<?xml version='1.0' encoding='utf-8'?>
<regulation prefix="Regulation" num=".03" citation="COMAR 10.09.94.03" title_num="10" subtitle_num="09" chapter_num="94" heading="Conditions for Participation.">
  <paragraph num="A.">
    <text>A provider shall meet all conditions for participation as set forth in COMAR 10.09.36.</text>
  </paragraph>
  <paragraph num="B.">
    <text>To participate in the Program as a special pediatric 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 U.S. 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 services;</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; and</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 admission or outpatient 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.</text>
      </paragraph>
    </paragraph>
  </paragraph>
  <paragraph num="C.">
    <text>If an out-of-State or District of Columbia hospital, the hospital shall:</text>
    <paragraph num="(1)">
      <text>Have in effect a utilization review plan applicable to all participants who receive Medical Assistance under Title XIX of the Social Security Act which meets the requirements of §1861(k) of the Social Security Act unless a waiver has been granted by the Secretary of Health and Human Services; and</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Allow HealthChoice managed care organizations to pay no more and no less than the reimbursement rates established in Regulation .07 of this chapter unless the parties mutually agree to an alternative arrangement in a contract either on or after July 1, 2011.</text>
    </paragraph>
  </paragraph>
</regulation>