<?xml version='1.0' encoding='utf-8'?>
<regulation prefix="Regulation" num=".13" citation="COMAR 10.14.02.13" title_num="10" subtitle_num="14" chapter_num="02" heading="Freestanding Ambulatory Surgical Center Services.">
  <paragraph num="A.">
    <text>To be considered a participating freestanding ambulatory surgical center in the Program, the provider shall:</text>
    <paragraph num="(1)">
      <text>Be Medicare certified to provide ambulatory surgical services in Maryland or a jurisdiction bordering Maryland;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Comply with COMAR 10.09.42.02 and .03B;</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Agree to abide by the provisions set forth in this regulation by signing and sending to the Department the designated Departmental form;</text>
    </paragraph>
    <paragraph num="(4)">
      <text>Agree to accept, as payment in full for the reimbursed service, the amount paid by the Program as specified in §E of this regulation plus, if applicable, the amount paid by the eligible patient's health insurer and the patient contribution amount;</text>
    </paragraph>
    <paragraph num="(5)">
      <text>Agree not to bill an eligible patient, who is either uninsured or who is insured with Medicare only, for the reimbursed service;</text>
    </paragraph>
    <paragraph num="(6)">
      <text>Agree not to bill an eligible patient, who has insurance coverage other than Medicare only, for an additional charge for the reimbursed service other than the patient contribution amount;</text>
    </paragraph>
    <paragraph num="(7)">
      <text>Maintain adequate records for a minimum of 6 years and, upon request, allow the Department access to the records; and</text>
    </paragraph>
    <paragraph num="(8)">
      <text>Agree to the medical requirements of the Program pursuant to Regulation .04A(8)—(10) of this chapter.</text>
    </paragraph>
  </paragraph>
  <paragraph num="B.">
    <text>The Program shall reimburse a participating freestanding ambulatory surgical center for a service when the service:</text>
    <paragraph num="(1)">
      <text>Complies with COMAR 10.09.42.04; and</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Is directly related to the diagnosis and treatment of breast cancer, cervical cancer, or a precancerous cervical lesion including, but not limited to, the following:</text>
      <paragraph num="(a)">
        <text>Breast biopsy;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Conization;</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Dilation and curettage;</text>
      </paragraph>
      <paragraph num="(d)">
        <text>Laser treatment;</text>
      </paragraph>
      <paragraph num="(e)">
        <text>Mastotomy; and</text>
      </paragraph>
      <paragraph num="(f)">
        <text>Simple or partial mastectomy excluding modified radical mastectomy and radical mastectomy.</text>
      </paragraph>
    </paragraph>
  </paragraph>
  <paragraph num="C.">
    <text>The Program does not reimburse for the following:</text>
    <paragraph num="(1)">
      <text>A service that is not directly related to the diagnosis and treatment of breast cancer, cervical cancer, or a precancerous cervical lesion; and</text>
    </paragraph>
    <paragraph num="(2)">
      <text>A service or procedure pursuant to COMAR 10.09.42.05.</text>
    </paragraph>
  </paragraph>
  <paragraph num="D.">
    <text>A participating freestanding ambulatory surgical center shall:</text>
    <paragraph num="(1)">
      <text>Accept and perform the responsibilities pursuant to Regulation .04E(1)—(7) and (9) of this chapter; and</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Submit a bill for the reimbursed service provided for an eligible patient 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 has insurance that does not provide coverage for the reimbursed service, the participating freestanding ambulatory surgical center shall send the bill to the Department; or</text>
      </paragraph>
      <paragraph num="(b)">
        <text>If an eligible patient is covered by Medicare or other insurance, the participating freestanding ambulatory surgical center shall bill:</text>
        <paragraph num="(i)">
          <text>Medicare or the other insurance the composite rate for the service or procedure performed; and</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>The Department for the outstanding deductible and patient contribution amount.</text>
        </paragraph>
      </paragraph>
    </paragraph>
  </paragraph>
  <paragraph num="E.">
    <text>The Department shall pay the participating freestanding ambulatory surgical center for a reimbursed service:</text>
    <paragraph num="(1)">
      <text>Pursuant to COMAR 10.09.42.06A, B, D, and E for an eligible patient who is uninsured or has insurance that does not provide coverage for the reimbursed service;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Pursuant to COMAR 10.09.42.06F for an eligible patient who is covered by Medicare; or</text>
    </paragraph>
    <paragraph num="(3)">
      <text>The outstanding deductible and patient contribution amount required by the insurer for an eligible patient who has insurance, other than Medicare, that provides coverage for the reimbursed service.</text>
    </paragraph>
  </paragraph>
  <paragraph num="F.">
    <text>The Program shall reimburse for claims submitted pursuant to this regulation as set forth in Regulation .21 of this chapter.</text>
  </paragraph>
</regulation>