Regulation .03 Conditions for Participation.
Regulation .03 Conditions for Participation.LinkCopy Citation
A.
A provider shall meet all conditions for participation as set forth in COMAR 10.09.36.03.
B.
To participate in the Program as an acute hospital services provider, the provider shall:
(1)
Meet the requirements of Title XIX of the Social Security Act for participation as a hospital, as issued by the Department of Health and Human Services;
(2)
Directly provide or make available through contractual arrangements or transfer agreements, medically necessary covered services;
(3)
Accept payment by the Program as payment in full for the covered service;
(4)
Make available to the Department or its designee the participant’s medical record for review and certification of medical necessity for admission and continuation of stay;
(5)
Maintain documentation of each contact with the participant as part of the complete medical record, which, at a minimum, includes:
(a)
Date of service;
(b)
The participant’s chief medical complaint or reason for visit;
(c)
A description of the services provided, including:
(i)
Progress notes;
(ii)
Imaging studies;
(iii)
Laboratory results;
(iv)
Medication administration records; and
(v)
Discharge summary; and
(d)
A signature, electronic or handwritten, along with the printed or typed name of the individual providing care, with the appropriate title; and
(6)
If the hospital provider is the only hospital within the county, participate with each participating HealthChoice Managed Care Organization in the county.
C.
If an out-of-State or District of Columbia hospital, the hospital shall:
(1)
Unless a waiver has been granted by the Secretary of Health and Human Services, have in effect a utilization review plan applicable to all participants who receive Medical Assistance under Title XVII of the Social Security Act which meets the requirements of §1861(k) of the Social Security Act; and
(2)
Comply with applicable regulations of this chapter and COMAR 10.09.36.