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 a special psychiatric 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)
Meet the following staffing requirements 24 hours per day, 7 days per week:
(a)
On-call or on-site physician services including psychiatric physicians;
(b)
On-site registered nurses;
(c)
On-site advanced cardiac life support services;
(3)
If licensed to provide inpatient psychiatric services for individuals younger than 21 years old:
(a)
Meet the requirements for participation as defined in 42 CFR §440.160; and
(b)
Provide acute psychiatric services as defined in 42 CFR Part 441, Subpart D;
(4)
Directly provide or make available through contractual arrangements or transfer agreements, medically necessary covered services;
(5)
Accept payment by the Program as payment in full for the covered service;
(6)
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;
(7)
Maintain documentation of each contact with the participant as part of the medical record, which, at a minimum, includes:
(a)
Date of service;
(b)
A plan of treatment as defined in Regulation .01B of this chapter;
(c)
The participant’s chief medical complaint or reason for visit;
(d)
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
(e)
A signature, electronic or handwritten, along with the printed or typed name of the individual providing care, with the appropriate title;
(8)
Submit to the Department or its designee within 5 months of the close of the hospital’s fiscal year, as required by the Department, a hospital cost report for outpatient services which are subject to cost settlement in accordance with Regulation .11 of this chapter;
C.
If an out-of-State or District of Columbia hospital, the special psychiatric 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.