<?xml version='1.0' encoding='utf-8'?>
<regulation prefix="Regulation" num=".03" citation="COMAR 10.09.92.03" title_num="10" subtitle_num="09" chapter_num="92" heading="Conditions for Participation.">
  <paragraph num="A.">
    <text>A provider shall meet all conditions for participation as set forth in COMAR 10.09.36.03.</text>
  </paragraph>
  <paragraph num="B.">
    <text>To participate in the Program as an acute hospital services provider, the provider shall:</text>
    <paragraph num="(1)">
      <text>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;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Directly provide or make available through contractual arrangements or transfer agreements, medically necessary covered services;</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Accept payment by the Program as payment in full for the covered service;</text>
    </paragraph>
    <paragraph num="(4)">
      <text>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;</text>
    </paragraph>
    <paragraph num="(5)">
      <text>Maintain documentation of each contact with the participant as part of the complete medical record, which, at a minimum, includes:</text>
      <paragraph num="(a)">
        <text>Date of service;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>The participant’s chief medical complaint or reason for visit;</text>
      </paragraph>
      <paragraph num="(c)">
        <text>A description of the services provided, including:</text>
        <paragraph num="(i)">
          <text>Progress notes;</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>Imaging studies;</text>
        </paragraph>
        <paragraph num="(iii)">
          <text>Laboratory results;</text>
        </paragraph>
        <paragraph num="(iv)">
          <text>Medication administration records; and</text>
        </paragraph>
        <paragraph num="(v)">
          <text>Discharge summary; and</text>
        </paragraph>
      </paragraph>
      <paragraph num="(d)">
        <text>A signature, electronic or handwritten, along with the printed or typed name of the individual providing care, with the appropriate title; and</text>
      </paragraph>
    </paragraph>
    <paragraph num="(6)">
      <text>If the hospital provider is the only hospital within the county, participate with each participating HealthChoice Managed Care Organization in the county.</text>
    </paragraph>
  </paragraph>
  <paragraph num="C.">
    <text>If an out-of-State or District of Columbia hospital, the hospital shall:</text>
    <paragraph num="(1)">
      <text>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</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Comply with applicable regulations of this chapter and COMAR 10.09.36.</text>
    </paragraph>
  </paragraph>
</regulation>