<?xml version='1.0' encoding='utf-8'?>
<regulation prefix="Regulation" num=".07" citation="COMAR 10.18.07.07" title_num="10" subtitle_num="18" chapter_num="07" heading="Payment Procedures.">
  <paragraph num="A.">
    <text>A recipient, recipient’s representative, health care provider, insurer, employer, or health plan administrator, as applicable:</text>
    <paragraph num="(1)">
      <text>May request payment costs allowed under this chapter on behalf of the recipient according to procedures established by the Department;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Shall submit a payment request that is:</text>
      <paragraph num="(a)">
        <text>An invoice for the recipient’s health or prescription drug plan insurance premium, copays, coinsurance, and deductibles for core medical services issued by an insurer, an employer, a health plan administrator, prescription drug plan administrator, or a health care provider; and</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Submitted timely to allow for payment in accordance with §§A(3) and B(4) of this regulation; and</text>
      </paragraph>
    </paragraph>
    <paragraph num="(3)">
      <text>Shall make the initial request for the payment of costs within the time frames established by the health or prescription drug insurance policy.</text>
    </paragraph>
  </paragraph>
  <paragraph num="B.">
    <text>The Department:</text>
    <paragraph num="(1)">
      <text>Shall process a payment request as required by this chapter;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Shall inform a recipient or the recipient’s representative if an invoice is not paid;</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Shall make payments in accordance with any applicable policies and procedures for the administration of federal funds issued pursuant to the Ryan White CARE Act Amendments of 1996, P. L. 104—146, and any subsequent modifications to the Act; and</text>
    </paragraph>
    <paragraph num="(4)">
      <text>Shall make subsequent payments:</text>
      <paragraph num="(a)">
        <text>As permitted under a health or prescription drug plan; or</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Upon agreement between the Department and the:</text>
        <paragraph num="(i)">
          <text>Insurer;</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>Employer;</text>
        </paragraph>
        <paragraph num="(iii)">
          <text>Health plan administrator;</text>
        </paragraph>
        <paragraph num="(iv)">
          <text>Prescription drug plan administrator; or</text>
        </paragraph>
        <paragraph num="(v)">
          <text>Health care provider.</text>
        </paragraph>
      </paragraph>
    </paragraph>
  </paragraph>
</regulation>