<?xml version='1.0' encoding='utf-8'?>
<regulation prefix="Regulation" num=".14" citation="COMAR 10.14.02.14" title_num="10" subtitle_num="14" chapter_num="02" heading="Occupational Therapy Services.">
  <paragraph num="A.">
    <text>To be considered a participating occupational therapist in the Program, the provider shall:</text>
    <paragraph num="(1)">
      <text>Be an occupational therapist licensed to practice occupational therapy in Maryland or a jurisdiction bordering Maryland;</text>
    </paragraph>
    <paragraph num="(2)">
      <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="(3)">
      <text>Follow standard health and safety procedures to protect an eligible patient from potential hazards;</text>
    </paragraph>
    <paragraph num="(4)">
      <text>Agree to requirements of the Program set forth in Regulation .04A(5), (9), and (10) of this chapter;</text>
    </paragraph>
    <paragraph num="(5)">
      <text>Agree to accept as payment in full the amount paid by the Program under §E of this regulation, plus the amount paid by the eligible patient's health insurer, if applicable; and</text>
    </paragraph>
    <paragraph num="(6)">
      <text>Agree not to bill an eligible patient an additional charge for the service.</text>
    </paragraph>
  </paragraph>
  <paragraph num="B.">
    <text>The cost of an occupational therapist’s services are covered as set forth in COMAR 10.09.04.04B(4).</text>
  </paragraph>
  <paragraph num="C.">
    <text>The Program does not reimburse for services:</text>
    <paragraph num="(1)">
      <text>Performed by an occupational therapy assistant if not under the direct supervision of a licensed occupational therapist;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Performed by an occupational therapy aide; or</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Not directly related to the treatment of breast or cervical cancer.</text>
    </paragraph>
  </paragraph>
  <paragraph num="D.">
    <text>The participating occupational therapist is responsible for the following:</text>
    <paragraph num="(1)">
      <text>Submitting to the Department, within 12 months of the date of service, a request for payment on the designated form;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Certifying on the invoice that a treatment order is on file and was in effect at the time services were rendered; and</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Specifying on the invoice the type of treatment provided.</text>
    </paragraph>
  </paragraph>
  <paragraph num="E.">
    <text>Reimbursement Principles.</text>
    <paragraph num="(1)">
      <text>The Department shall reimburse the participating occupational therapist:</text>
      <paragraph num="(a)">
        <text>For a covered service performed in the provider’s office the amount of:</text>
        <paragraph num="(i)">
          <text>The current Medical Assistance approved rate for the State for an eligible patient who is uninsured or has insurance that does not provide coverage for the reimbursed procedure or service; or</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>The outstanding deductible and patient contribution for an eligible patient who is covered by Medicare or other insurance; and</text>
        </paragraph>
      </paragraph>
      <paragraph num="(b)">
        <text>For covered services performed in the home of an eligible patient under Regulation .11F of this chapter.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(2)">
      <text>The Department may not reimburse the participating occupational therapist for:</text>
      <paragraph num="(a)">
        <text>Services rendered by mail or telephone;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Completion of a form or report;</text>
      </paragraph>
      <paragraph num="(c)">
        <text>A broken or missed appointment; or</text>
      </paragraph>
      <paragraph num="(d)">
        <text>A service which is provided at no charge to the general public.</text>
      </paragraph>
    </paragraph>
  </paragraph>
  <paragraph num="F.">
    <text>The participating occupational therapist shall obtain recovery under Regulation .17 of this chapter.</text>
  </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>