<?xml version='1.0' encoding='utf-8'?>
<regulation prefix="Regulation" num=".05" citation="COMAR 10.14.02.05" title_num="10" subtitle_num="14" chapter_num="02" heading="Nurse Practitioner Services.">
  <paragraph num="A.">
    <text>To be considered a participating nurse practitioner in the Program, the provider shall:</text>
    <paragraph num="(1)">
      <text>Be a certified nurse practitioner in Maryland or a jurisdiction bordering Maryland;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Have a current written attestation with a physician who is licensed to practice medicine in Maryland or a jurisdiction bordering Maryland, if required by that jurisdiction;</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Agree to accept, for each reimbursed medical procedure performed or service provided, the following reimbursement including, if applicable, a medical management fee as described in Regulation .15 of this chapter:</text>
      <paragraph num="(a)">
        <text>The current Medical Assistance approved rate in the State for an eligible patient who is uninsured or has insurance that does not provide coverage for a certain procedure or service;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>The reimbursement rate approved by the insurer plus the payment of the deductible and patient contribution amount by the Department for an eligible patient who has insurance, other than Medicare, that provides coverage for a certain procedure or service;</text>
      </paragraph>
      <paragraph num="(c)">
        <text>The reimbursement rate approved by Medicare plus the payment of the deductible and patient contribution amount by the Department for an eligible patient who is covered by Medicare only; or</text>
      </paragraph>
      <paragraph num="(d)">
        <text>For an eligible patient who has insurance that provides coverage for a reimbursed procedure or service that is less than the current Medical Assistance approved rate, the reimbursement rate approved by the insurer plus the difference between the reimbursement rate approved by the insurer and the Medical Assistance approved rate in the State plus the payment of the deductible by the Department;</text>
      </paragraph>
    </paragraph>
    <paragraph num="(4)">
      <text>Agree to abide by the provisions set forth in this section by signing and sending to the Department the designated Departmental form; and</text>
    </paragraph>
    <paragraph num="(5)">
      <text>Agree to the medical, financial, and reporting requirements of the Program pursuant to Regulation .04A(5)—(6), (7)(a)—(e), and (8)—(10) of this chapter.</text>
    </paragraph>
  </paragraph>
  <paragraph num="B.">
    <text>An eligible health care provider may be a certified nurse practitioner.</text>
  </paragraph>
  <paragraph num="C.">
    <text>The reimbursed medical procedure includes but is not limited to:</text>
    <paragraph num="(1)">
      <text>Colposcopically directed cervical or vaginal biopsy or both;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Colposcopy;</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Cyst aspiration;</text>
    </paragraph>
    <paragraph num="(4)">
      <text>Endocervical curettage; and</text>
    </paragraph>
    <paragraph num="(5)">
      <text>Endometrial biopsy if the patient has taken Tamoxifen for the treatment of breast cancer or if cervical cancer has been documented.</text>
    </paragraph>
  </paragraph>
  <paragraph num="D.">
    <text>Non-reimbursed medical procedures and services include a procedure or service not related to the diagnosis and treatment of breast and cervical cancer.</text>
  </paragraph>
  <paragraph num="E.">
    <text>The participating nurse practitioner shall accept the responsibilities pursuant to Regulation .04E, F, and G of this chapter.</text>
  </paragraph>
</regulation>