center Services.">
  <paragraph num="A.">
    <text>To participate as a federally qualified health center, the provider shall meet the requirements of Regulations .03 and .04B of this chapter and shall:</text>
    <paragraph num="(1)">
      <text>Meet the conditions for coverage in accordance with 42 CFR §491, Subpart A;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Be enrolled in the EPSDT/Healthy Kids Program as provided in COMAR 10.09.23 and provide EPSDT/Healthy Kids services to participants who are eligible to receive them;</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Supply the Department with financial and other information as requested;</text>
    </paragraph>
    <paragraph num="(4)">
      <text>Meet one of the following conditions:</text>
      <paragraph num="(a)">
        <text>Meet all of the requirements for receiving a grant under §329, 330, or 340 of the Public Health Service Act, 42 U.S.C. §254(c), as determined by the Secretary of the United States Department of Health, and in accordance with 42 CFR §405.2401;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Receive a waiver from the Secretary of the United States Department of Health and Human Services of one or more of the requirements for receiving a grant pursuant to §329, 330, or 340 of the Public Health Service Act; or</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Be an outpatient health program or facility operated by a tribe or tribal organization under the Indian Self-Determination Act or by an Urban Indian organization receiving funds under Title V of the Indian Health Care Improvement Act;</text>
      </paragraph>
    </paragraph>
    <paragraph num="(5)">
      <text>Comply with the requirements contained in COMAR 10.09.59 if delivering mental health services and COMAR 10.09.80 when providing substance use disorder services; and</text>
    </paragraph>
    <paragraph num="(6)">
      <text>Comply with the requirements contained in COMAR 10.09.05, if rendering dental services.</text>
    </paragraph>
  </paragraph>
  <paragraph num="B.">
    <text>Covered services are the same as those authorized to be provided by rural health clinics as described in 42 CFR §440.20(b), rural health clinic services, and 42 CFR §440.20(c), other ambulatory services furnished by a rural health clinic.</text>
  </paragraph>
  <paragraph num="C.">
    <text>In the event that the provider elects to institute a scope of services change, the provider shall:</text>
    <paragraph num="(1)">
      <text>Notify the Department of its intent to institute the scope of services change:</text>
      <paragraph num="(a)">
        <text>Not later than 30 days before it begins to deliver services under the scope of services change; or</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Within 30 days after the adoption of this section; and</text>
      </paragraph>
    </paragraph>
    <paragraph num="(2)">
      <text>Provide the Department with any information the Department needs to:</text>
      <paragraph num="(a)">
        <text>Assure continuity of care for enrollees;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Arrange for the processing and payment of claims; or</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Otherwise administer services to Medical Assistance participants under the provider's scope of services change.</text>
      </paragraph>
    </paragraph>
  </paragraph>
  <paragraph num="D.">
    <text>Rate Revisions for FQHCs Due to Scope of Services Change or Extraordinary One-Time Circumstance.</text>
    <paragraph num="(1)">
      <text>If an FQHC implements a change in the FQHCs scope of services or if the FQHC experiences an extraordinary one-time circumstance, the FQHC or the Department may request a revision of the FQHC's prospective rate of reimbursement.</text>
    </paragraph>
    <paragraph num="(2)">
      <text>The FQHC shall provide the Department with written notification no later than 30 days after the implementation of the scope of services change or the occurrence of the one-time circumstance.</text>
    </paragraph>
    <paragraph num="(3)">
      <text>After receiving notification from an FQHC that the FQHC plans to institute a scope of services change, the Department shall notify the FQHC within 30 days if the Department wishes to request a revision to an FQHC's rate.</text>
    </paragraph>
    <paragraph num="(4)">
      <text>An FQHC or the Department may not request more than one rate revision per FQHC per calendar year under this regulation.</text>
    </paragraph>
    <paragraph num="(5)">
      <text>When an FQHC or the Department requests a rate revision based on §D(1) of this regulation, the FQHC shall submit to the Department or its designee a cost report and supporting documentation.</text>
    </paragraph>
    <paragraph num="(6)">
      <text>The cost report and supporting documentation required under §D(5) of this regulation shall:</text>
      <paragraph num="(a)">
        <text>Be submitted within 90 days after the end of the first 1-year period immediately following the implementation of the scope of service change or the occurrence of the extraordinary one-time circumstance;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Reflect the change in costs relating to the rate revision request for the center's operations for the first 1-year period immediately following the implementation of the scope of service change or the occurrence of the extraordinary one-time circumstance;</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Conform with the standards described in §C of this regulation and instructions issued by the Department or its designee;</text>
      </paragraph>
      <paragraph num="(d)">
        <text>Contain an explanation of the scope of services change or extraordinary one-time circumstance and schedules to support the calculation of the change in the cost-per-visit rate; and</text>
      </paragraph>
      <paragraph num="(e)">
        <text>Be subject to verification and adjustment by the Department or its designee.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(7)">
      <text>Rate revisions granted under this section shall be effective the date the change of scope was approved by the Health Resources and Services Administration (HRSA) or the occurrence of the extraordinary one-time circumstance.</text>
    </paragraph>
    <paragraph num="(8)">
      <text>The revised rate granted under this section shall be the rate referenced in §A(3) of this regulation.</text>
    </paragraph>
  </paragraph>
  <paragraph num="E.">
    <text>Rates of reimbursement established according to this regulation shall be for:</text>
    <paragraph num="(1)">
      <text>Payment of covered services rendered to participants; and</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Determining supplemental payments under COMAR 10.09.65.21A.</text>
    </paragraph>
  </paragraph>
</regulation>