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<chapter num="20" heading="Organized Health Care Delivery Systems" title_num="10" subtitle_num="22">
  <regulation prefix="Regulation" num=".01" heading="Purpose.">
    <text>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.</text>
  </regulation>
  <regulation prefix="Regulation" num=".02" heading="Scope.">
    <text>This chapter establishes the:</text>
    <paragraph num="A.">
      <text>Methodology that the Department shall use in the designation of entities as Organized Health Care Delivery Systems; and</text>
    </paragraph>
    <paragraph num="B.">
      <text>Requirements to be fulfilled by Organized Health Care Delivery Systems.</text>
    </paragraph>
  </regulation>
  <regulation prefix="Regulation" num=".03" heading="Additional Regulatory Compliance.">
    <text>In addition to this chapter, a person who becomes an Organized Health Care Delivery System shall comply with the following regulations, as applicable:</text>
    <paragraph num="A.">
      <text>COMAR 10.22.01 — .10;</text>
    </paragraph>
    <paragraph num="B.">
      <text>COMAR 10.22.17;</text>
    </paragraph>
    <paragraph num="C.">
      <text>COMAR 10.22.18; and</text>
    </paragraph>
    <paragraph num="D.">
      <text>COMAR 10.09.26.</text>
    </paragraph>
  </regulation>
  <regulation prefix="Regulation" num=".04" heading="Definitions.">
    <paragraph num="A.">
      <text>In addition to the definitions set forth in COMAR 10.22.01, in this chapter, the following terms have the meanings indicated.</text>
    </paragraph>
    <paragraph num="B.">
      <text>Terms Defined.</text>
      <paragraph num="(1)">
        <text>“Administration” means the Developmental Disabilities Administration.</text>
      </paragraph>
      <paragraph num="(2)">
        <text>“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.</text>
      </paragraph>
      <paragraph num="(3)">
        <text>“Provider entity” means the OHCDS or potential OHCDS.</text>
      </paragraph>
      <paragraph num="(4)">
        <text>“Provider of service” means the person who actually delivers the service to the consumer.</text>
      </paragraph>
    </paragraph>
  </regulation>
  <regulation prefix="Regulation" num=".05" heading="Designation as an OHCDS.">
    <text>The Administration shall designate a provider who applies to be an OHCDS if the provider entity:</text>
    <paragraph num="A.">
      <text>Submits an application on a form approved by the Administration;</text>
    </paragraph>
    <paragraph num="B.">
      <text>Is licensed by the Administration to provide one of the following services:</text>
      <paragraph num="(1)">
        <text>Community supported living arrangements;</text>
      </paragraph>
      <paragraph num="(2)">
        <text>Family and individual support services;</text>
      </paragraph>
      <paragraph num="(3)">
        <text>Day services;</text>
      </paragraph>
      <paragraph num="(4)">
        <text>Supported employment services;</text>
      </paragraph>
      <paragraph num="(5)">
        <text>Residential services; and</text>
      </paragraph>
      <paragraph num="(6)">
        <text>Other services as applicable;</text>
      </paragraph>
    </paragraph>
    <paragraph num="C.">
      <text>Is a Medicaid enrolled provider and renders at least one Medicaid Service directly; and</text>
    </paragraph>
    <paragraph num="D.">
      <text>Meets the requirements of this chapter.</text>
    </paragraph>
  </regulation>
  <regulation prefix="Regulation" num=".06" heading="OHCDS Requirements.">
    <text>An OHCDS may either provide services itself or subcontract with another entity, and shall:</text>
    <paragraph num="A.">
      <text>Ensure that services provided are consistent with the consumer's Individual Plan and are detailed in the payment agreement with the Administration;</text>
    </paragraph>
    <paragraph num="B.">
      <text>Submit reports and comply with record keeping in accordance with Health-General Article, §§7-306.1 and 7-910, Annotated Code of Maryland; and</text>
    </paragraph>
    <paragraph num="C.">
      <text>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.</text>
    </paragraph>
  </regulation>
  <regulation prefix="Regulation" num=".07" heading="OHCDS Subcontracting Requirements.">
    <text>When subcontracting, the OHCDS shall:</text>
    <paragraph num="A.">
      <text>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;</text>
    </paragraph>
    <paragraph num="B.">
      <text>Enter into a subcontract with each provider of service that:</text>
      <paragraph num="(1)">
        <text>Contains the scope, frequency, duration, and cost of the services to be provided;</text>
      </paragraph>
      <paragraph num="(2)">
        <text>Documents the qualifications of the provider of service;</text>
      </paragraph>
      <paragraph num="(3)">
        <text>Details service termination procedures;</text>
      </paragraph>
      <paragraph num="(4)">
        <text>Is consistent with the Individual's Plan; and</text>
      </paragraph>
      <paragraph num="(5)">
        <text>Is executed by the individual, the service provider, and the OHCDS; and</text>
      </paragraph>
    </paragraph>
    <paragraph num="C.">
      <text>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.</text>
    </paragraph>
  </regulation>
  <regulation prefix="Regulation" num=".08" heading="Freedom of Choice of Providers.">
    <text>This chapter does not infringe on an individual's right to choose freely among qualified providers at any time.</text>
  </regulation>
  <regulation prefix="Regulation" num=".09" heading="Termination of Designation.">
    <text>The Administration may terminate OHCDS designation as set forth in COMAR 10.22.03.06 and 10.22.03.07.</text>
  </regulation>
  <annotations>
    <annotation type="Authority">Health-General Article, §7-904, Annotated Code of Maryland</annotation>
    <annotation type="History" subtype="Administrative History">Effective date:</annotation>
    <annotation type="History" subtype="Administrative 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)</annotation>
  </annotations>
</chapter>