Md. Code Regs. 10.09.77.01 - Definitions
A. In this chapter,
the following terms have the meanings indicated.
B. Terms Defined.
(1) "Department" means the State Department
of Health and Mental Hygiene, the single State agency designated to administer
the Medical Assistance Program under Title XIX of the Social Security Act,
42 U.S.C. §
1396 et seq.
(2) "Free-standing clinic" means a health
care facility that is not licensed as a hospital, part of a hospital, or
nursing home and is not administratively part of a physician's, dentist's, or
osteopath's office, but which has a separate staff functioning under the
direction of a clinic administrator or health officer and is organized and
operated to provide ambulatory health services.
(3) "Free-standing urgent care center" means
a location, distinct from a hospital emergency room, a physician's office, or a
free-standing clinic, whose purpose is to diagnose and treat illness or injury
for unscheduled, ambulatory patients seeking immediate medical
attention.
(4) "Hospital" means an
institution which falls within the jurisdiction of Health-General Article,
Title 19, Subtitle 3, Annotated Code of Maryland, and is licensed pursuant to
COMAR 10.07.01.
(5) "Medical
Assistance Program" means a program of comprehensive medical and other
health-related care for indigent and medically indigent persons.
(6) "Medically necessary" means that the
service or benefit is:
(a) Directly related
to diagnostic, preventive, curative, palliative, rehabilitative, or
ameliorative treatment of an illness, injury, disability, or health
condition;
(b) Consistent with
currently accepted standards of good medical practice;
(c) The most cost efficient service that can
be provided without sacrificing effectiveness or access to care; and
(d) Not primarily for the convenience of the
consumer, family, or provider.
(7) "Medicare" means the insurance program
administered by the federal government under Title XVIII of the Social Security
Act, U.S.C. §1395 et seq.
(8)
"Participant" means an individual who is certified as eligible for and is
receiving Medical Assistance benefits.
(9) "Patient" means a participant awaiting or
undergoing health care or treatment.
(10) "Physician" means an individual legally
licensed to practice medicine in the state in which the physician's practice is
located.
(11) "Program" means the
Maryland Medical Assistance Program.
(12) "Provider" means a free-standing urgent
care center which, through appropriate agreement with the Department, has been
identified as a Program provider by the issuance of a Medical Assistance
provider number.
(13) "Urgent care"
means the delivery of ambulatory care, such as for acute illnesses or minor
traumas, in a facility dedicated to the delivery of unscheduled, walk-in care
outside of a hospital emergency department, a free-standing clinic, or a
physician's office.
Notes
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