<?xml version='1.0' encoding='utf-8'?>
<regulation prefix="Regulation" num=".19" citation="COMAR 10.11.03.19" title_num="10" subtitle_num="11" chapter_num="03" heading="Billing Procedures for Hospitals.">
  <paragraph num="A.">
    <text>All hospitals shall comply with the following procedures:</text>
    <paragraph num="(1)">
      <text>Hospitals located in Maryland that participate in the CMS Program shall charge and be reimbursed at the Medical Assistance rates approved by the Health Services Cost Review Commission;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>The CMS Program shall pay room and board charges for the day of admission, and may not pay room and board charges for the day of discharge from the hospital;</text>
    </paragraph>
    <paragraph num="(3)">
      <text>The CMS Program may not reimburse for the services of a hospital’s salaried or contractual physicians as a separate line item;</text>
    </paragraph>
    <paragraph num="(4)">
      <text>The contractual physicians' salaries shall be included in the room and board rate or the appropriate ancillary service;</text>
    </paragraph>
    <paragraph num="(5)">
      <text>When a patient is discharged from one general hospital and is admitted to another general hospital and 24 hours have not elapsed between the discharge and admission, the CMS Program shall pay only for those medically necessary days, with the payment for the patient’s hospitalization being apportioned between the two hospitals;</text>
    </paragraph>
    <paragraph num="(6)">
      <text>The CMS Program shall be contacted regarding exceptions or extenuating circumstances relating to admissions and discharges if the patient returns the same day before the hospital patient count;</text>
    </paragraph>
    <paragraph num="(7)">
      <text>All nonemergency inpatient hospital admissions require preadmission approval by the CMS Program;</text>
    </paragraph>
    <paragraph num="(8)">
      <text>Authorization is required by the CMS Program or its designee for more than one preoperative inpatient day; and</text>
    </paragraph>
    <paragraph num="(9)">
      <text>The CMS Program may not reimburse for hospital admissions where a child has been discharged due to cancellation of planned surgery or treatment. The hospital may not bill the family for these charges.</text>
    </paragraph>
  </paragraph>
  <paragraph num="B.">
    <text>In addition, all out-of-state providers shall:</text>
    <paragraph num="(1)">
      <text>Participate in Title XVIII of the Social Security Act;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Have in effect a utilization review plan applicable to all patients who receive Medical Assistance under Title XIX of the Social Security Act and which meets the requirements of the Social Security Act, §186(k), unless a waiver has been granted by the Secretary of Health and Human Services; and</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Meet additional conditions for participation and comply with the requirements specified in Regulation .11 of this chapter.</text>
    </paragraph>
  </paragraph>
  <paragraph num="C.">
    <text>All hospital services shall be reimbursed at the Medical Assistance rate.</text>
  </paragraph>
</regulation>