Md. Code Regs. 10.09.29.06 - Preauthorization Requirements
The following procedures or services require preauthorization:
A. Out-of-State
admissions. Adequate documentation shall be provided demonstrating that the
placement meets one of the conditions as follows:
(1) Effective services at an in-State
facility are not available;
(2) For
similar services, an inpatient placement is not currently available in
Maryland; or
(3) The recipient
resides out-of-State and the cost for the out-of-State service is comparable to
the cost of similar services in Maryland.
B. Services which are determined by Medicare
to be ineffective, unsafe, or without proven clinical value are generally
presumed to be not medically necessary, but will be preauthorized if the
provider can satisfactorily document sufficient medical necessity except as
specified in Regulation .05C of this chapter.
C. All admissions, which shall comply with
the requirements under COMAR
10.09.59.08 for
preauthorization.
Notes
Regulations .06 amended as an emergency provision effective July 1, 1997 (24:16 Md. R. 1150); amended permanently effective December 29, 1997 (24:26 Md. R. 1758); amended effective 49:7 Md. R. 462, eff.
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