Md. Code Regs. 10.09.18.03 - Conditions for Participation
To participate in the Program, the provider shall:
A. Unless exempt from Medicare accreditation
requirements:
(1) Be accredited by a
Medicare-approved accreditation organization;
(2) Effective November 1, 2011, provide
documentation of:
(a) Accreditation;
or
(b) Having submitted an
application for accreditation; and
(3) Effective April 1, 2012, be accredited or
terminated from the Program;
B. Apply for participation in the Program
using the application form designated by the Department;
C. If located more than 25 miles from the
border of Maryland, shall provide to the Program documentation demonstrating
that the enrollment and screening requirements of 42 CFR Part 455, Subpart E
have been performed within the 12 months preceding the application for initial
enrollment or revalidation of enrollment by:
(1) A Medicare contractor; or
(2) The Medicaid agency or the Children's
Health Insurance Program of another state;
D. Be approved for participation by the
Department;
E. Verify the
recipient's eligibility;
F.
Maintain for a minimum of 6 years adequate records 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;
G. Provide service without discrimination as
to race, creed, color, age, sex, national origin, marital status, or physical
or mental handicap;
H. Not
knowingly employ a former Medicaid provider, or a former employee of a Medicaid
provider, to provide service to Medical Assistance patients after that provider
or employee has been disqualified from the Program, unless prior approval has
been received from the Department;
I. Accept payment by the Department as
payment in full for services rendered, and make no additional charge to any
person for covered services;
J.
Agree that if the Program denies payment or requests repayment on the basis
that an otherwise covered service was not medically necessary or preauthorized,
the provider may not seek payment for that service from the
recipient;
K. Agree that if the
Program denies payment due to late billing, he may not seek payment from the
recipient;
L. Place no restriction
on a recipient's right to select providers of the recipient's choice;
M. Have emergency services available on a 24
hour-a-day basis;
N. Be prepared to
furnish necessary maintenance and repairs to oxygen and related respiratory
equipment;
O. Insure on every visit
to the patient that all oxygen and related respiratory equipment functions
properly;
P. Provide suitable
identification, including a recent photograph, which employees who visit
patients at home will carry on their person and display on request;
Q. Agree to discontinue billing or remove
equipment promptly, if the patient dies, is institutionalized, or otherwise
ceases to require the oxygen;
R.
Provide an ancillary source of oxygen to last at least 24 hours when the
primary source is a concentrator.
Notes
Regulation .03D amended effective April 5, 2010 (37:7 Md. R. 570)
Regulation .03H amended effective May 29, 1989 (16:10 Md. R. 1109)
Regulation .03P amended effective November 5, 1984 (11:22 Md. R. 1899)
Regulations .03 amended effective 42:7 Md. R. 568, eff.
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