Chapter 20. Organized Health Care Delivery Systems
Regulation .01 Purpose.LinkCopy Citation
The purpose of this chapter is to set forth the designation process and requirements for Organized Health Care Delivery Systems (OHCDS). Entities with this designation may subcontract with Medicaid and Non-Medicaid providers to allow individuals to receive services approved in their Individual Plans in the manner which best suits their needs and results in the more complete fulfillment of their plans.
Regulation .02 Scope.LinkCopy Citation
This chapter establishes the:
A.
Methodology that the Department shall use in the designation of entities as Organized Health Care Delivery Systems; and
B.
Requirements to be fulfilled by Organized Health Care Delivery Systems.
Regulation .03 Additional Regulatory Compliance.LinkCopy Citation
In addition to this chapter, a person who becomes an Organized Health Care Delivery System shall comply with the following regulations, as applicable:
A.
COMAR 10.22.01 — .10;
B.
COMAR 10.22.17;
C.
COMAR 10.22.18; and
D.
COMAR 10.09.26.
Regulation .04 Definitions.LinkCopy Citation
A.
In addition to the definitions set forth in COMAR 10.22.01, in this chapter, the following terms have the meanings indicated.
B.
Terms Defined.
(1)
“Administration” means the Developmental Disabilities Administration.
(2)
“Organized Health Care Delivery System (OHCDS)” means, under 42 CFR §447.10, a public or private organization for delivering health services that provides at least one Medicaid service directly and utilizes its own employees rather than contractors.
(3)
“Provider entity” means the OHCDS or potential OHCDS.
(4)
“Provider of service” means the person who actually delivers the service to the consumer.
Regulation .05 Designation as an OHCDS.LinkCopy Citation
The Administration shall designate a provider who applies to be an OHCDS if the provider entity:
A.
Submits an application on a form approved by the Administration;
B.
Is licensed by the Administration to provide one of the following services:
(1)
Community supported living arrangements;
(2)
Family and individual support services;
(3)
Day services;
(4)
Supported employment services;
(5)
Residential services; and
(6)
Other services as applicable;
C.
Is a Medicaid enrolled provider and renders at least one Medicaid Service directly; and
D.
Meets the requirements of this chapter.
Regulation .06 OHCDS Requirements.LinkCopy Citation
An OHCDS may either provide services itself or subcontract with another entity, and shall:
A.
Ensure that services provided are consistent with the consumer's Individual Plan and are detailed in the payment agreement with the Administration;
B.
Submit reports and comply with record keeping in accordance with Health-General Article, §§7-306.1 and 7-910, Annotated Code of Maryland; and
C.
Submit claims for Federal Financial Participation monthly or on an alternative time frame established by the Administration of which 50 percent of the OHCDS' quarterly payment may be withheld if required paperwork is not submitted within the designated time frame.
Regulation .07 OHCDS Subcontracting Requirements.LinkCopy Citation
When subcontracting, the OHCDS shall:
A.
Ensure that the providers of service meet all applicable provider qualifications set forth in COMAR 10.22 and 10.09.26, and any applicable industry or regulatory standards;
B.
Enter into a subcontract with each provider of service that:
(1)
Contains the scope, frequency, duration, and cost of the services to be provided;
(2)
Documents the qualifications of the provider of service;
(3)
Details service termination procedures;
(4)
Is consistent with the Individual's Plan; and
(5)
Is executed by the individual, the service provider, and the OHCDS; and
C.
Maintain detailed records, to be available to the Administration, its designee, or the respective consumer for review at any time, on the purchase of services from qualified entities or individuals, including invoices.
Regulation .08 Freedom of Choice of Providers.LinkCopy Citation
This chapter does not infringe on an individual's right to choose freely among qualified providers at any time.
Regulation .09 Termination of Designation.LinkCopy Citation
The Administration may terminate OHCDS designation as set forth in COMAR 10.22.03.06 and 10.22.03.07.
Chapter annotations
Authority: Health-General Article, §7-904, Annotated Code of Maryland
History: Effective date:
History: Regulations .01 — .09 adopted as an emergency provision effective June 1, 2004 (31:16 Md. R. 1252); adopted permanently effective September 27, 2004 (31:19 Md. R. 1432)