<?xml version='1.0' encoding='utf-8'?>
<regulation prefix="Regulation" num=".06" citation="COMAR 10.09.18.06" title_num="10" subtitle_num="09" chapter_num="18" heading="Prepayment Authorization Requirements.">
  <paragraph num="A.">
    <text>The following items require a written prepayment authorization:</text>
    <paragraph num="(1)">
      <text>Nasal continuous positive pressure (NCPAP) system;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Custom made tracheostomy tubes; and</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Intermittent positive pressure breathing (IPPB) machine.</text>
    </paragraph>
  </paragraph>
  <paragraph num="B.">
    <text>Prepayment authorization is issued when:</text>
    <paragraph num="(1)">
      <text>Program procedures are met;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Program limitations are met; and</text>
    </paragraph>
    <paragraph num="(3)">
      <text>The Prescriber submits to the Department adequate documentation demonstrating that the service to be preauthorized is medically necessary.</text>
    </paragraph>
  </paragraph>
  <paragraph num="C.">
    <text>The prescriber shall submit requests for prepayment authorization in writing using the format and procedures designated by the Department.</text>
  </paragraph>
  <paragraph num="D.">
    <text>Prepayment authorization, when required, may be requested via a facsimile machine to expedite hospital, nursing facility, or other medical institutional discharge or in emergency situations approved by the Program. In this case, the facsimile of the completed prepayment authorization form shall be followed by a written request, using the original of the form, which shall be submitted immediately to the Department.</text>
  </paragraph>
  <paragraph num="E.">
    <text>Written prepayment authorization is valid for a period to be determined by the Program but not to exceed a maximum of 365 days beginning with the date of issue by the Program, and is contingent on the recipient's continuing eligibility.</text>
  </paragraph>
  <paragraph num="F.">
    <text>Prepayment authorization normally required by the Program is waived when the services are covered and approved by Medicare. However, if the entire or any part of a claim is rejected by Medicare, and the claim is referred to the Program for payment, payment will be made for services covered by the Program only if authorization for those services has been obtained before billing. Non-Medicare claims require prepayment authorization according to §§A—E of this regulation.</text>
  </paragraph>
</regulation>