In this chapter, the following terms have the meanings indicated. Terms Defined. “CMS” means Centers for Medicare and Medicaid Services. “Department” means the Maryland Department of Health. “Mammography” means the radiographic examination of the soft tissues of the breast. “Medical Assistance Program” means the program of comprehensive medical and other health-related care for indigent and medically indigent persons. “Medically necessary” means medically necessary as defined in COMAR 10.09.36.01. “Medicare” means the insurance program administered by the federal government under Title XVIII of the Social Security Act, 42 U.S.C. §1395 et seq. “NPI” means National Provider Identifier. “Program” means the Medical Assistance Program. “Portable X-ray provider” means an entity that moves its portable X-ray equipment that is separate from and unattached to the vehicle to a fixed location (e.g. a physician’s office or nursing home). “Provider” means: An individual, association, partnership, corporation, unincorporated group, or any other person authorized, licensed, or certified to provide services for Program recipients and who, through appropriate agreement with the Department, has been identified as a Program provider by the issuance of an individual account number; An agent, employee, or related party of a person identified in §B(10)(a) of this regulation; or An individual or any other person with an ownership interest in a person identified in §B(10)(a) of this regulation. “Recipient” means an individual who is certified as eligible for, and is receiving, Medical Assistance benefits. Providers of Medical Assistance Program services shall, to the extent required by law, be licensed and legally authorized to practice or deliver services in the state in which the service is provided. The provider and the equipment personnel shall be licensed or registered in accordance with applicable federal, State and local laws in accordance with 42 CFR §486.100. The portable X-ray provider shall be certified and registered by the Department of Environment in accordance with COMAR 26.12.01—.03 A portable X-ray provider that performs mammography services shall be certified by the Food and Drug Administration (FDA). The driver that transports portable X-ray equipment: Shall possess a valid operator’s license appropriate for the type of vehicle that is driven; May not have violations related to the operation of a motor vehicle in the last 3 years; and May not have any violations involving alcohol or other illegal substances related to the operation of a motor vehicle in the last 10 years. A provider shall meet all conditions for participation as set forth in COMAR 10.09.36.03. The provider shall also: Be certified by CMS to furnish portable X-ray services; Meet the licensure requirements as provided in Regulation .02 of this chapter; Meet performance standards in accordance with 42 CFR §410.33(g); Ensure that portable X-ray services are rendered under the supervision of a qualified physician in accordance with 42 CFR §486.102; Ensure that portable X-ray services are rendered by a qualified technician in accordance with 42 CFR §486.104; Ensure that portable X-ray services performed for Medical Assistance recipients are ordered by a doctor of medicine or a doctor of osteopathy and records are properly preserved in accordance with 42 CFR §486.106; Ensure that inspections of all X-ray equipment and shielding are made by qualified individuals at intervals not greater than 24 months in accordance with 42 CFR §486.110; and Identify the ordering practitioner who authorized the diagnostic services by either: Recording the National Provider Identifier (NPI) number for the individual practitioner on the claim; or Recording the name and NPI of the authorized ordering practitioner on the invoice and attaching to the invoice a copy of the properly completed order that identifies the authorized ordering practitioner. The Program covers medically necessary services rendered to recipients, when the services are: Provided according to the laws and regulations of the State and locality in which they are rendered in accordance with 42 CFR §486.100; Rendered by a physician who meets the qualification standards in accordance with 42 CFR §486.102 or qualified non-physician (technician) who meets the qualification standards in accordance to 42 CFR §486.104; and Ordered in writing by the treating physician or nurse practitioner who is enrolled as a provider in the Program with an active status on the date of service in accordance with State law. Portable X-ray services include the following: Skeletal films involving extremities, pelvis, vertebral column, and skull; Chest films which do not involve the use of contrast media; Abdominal films which do not involve the use of contrast media; Diagnostic mammograms, if approved by the FDA; Transportation of portable X-ray equipment to a patient’s home or a long term care facility (LTCF); and Electrocardiograms (EKGs/ECGs). The Program does not cover the following: Services for which the portable X-ray provider cannot provide a properly completed order identifying the authorized ordering physician or practitioner by National Provider Identifier (NPI); Services not adequately documented in the recipient’s medical record; Services not medically necessary; Procedures that are known by the provider as investigational or experimental in nature; Services which are specifically included as an integral part of another service; Consultations; Office visits; Injections; Surgeries; and Therapeutic services. X-ray services ordered by an: Individual who is not enrolled as a provider in the Program with an active status on the date of service; and Entity, facility, or another provider that is not an individual. General policies for payment that are applicable to all providers are set forth in COMAR 10.09.36.04. The Department shall allow a single transportation payment for each trip the portable X-ray provider makes to a particular location. The Department shall reimburse for covered services at the lesser of: The provider’s customary charge unless the service is free to individuals not covered by Medicaid; or The Department’s fee schedule. The Department’s fee-schedule is contained in COMAR 10.09.02.07D. Payments on Medicare cross-over claims are authorized if : The provider accepts Medicare assignment; Medicare makes direct payment to the provider; Medicare has determined that the services are medically necessary; The services are covered by the program; and The initial billing is made directly to Medicare according to Medicare guidelines. The Department shall make supplemental payment on Medicare claims subject to the following provisions: Coinsurance shall be paid at the lesser of: 100 percent of the coinsurance amount; or The balance remaining after the Medicare payment is subtracted from the Medicaid rate. The Program may not make a direct payment to a recipient. Billing time limitations are those set forth in COMAR 10.09.36.06. The provider may not bill the Program or recipient for: Completion of forms and reports; Broken or missed appointments; Services rendered by mail or telephone; and Providing a copy of a recipient’s medical record when requested by another licensed provider on behalf of the recipient. The portable X-ray provider shall identify the individual who ordered the portable X-ray services by recording the individual practitioner’s National Provider Identifier (NPI) number on the claim. General policies governing recovery and reimbursement procedures that are applicable to all providers are set forth in COMAR 10.09.36.07 General policies governing the cause for suspension and removal and imposition of sanctions procedures that are applicable to all providers are set forth in COMAR 10.09.36.08. General policies governing appeal procedures that are applicable to all providers are set forth in COMAR 10.09.36.09. Health-General Article, §§2-104(b), 15-103, and 15-105, Annotated Code of Maryland Effective date: April 28, 2014 (41:8 Md. R. 472) Regulation .04A amended effective January 1, 2018 (44:26 Md. R. 1214) Regulation .05A amended effective January 1, 2018 (44:26 Md. R. 1214) Regulation .05K adopted effective January 1, 2018 (44:26 Md. R. 1214) Regulation .07C, I amended effective July 4, 2016 (43:13 Md. R. 712) Regulation .07D amended effective February 27, 2017 (44:4 Md. R. 252) Regulation .07J adopted effective January 1, 2018 (44:26 Md. R. 1214)