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<regulation prefix="Regulation" num=".03" citation="COMAR 10.09.23.03" title_num="10" subtitle_num="09" chapter_num="23" heading="Conditions for Participation.">
  <paragraph num="A.">
    <text>In order to receive payments as a Medicaid provider, providers shall meet the following general requirements:</text>
    <paragraph num="(1)">
      <text>All conditions for participation set forth in COMAR 10.09.36;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>If delivering services via telehealth, comply with COMAR 10.09.49 and any subregulatory guidance issued by the Department;</text>
    </paragraph>
    <paragraph num="(3)">
      <text>The licensure and provider qualification requirements in Regulation .02 of this chapter; and</text>
    </paragraph>
    <paragraph num="(4)">
      <text>Verify the licenses and credentials of all professionals employed or contracted by the provider, and keep on file documentation of how that verification was completed.</text>
    </paragraph>
  </paragraph>
  <paragraph num="B.">
    <text>To be certified to participate in the Healthy Kids Program as an EPSDT screening provider, a provider shall agree to:</text>
    <paragraph num="(1)">
      <text>Provide EPSDT comprehensive well-child services as outlined in the EPSDT periodicity schedule and in a manner prescribed by the Department;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Provide or arrange for referral, diagnosis, treatment, and follow-up when the screening indicates a need for additional services;</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Inform the parent or guardian of the next preventive health care visit, and assist with scheduling;</text>
    </paragraph>
    <paragraph num="(4)">
      <text>Cooperate with Departmental efforts to assure that children receive needed follow-up and treatment services;</text>
    </paragraph>
    <paragraph num="(5)">
      <text>Conform to the equipment, facilities, and procedural standards set by the Department;</text>
    </paragraph>
    <paragraph num="(6)">
      <text>Maintain a patient record system that is sufficiently detailed and current to allow another physician who is unfamiliar with the patient to properly continue treatment in the absence of the initial provider;</text>
    </paragraph>
    <paragraph num="(7)">
      <text>Participate in the Vaccines for Children Program;</text>
    </paragraph>
    <paragraph num="(8)">
      <text>Permit periodic on-site quality assurance visits by the Department or its designee following a protocol established by the Department to:</text>
      <paragraph num="(a)">
        <text>Assure that the equipment necessary to perform required procedures is available;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Review the charts of participants to assure delivery of EPSDT screens;</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Determine that required procedures are being performed correctly and that appropriate follow-up is provided; and</text>
      </paragraph>
      <paragraph num="(d)">
        <text>Assess the need for any follow-up provider training, staff training, technical assistance, or in-service training; and</text>
      </paragraph>
    </paragraph>
    <paragraph num="(9)">
      <text>Maintain a minimum score of 80 percent on all Healthy Kids Program quality assurance reviews.</text>
    </paragraph>
  </paragraph>
  <paragraph num="C.">
    <text>An MCO that has contracted with the Department shall ensure its enrollees have access to EPSDT comprehensive well-child services in accordance with COMAR 10.67.05.05A(3).</text>
  </paragraph>
</regulation>