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<regulation prefix="Regulation" num=".04" citation="COMAR 10.09.54.04" title_num="10" subtitle_num="09" chapter_num="54" heading="Conditions for Provider Participation — General Requirements.">
  <paragraph num="A.">
    <text>To participate as a provider of a service covered under this chapter a provider shall:</text>
    <paragraph num="(1)">
      <text>Meet all of the conditions for participation as a Maryland Medical Assistance Program provider as set forth in COMAR 10.09.36, except as otherwise specified in this chapter;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Verify the qualifications of all individuals who render services on the provider's behalf, and provide a copy of the current license or credentials upon request;</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Implement the reporting and follow-up of incidents and complaints in accordance with the Department's established reportable events policy;</text>
    </paragraph>
    <paragraph num="(4)">
      <text>Agree to cooperate with required inspections, reviews, and audits by authorized governmental representatives;</text>
    </paragraph>
    <paragraph num="(5)">
      <text>Agree to provide services, and to subsequently bill the Department in accordance with the reimbursement methodology specified in this chapter for only those services covered under this chapter which have been:</text>
      <paragraph num="(a)">
        <text>Pre-approved in the participant's plan of service;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Provided in a manner consistent with the participant's plan of service; and</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Identified in the provider agreement as within the scope of the provider's Medicaid participation;</text>
      </paragraph>
    </paragraph>
    <paragraph num="(6)">
      <text>Agree to maintain and have available written documentation of services, including dates and hours of services provided to participants, for a period of 6 years, in a manner approved by the Department;</text>
    </paragraph>
    <paragraph num="(7)">
      <text>Agree not to suspend, terminate, increase, or reduce services for an individual without authorization from the Department and with consultation and agreement by the participant or a participant's representative when applicable;</text>
    </paragraph>
    <paragraph num="(8)">
      <text>Submit a transition plan to the case manager and participant or participant's representative when applicable when suspending or terminating services;</text>
    </paragraph>
    <paragraph num="(9)">
      <text>Verify Medicaid eligibility at the beginning of each month that services will be rendered;</text>
    </paragraph>
    <paragraph num="(10)">
      <text>Not be a Medicaid provider or principal of a Medicaid provider that has overpayments that remain due to the Department;</text>
    </paragraph>
    <paragraph num="(11)">
      <text>Notify the Department in writing at least 45 days in advance of any:</text>
      <paragraph num="(a)">
        <text>Voluntary closure;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Change of ownership;</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Change of location;</text>
      </paragraph>
      <paragraph num="(d)">
        <text>Sale of the business;</text>
      </paragraph>
      <paragraph num="(e)">
        <text>Change in the name under which the provider is doing business; or</text>
      </paragraph>
      <paragraph num="(f)">
        <text>Change in provider tax identification number;</text>
      </paragraph>
    </paragraph>
    <paragraph num="(12)">
      <text>Include in the notice to the Department regarding any change of status under §A(11) of this regulation, the method for informing waiver participants and representatives of its intent to close, change ownership, change location, or sell its business;</text>
    </paragraph>
    <paragraph num="(13)">
      <text>Apply for a new license if applicable, whenever ownership is to be transferred from the person or organization named on the license to another person or organization in time to assure continuity of waiver services;</text>
    </paragraph>
    <paragraph num="(14)">
      <text>Submit a Medicaid provider application to the Department if the new owner chooses to participate in the waiver program;</text>
    </paragraph>
    <paragraph num="(15)">
      <text>Obtain a state and federal background check through the Criminal Justice Information  System on all staff in accordance with the procedure for a State criminal history records check established under Health-General Article, Title 19, Subtitle 19, Annotated Code of Maryland;</text>
    </paragraph>
    <paragraph num="(16)">
      <text>Render services in person, except as expressly authorized by the Department in the regulation governing that service type; and</text>
    </paragraph>
    <paragraph num="(17)">
      <text>If rendering services via telehealth, comply with COMAR 10.09.49 and any subregulatory guidance issued by the Department.</text>
    </paragraph>
  </paragraph>
  <paragraph num="B.">
    <text>To participate as a provider of a service covered under this chapter, a provider or its principals may not, within the past 24 months, have:</text>
    <paragraph num="(1)">
      <text>Had a license or certificate suspended or revoked as a health care provider, health care facility, or provider of direct care services;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Undergone the imposition of sanctions under COMAR 10.09.36.08;</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Been subject to disciplinary action, including actions by the licensing board, that indicate behavior which is potentially harmful to participants;</text>
    </paragraph>
    <paragraph num="(4)">
      <text>Been cited by a State agency for deficiencies which affect participants health and safety; or</text>
    </paragraph>
    <paragraph num="(5)">
      <text>Experienced a termination of a Medicaid provider agreement or been barred from work or participation by a public or private agency due to:</text>
      <paragraph num="(a)">
        <text>Failure to meet contractual obligations; or</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Fraudulent billing practices.</text>
      </paragraph>
    </paragraph>
  </paragraph>
  <paragraph num="C.">
    <text>A provider who renders health-related services to participants shall agree to:</text>
    <paragraph num="(1)">
      <text>Periodically indicate the condition of a participant in accordance with the procedures and forms designated by the Department; and</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Share and discuss the documented information at the request of the participant.</text>
    </paragraph>
  </paragraph>
  <paragraph num="D.">
    <text>A provider, its principals, or its staff may not have a history of behavior or convictions that could be harmful to participants, as evidenced through a State and federal background check conducted in accordance with §A(15) of this regulation.</text>
  </paragraph>
</regulation>