This chapter: Defines the emergency medical treatment and the limitations on this treatment paid for by the Department for the victims of child abuse and neglect; Defines provider license requirements and conditions for participation, payment, and reimbursement provisions; and Establishes appeal procedures. In this chapter, the following terms have the meanings indicated. Terms Defined. “Abuse” means: The physical or mental injury of a child by any parent or other person who has permanent or temporary care or custody or responsibility for supervision of a child, or by any household or family member, under circumstances that indicate that the child's health or welfare is harmed or at substantial risk of being harmed; or Sexual abuse of a child, whether physical injuries are sustained or not. “Child” means any individual under 18 years old. “Department” means the Maryland Department of Health. “Emergency medical treatment” means medical or surgical care rendered by a physician or health care institution to a child to relieve any urgent illness or life threatening health condition or to determine the nature or extent of any alleged injury or health condition. Emergency medical treatment does not include non-emergency outpatient treatment or periodic nonemergency health care. “Examination” means the medical evaluation of a child to determine the nature and extent of any physical neglect, physical injury, or physical abuse. “Local department of social services” means the Baltimore City or county social services department under the supervision of the Social Services Administration. “Medical Assistance Program” means a program of comprehensive medical and other health-related care for indigent and medically indigent persons. “Mental injury” means the observable, identifiable, and substantial impairment of a child's mental or psychological ability to function. “Neglect” means the leaving of a child unattended or other failure to give proper care and attention to a child by any parent or other person who has permanent or temporary care or custody or responsibility for supervision of the child, under circumstances that indicate: That the child's health or welfare is harmed or placed at substantial risk of harm; or Mental injury to the child or a substantial risk of mental injury. “Physician” means an individual legally licensed to practice medicine in Maryland. “Program” means the Child Abuse and Neglect Medical Reimbursement Program. “Provider” means any physician or health care institution which renders medical care or services to a child who has been or is alleged to have been abused or neglected. “Sexual abuse” means any act that involves sexual molestation or exploitation of a child by a parent or other person who has permanent or temporary care or custody or responsibility for supervision of a child, or by any household or family member, and includes: Incest, rape, or sexual offense in any degree; Sodomy; and Unnatural or perverted sexual practices. A doctor of medicine shall be licensed and legally authorized to practice medicine and surgery in Maryland. A hospital shall be licensed by the Department as a hospital, pursuant to Hospital and Related Institutions subtitle, Health-General Article, Title 19, Subtitle 3, Annotated Code of Maryland, and shall obtain other licenses as may be required by applicable State and local laws. To be reimbursed by the Program, the provider shall: Accept payment by the Program as payment in full for the services rendered to an eligible child and make no additional charge to any person for covered services; Agree that if the Program denies payment or requests repayment on the basis that an otherwise covered service was not medically necessary, the provider may not seek payment for that service from the child or child's parent or guardian; Provide services without regard to race, creed, color, sex, national origin, marital status, or physical or mental handicap; Maintain records for a minimum of 5 years which are sufficient in detail to support the invoices submitted for payment and make these records available, upon request, to the Department or its designee; Examine or treat any child to determine the nature and extent of any injury as a result of abuse or neglect to the child if the child is brought to the provider: In accordance with a court order; By a police officer who states that the police officer believes the child is an abused child; or By a representative of a local department of social services who states that the representative believes the child is an abused or neglected child. The provider may not require the consent of the child's parent, guardian, or custodian as a condition of examination or emergency medical treatment. Immunity from Civil Liability. A physician who examines or treats a child under this chapter is immune from any civil liability that may result from the failure to obtain consent from the child's parents, guardian, or custodian for the examination or treatment of the child. The immunity extends to any: Health care institution with which the physician is affiliated, or to which the child is brought; and Individual working under the control or supervision of the physician or under the control or supervision of the health care institution. The Program covers emergency medical treatment rendered to children who are alleged victims of abuse or neglect. This treatment includes: Medical or surgical care rendered by a physician or health care institution; and Diagnostic tests. The Program does not cover the following: Nonemergency outpatient treatment; Periodic nonemergency health care; Services which are investigational or experimental; or Services related to the assessment and treatment of mental injury. The provider shall submit the request for payment on the appropriate Medical Assistance Program invoice form. The Department reserves the right to return to the provider, before payment, all invoices not properly signed, completed, and accompanied by properly completed forms required by the Department. Providers shall charge the Program their usual and customary charge to the general public for similar services. The fee schedule for covered services except hospital services shall be the same as is contained in the Maryland Medical Assistance Program’s Professional Services Provider Manual and Fee Schedule which is incorporated by reference in COMAR 10.09.02.07D. The reimbursement rates for all covered hospital services shall be the Health Services Cost Review Commission approved rates less the discount allowed the Medical Assistance Program. For covered services, the Program shall pay the lower of: The provider's usual and customary charge to the general public for similar services; or The applicable rate described in §D or E of this regulation. Supplemental payment on Medicare claims shall be made by the Program subject to the following provisions: Deductible insurance shall be paid in full; Coinsurance shall be paid in full; Services not covered by Medicare are payable according to §F of this regulation. Payments on Medicare claims shall be authorized if: The provider accepts Medicare assignments; Medicare makes direct payment to the provider; Services are covered by the Program; Initial billing is made directly to Medicare according to Medicare guidelines. The provider may not bill the Program for: Completion of forms and reports; Professional services rendered by mail or telephone; Services which are provided at no charge to the general public. The Program shall make no direct payment to anyone except providers. The Program may not reimburse invoices received for payment by the local department of social services more than 90 days after the date of service. Providers shall bill the Program in the following manner: Claims shall be submitted on appropriate forms; Claims shall be submitted to the local department of social services and shall be received by that department within 90 days of the date of service; A claim which is rejected for payment due to improper completion or incomplete information shall be paid only if it is properly completed, resubmitted, and received by the Program within the original 90-day period or within 60 days of the rejection, whichever is later. The child's parent or guardian is liable to the Maryland Department of Health for all payments made on behalf of the child by this Program. The child's parent or guardian shall take any steps necessary to secure health benefits available for the child from a public or private benefit program. Upon notification to the provider that the child has insurance or other coverage for services covered by this chapter, the provider shall seek payment from that source. If payment is made to a provider by both the Program and other insurance or other source, the provider shall refund the Program, within 60 days of receipt, the amount paid by the Program or the insurance or other source, whichever is less. The provider shall reimburse the Program for any overpayments. Providers filing appeals from administrative decisions made in connection with these regulations shall do so according to State Government Article, Title 10, Subtitle 2, and Health-General Article, §§2-201—2-207, Annotated Code of Maryland. Appeals shall be filed within 30 days of receipt of notice of administrative decisions. Payment under this chapter is contingent on the availability of funds in accordance with State Finance and Procurement Article, §§7-234 and 7-235, Annotated Code of Maryland. Family Law Article, §§5-701—5-910, Annotated Code of Maryland Effective date: March 10, 1986 (13:5 Md. R. 546) Chapter revised effective October 20, 1997 (24:21 Md. R. 1450) Regulation .07D amended effective February 27, 2017 (44:4 Md. R. 252)