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<regulation prefix="Regulation" num=".01" citation="COMAR 10.09.77.01" title_num="10" subtitle_num="09" chapter_num="77" heading="Definitions.">
  <paragraph num="A.">
    <text>In this chapter, the following terms have the meanings indicated.</text>
  </paragraph>
  <paragraph num="B.">
    <text>Terms Defined.</text>
    <paragraph num="(1)">
      <text>“Department” means the Maryland Department of Health, the single State agency designated to administer the Medical Assistance Program under Title XIX of the Social Security Act, 42 U.S.C. §1396 et seq.</text>
    </paragraph>
    <paragraph num="(2)">
      <text>“Free-standing clinic” means a health care facility that is not licensed as a hospital, part of a hospital, or nursing home and is not administratively part of a physician's, dentist's, or osteopath's office, but which has a separate staff functioning under the direction of a clinic administrator or health officer and is organized and operated to provide ambulatory health services.</text>
    </paragraph>
    <paragraph num="(3)">
      <text>“Free-standing urgent care center” means a location, distinct from a hospital emergency room, a physician's office, or a free-standing clinic, whose purpose is to diagnose and treat illness or injury for unscheduled, ambulatory patients seeking immediate medical attention.</text>
    </paragraph>
    <paragraph num="(4)">
      <text>“Hospital” means an institution which falls within the jurisdiction of Health-General Article, Title 19, Subtitle 3, Annotated Code of Maryland, and is licensed pursuant to COMAR 10.07.01.</text>
    </paragraph>
    <paragraph num="(5)">
      <text>“Medical Assistance Program” means a program of comprehensive medical and other health-related care for indigent and medically indigent persons.</text>
    </paragraph>
    <paragraph num="(6)">
      <text>“Medically necessary” means that the service or benefit is:</text>
      <paragraph num="(a)">
        <text>Directly related to diagnostic, preventive, curative, palliative, rehabilitative, or ameliorative treatment of an illness, injury, disability, or health condition;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Consistent with currently accepted standards of good medical practice;</text>
      </paragraph>
      <paragraph num="(c)">
        <text>The most cost efficient service that can be provided without sacrificing effectiveness or access to care; and</text>
      </paragraph>
      <paragraph num="(d)">
        <text>Not primarily for the convenience of the consumer, family, or provider.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(7)">
      <text>“Medicare” means the insurance program administered by the federal government under Title XVIII of the Social Security Act, U.S.C. §1395 et seq.</text>
    </paragraph>
    <paragraph num="(8)">
      <text>“Participant” means an individual who is certified as eligible for and is receiving Medical Assistance benefits.</text>
    </paragraph>
    <paragraph num="(9)">
      <text>“Patient” means a participant awaiting or undergoing health care or treatment.</text>
    </paragraph>
    <paragraph num="(10)">
      <text>“Physician” means an individual legally licensed to practice medicine in the state in which the physician's practice is located.</text>
    </paragraph>
    <paragraph num="(11)">
      <text>“Program” means the Maryland Medical Assistance Program.</text>
    </paragraph>
    <paragraph num="(12)">
      <text>“Provider” means a free-standing urgent care center which, through appropriate agreement with the Department, has been identified as a Program provider by the issuance of a Medical Assistance provider number.</text>
    </paragraph>
    <paragraph num="(13)">
      <text>“Urgent care” means the delivery of ambulatory care, such as for acute illnesses or minor traumas, in a facility dedicated to the delivery of unscheduled, walk-in care outside of a hospital emergency department, a free-standing clinic, or a physician's office.</text>
    </paragraph>
  </paragraph>
</regulation>