<?xml version='1.0' encoding='utf-8'?>
<regulation prefix="Regulation" num=".05" citation="COMAR 10.09.84.05" title_num="10" subtitle_num="09" chapter_num="84" 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:</text>
    <paragraph num="(1)">
      <text>Shall meet all of the conditions for participation as a Medicaid provider as set forth in COMAR 10.09.36, except as otherwise specified in this chapter;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Shall obtain written verification of the qualifications of all individuals who render services on the provider’s behalf and provide a copy of the current license or credentials on request;</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Shall implement the reporting and follow-up of incidents and complaints in accordance with the Department’s established policy by:</text>
      <paragraph num="(a)">
        <text>Reporting incidents and complaints within 24 hours of knowledge of the event;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Submitting a written report within 7 calendar days on a form designated by the Department; and</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Notifying the local department of social services immediately if the provider has a reason to believe that the participant has been subjected to abuse, neglect, self-neglect, or exploitation, in accordance with COMAR 07.02.16;</text>
      </paragraph>
    </paragraph>
    <paragraph num="(4)">
      <text>Shall agree to cooperate with required inspections, reviews, and audits by authorized governmental agents;</text>
    </paragraph>
    <paragraph num="(5)">
      <text>Shall 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>Preauthorized 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>Shall 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 from the date of service, in a manner approved by the Department;</text>
    </paragraph>
    <paragraph num="(7)">
      <text>Shall agree not to suspend, terminate, increase, or reduce services for an individual without authorization from the Department and only after consultation and input from the participant or, when applicable, the participant’s representative;</text>
    </paragraph>
    <paragraph num="(8)">
      <text>Shall submit a transition plan to the case manager or supports planner and participant or, when applicable, the participant’s representative when suspending or terminating services;</text>
    </paragraph>
    <paragraph num="(9)">
      <text>Shall verify Medicaid eligibility at the beginning of each month that services will be rendered;</text>
    </paragraph>
    <paragraph num="(10)">
      <text>May not be a Medicaid provider or principal of a Medicaid provider that has overpayments that remain due to the Department; and</text>
    </paragraph>
    <paragraph num="(11)">
      <text>Shall be free from conflicts of interest.</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 direct care services worker;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Been suspended or removed from participating as a Medicaid provider under COMAR 10.09.20;</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Undergone the imposition of sanctions under COMAR 10.09.36.08;</text>
    </paragraph>
    <paragraph num="(4)">
      <text>Been subject to disciplinary action, including actions by the licensing board or any provider or principal of any provider agency;</text>
    </paragraph>
    <paragraph num="(5)">
      <text>Been cited by a State agency for deficiencies which affect participants’ health and safety; or</text>
    </paragraph>
    <paragraph num="(6)">
      <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 provide information about 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>
</regulation>