(a) In this section, “dual eligibility” means simultaneous eligibility for health insurance coverage under both the Program and Medicare and for which the Department may obtain federal matching funds. (b) The Department shall adopt rules and regulations for the reimbursement of providers under the Program. However, except for an invoice that must be submitted to a Medicare […]
(a) This section does not apply to a person providing pharmacy benefit manager services. (b) If a pharmacy is required to submit a request for payment electronically to the Department under § 15-105(b) of this subtitle, then the pharmacy may choose to be reimbursed electronically, and in that event, the Department shall reimburse the pharmacy electronically under […]
The Program shall reimburse health care providers in accordance with the requirements of Title 19, Subtitle 1, Part IV of this article.
(a) (1) In cooperation with the professional organizations whose members provide health care under the Program, the Secretary shall establish a system of review for all health care that is provided. (2) The review shall include a study of the quality of care and the proper use of the services by the Program recipient or the provider. (b) A […]
(a) The Department may require facilities that participate in the Program to submit cost reports, as defined by the Department, within the time set by the Department. (b) If a report is not submitted within that time, the Department shall withhold from the facility up to 10 percent of current interim payments for the calendar month in […]
(a) In this section, “board” means an appeal board established under this section. (b) (1) The Secretary may: (i) Establish one or more boards for purposes of this section; and (ii) Designate the jurisdiction of a board. (2) A board shall consist of 3 members. (3) Of the 3 board members: (i) 2 shall be appointed by the Secretary; and (ii) 1 shall be […]
(a) An individual is not ineligible under the Program solely because Social Security benefits received by the individual are increased, unless: (1) The individual is considered ineligible because of the increase under applicable rules or regulations of the United States Department of Health and Human Services; and (2) As to that individual, federal matching funds for the State […]
(a) The Department, in consultation with the Office of the Attorney General, shall: (1) Develop and implement a plan for making the advance directive information sheet developed under § 5–615 of this article widely available; and (2) Make the information sheet described in item (1) of this subsection available in a conspicuous location in each local health department, […]
** CONTINGENCY – NOT IN EFFECT – CHAPTER 82 OF 2005 ** To the extent authorized by federal law or regulation, if a Program recipient who is at least 21 years old but is under the age of 65 years is incarcerated or is admitted to an institution for the treatment of mental disease, the […]
The Department shall reimburse acute general and chronic care hospitals that participate in the Program for care provided to Program recipients in accordance with rates that the Health Services Cost Review Commission approves under Title 19, Subtitle 2 of this article, if the United States Department of Health and Human Services approves this method of […]
(a) The Department may authorize reimbursement of a licensed day care center for the elderly or medically handicapped adults for medical care that the center provides to a Program recipient who is certified as requiring nursing home care. (b) (1) Reimbursement under this section is subject to the availability of federal funds. (2) The reimbursement rate for medical day […]
After consultation with the State Board of Pharmacy, the Secretary may authorize reimbursement of a physician for the dispensing of drugs to Program recipients, on the same basis as a licensed pharmacist if: (1) The physician dispenses drugs on a regular basis in the physician’s office; and (2) There is no pharmacy within 10 miles of that […]
(a) In this section, “inmate of a public institution” has the meaning stated in Title 42, § 435.1009 of the Code of Federal Regulations (1978 edition). (b) (1) If an inmate of a public institution is eligible for federally funded Medicaid benefits, the Department shall pay the custodial authority for any medical care that is provided to the […]
(a) In this section, “related institution” includes any of the following facilities, as classified from time to time by law, rule, or regulation: (1) A comprehensive care facility; (2) An extended care facility; (3) An intermediate care facility; and (4) A skilled nursing facility. (b) This section applies only to the extent that federal funds are available for reimbursement under this […]
(a) In this section, “emergency service transporter” means a public entity or volunteer fire, rescue, or emergency medical service that provides emergency medical services. (b) If an emergency service transporter charges for its services and requests reimbursement from the Program, the Department shall reimburse the emergency service transporter, in an amount as specified by regulations adopted by […]
(a) The Department may not place a Program recipient in a skilled or intermediate nursing facility if, because of the condition of the Program recipient, the placement would cause undue risk to the Program recipient. (b) To provide a basis for evaluating the placement of Program recipients who need skilled or intermediate nursing care in skilled or […]
The Department shall reimburse skilled nursing facilities for services provided to indigent or medically indigent patients under the age of 21 years.
(a) In this section, “leave of absence” includes: (1) A visit with friends or relatives; and (2) A leave to participate in a State approved therapeutic or rehabilitative program. (b) To ensure that a bed is reserved for a Program recipient who is on leave of absence from a nursing facility that has made a provider agreement with the […]
(a) (1) Unless the prescriber directs otherwise on the form or on an attached signed certification of need, the generic form of the drug authorized under § 12-504 of the Health Occupations Article shall be used to fill the prescription. (2) If the appropriate generic drug is not generally available, the Department may waive the requirement for generic […]
The Secretary may not consider drugs prescribed to treat diabetes, HIV, or AIDS to be specialty drugs for the purpose of providing services under the Program.
