<?xml version='1.0' encoding='utf-8'?>
<regulation prefix="Regulation" num=".03" citation="COMAR 10.09.38.03" title_num="10" subtitle_num="09" chapter_num="38" heading="Conditions for Participation.">
  <paragraph num="A.">
    <text>General requirements for participation in the Medical Assistance Program are that providers shall:</text>
    <paragraph num="(1)">
      <text>Meet the licensure requirements in Regulation .02 of this chapter, and verify the licenses and credentials of all professionals employed by the provider;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Apply for participation in the Program using an application form designated by the Department;</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Be approved for participation by the Department;</text>
    </paragraph>
    <paragraph num="(4)">
      <text>Have a provider agreement with the Department in effect;</text>
    </paragraph>
    <paragraph num="(5)">
      <text>Be identified as a Program provider by issuance of an individual provider number;</text>
    </paragraph>
    <paragraph num="(6)">
      <text>Verify the eligibility of recipients;</text>
    </paragraph>
    <paragraph num="(7)">
      <text>Accept payment by the Program as payment in full for services rendered and make no additional charge to any person for the covered services specified in Regulation .04 of this chapter;</text>
    </paragraph>
    <paragraph num="(8)">
      <text>Provide services without discrimination on the basis of race, color, sex, national origin, marital status, physical or mental handicap;</text>
    </paragraph>
    <paragraph num="(9)">
      <text>Maintain adequate records concerning service provision for a minimum of 6 years and make them available, upon request, to the Department or its designee;</text>
    </paragraph>
    <paragraph num="(10)">
      <text>Not knowingly employ or contract with any person, partnership, or corporation which has been disqualified from the Program to provide or supply service to Medical Assistance recipients, unless prior written approval has been received from the Department;</text>
    </paragraph>
    <paragraph num="(11)">
      <text>Agree that claims rejected for payment due to late billing may not be billed to the participant;</text>
    </paragraph>
    <paragraph num="(12)">
      <text>Not place a restriction on the recipient's right to choose the provider;</text>
    </paragraph>
    <paragraph num="(13)">
      <text>Agree that if the Program denies payment or requests repayment on the basis that an otherwise covered service was not medically necessary or has not been preauthorized, the provider may not seek payment for that service from the participant; and</text>
    </paragraph>
    <paragraph num="(14)">
      <text>Be selected by the participant from among qualified providers.</text>
    </paragraph>
  </paragraph>
  <paragraph num="B.">
    <text>Specific requirements for providers of risk assessment-plan of care services are that providers shall:</text>
    <paragraph num="(1)">
      <text>Be physicians or nurse midwives;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Provide the covered services as specified in Regulation .04A of this chapter in conjunction with the pregnant participant's initial clinical prenatal visit or, otherwise, as early as possible in the pregnancy;</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Maintain the participant's consolidated medical record; and</text>
    </paragraph>
    <paragraph num="(4)">
      <text>Agree to on-site visits by Department staff to monitor adherence to Regulation .04A of this chapter.</text>
    </paragraph>
  </paragraph>
  <paragraph num="C.">
    <text>Specific requirements for providers of enriched maternity services are that providers shall:</text>
    <paragraph num="(1)">
      <text>Be physicians or nurse midwives or be under the supervision of a physician or nurse midwife;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Provide the covered services as specified in Regulation .04B of this chapter in conjunction with each prenatal clinical visit of the pregnant participant and each postpartum clinical visit of the postpartum participant up to 60 days after the delivery; and</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Agree to on-site visits by Department staff to monitor adherence to Regulation .04B of this chapter.</text>
    </paragraph>
  </paragraph>
  <paragraph num="D.">
    <text>Specific requirements for participation in the provision of high-risk nutrition counseling services are that providers shall:</text>
    <paragraph num="(1)">
      <text>Be a dietician or nutritionist as specified in Regulation .02C of this chapter;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Contact the recipient within 10 working days of the receipt of a referral from a local health department or private prenatal care provider, unless client-related extenuating circumstances are documented; and</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Agree to on-site visits by Department staff to monitor adherence to Regulation .04C of this chapter.</text>
    </paragraph>
  </paragraph>
</regulation>