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<regulation prefix="Regulation" num=".11" citation="COMAR 10.14.02.11" title_num="10" subtitle_num="14" chapter_num="02" heading="Home Health Services.">
  <paragraph num="A.">
    <text>To be considered a participating home health services provider in the Program, the provider of home health services shall:</text>
    <paragraph num="(1)">
      <text>Be a home health services provider licensed in Maryland or a jurisdiction bordering Maryland;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Agree to abide by the provisions set forth in this regulation and apply for participation in the Program by signing and sending to the Department the designated Departmental form;</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Comply with COMAR 10.09.04.03A, B(2),(3), C(4), and D, if offering skilled nursing care;</text>
    </paragraph>
    <paragraph num="(4)">
      <text>Accept, as payment in full for covered services rendered, the amount paid by the Program pursuant to §D of this regulation plus, if applicable, the amount paid by the eligible patient's health insurer and the patient contribution amount, and agree not to bill an eligible patient an additional charge for the covered services; and</text>
    </paragraph>
    <paragraph num="(5)">
      <text>Maintain the patient care, medical supply, billing, and the patient contribution amount records for a minimum of 6 years and, upon request, allow the Department access to the records.</text>
    </paragraph>
  </paragraph>
  <paragraph num="B.">
    <text>The Program shall reimburse for a service listed in §C of this regulation when the service is:</text>
    <paragraph num="(1)">
      <text>Provided upon the written order of the participating physician and furnished under the current plan of treatment;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Rendered to an eligible patient who is certified by the participating physician as homebound;</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Consistent with the current diagnosis and treatment of the patient condition;</text>
    </paragraph>
    <paragraph num="(4)">
      <text>In accordance with accepted standards of practice;</text>
    </paragraph>
    <paragraph num="(5)">
      <text>Required by the medical condition rather than the convenience or preference of the patient;</text>
    </paragraph>
    <paragraph num="(6)">
      <text>Considered under accepted standards of practice to be a specific and effective treatment for the condition;</text>
    </paragraph>
    <paragraph num="(7)">
      <text>Required on a part-time, intermittent basis;</text>
    </paragraph>
    <paragraph num="(8)">
      <text>Rendered in the home of the eligible patient by a participating home health services provider;</text>
    </paragraph>
    <paragraph num="(9)">
      <text>Adequately described in the signed and dated progress note; and</text>
    </paragraph>
    <paragraph num="(10)">
      <text>Directly related to the diagnosis and treatment of breast cancer or cervical cancer.</text>
    </paragraph>
  </paragraph>
  <paragraph num="C.">
    <text>The Program provides reimbursement for the following:</text>
    <paragraph num="(1)">
      <text>Skilled nursing care provided by a licensed nurse when the complexity of the service requires the judgment, knowledge, and skill of a licensed nurse;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Physical therapy, provided by a licensed physical therapist as specified in Regulation .07 of this chapter;</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Occupational therapy provided by a licensed occupational therapist as specified in Regulation .14 of this chapter;</text>
    </paragraph>
    <paragraph num="(4)">
      <text>Medical supplies and equipment as specified in Regulation .10B of this chapter; and</text>
    </paragraph>
    <paragraph num="(5)">
      <text>Other supplies which are used during a reimbursed home health visit as part of the treatment ordered by the participating physician.</text>
    </paragraph>
  </paragraph>
  <paragraph num="D.">
    <text>The Program does not reimburse for services:</text>
    <paragraph num="(1)">
      <text>Not directly related to the treatment of breast and cervical cancer; and</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Pursuant to COMAR 10.09.04.05A, B, D, G, N, and P;</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Rendered by Home Health Aides; and</text>
    </paragraph>
    <paragraph num="(4)">
      <text>Rendered by social workers.</text>
    </paragraph>
  </paragraph>
  <paragraph num="E.">
    <text>The participating home health services provider is responsible for:</text>
    <paragraph num="(1)">
      <text>Submitting a bill for the reimbursed service provided on the form designated by the Department within 12 months of the date of service, as follows:</text>
      <paragraph num="(a)">
        <text>If an eligible patient is uninsured or is insured, but the insurance does not provide coverage for a reimbursed service, the participating home health services provider shall send the Department the bill for the service; or</text>
      </paragraph>
      <paragraph num="(b)">
        <text>If an eligible patient is covered by Medicare or other insurance, the participating home health services provider shall bill:</text>
        <paragraph num="(i)">
          <text>Medicare or the other insurance for the procedure or service; and</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>The Department for the outstanding deductible and patient contribution amount; and</text>
        </paragraph>
      </paragraph>
    </paragraph>
    <paragraph num="(2)">
      <text>Not billing the Department under this Program a charge in excess of that charged the general public for a similar service or for a service rendered at no charge to the general public.</text>
    </paragraph>
  </paragraph>
  <paragraph num="F.">
    <text>Reimbursement Rates. A non-hospital-based participating home health services provider located in Maryland, or a participating home health services provider located in a jurisdiction bordering Maryland shall be reimbursed by the Department:</text>
    <paragraph num="(1)">
      <text>Pursuant to COMAR 10.09.04.07D for an eligible patient who is uninsured or who has insurance that does not provide coverage for the reimbursement service; and</text>
    </paragraph>
    <paragraph num="(2)">
      <text>For the outstanding deductible and patient contribution amount, if applicable, for an eligible patient who is covered by Medicare or other insurance.</text>
    </paragraph>
  </paragraph>
  <paragraph num="G.">
    <text>The Program shall reimburse for claims submitted pursuant to this regulation as set forth in Regulation .21 of this chapter.</text>
  </paragraph>
</regulation>