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<regulation prefix="Regulation" num=".01" citation="COMAR 10.09.82.01" title_num="10" subtitle_num="09" chapter_num="82" 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 Maryland Medical Assistance Program under Title XIX of the Social Security Act, 42 U.S.C. §1396 et seq.</text>
    </paragraph>
    <paragraph num="(2)">
      <text>“Healthcare Common Procedure Coding System (HCPCS)” means a set of health care procedure codes based on the American Medical Association's Current Procedural Terminology (CPT).</text>
    </paragraph>
    <paragraph num="(3)">
      <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 current 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="(4)">
      <text>“Medicare-certified facility” means a facility which is certified for Medicare by the regional office of the Centers for Medicare and Medicaid Services (CMS).</text>
    </paragraph>
    <paragraph num="(5)">
      <text>“Provider-based outpatient oncology facility” means an outpatient facility that is:</text>
      <paragraph num="(a)">
        <text>Owned by a hospital;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Located off-site from the hospital; and</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Not regulated by the Health Services Cost Review Commission (HSCRC).</text>
      </paragraph>
    </paragraph>
    <paragraph num="(6)">
      <text>“Recipient” means an individual who is certified as eligible for, and is receiving, Medical Assistance benefits.</text>
    </paragraph>
  </paragraph>
</regulation>