Code of Maryland Regulations
Title 10 - MARYLAND DEPARTMENT OF HEALTH
Part 2
Subtitle 09 - MEDICAL CARE PROGRAMS
Chapter 10.09.12 - Disposable Medical Supplies and Durable Medical Equipment
Section 10.09.12.01 - Definitions
Universal Citation: MD Code Reg 10.09.12.01
Current through Register Vol. 51, No. 19, September 20, 2024
A. In this chapter, the following terms have the meanings indicated.
B. Terms Defined.
(1) "Customary charge" means the uniform
amount that the provider charges in the majority of cases for a specific supply
or piece of equipment, excluding token charges for charity patients and
substandard charges for welfare and other low income patients.
(2) "Customized equipment" means durable
medical equipment which is uniquely constructed or substantially modified by
the provider from the standard product:
(a)
For a specific recipient according to the description and orders of a
physician; and
(b) In such a way
that the equipment can only be used by the specific recipient.
(3) "Department" means Department
as defined in COMAR
10.09.36.01A.
(4) "Disposable medical supplies"
means consumable or disposable items with minimal or no potential for reuse
which are used to serve a medically necessary purpose and, with the exception
of disposable gloves and incontinence supplies, have no practical use in the
absence of illness, injury, disability, or health condition.
(5) "Durable medical equipment" means
equipment which satisfies all of the following requirements:
(a) It can withstand repeated use;
(b) It is used to serve a medically necessary
purpose; and
(c) It has no
practical use in the absence of illness, injury, disability, or health
condition.
(6) "Home"
means that place of residence occupied by the recipient, including an assisted
living facility, but other than a hospital, nursing facility, or other medical
institution.
(7) "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 or other applicable standards established by the state in which
the service is provided.
(8)
"Incontinence" means the inability to refrain from yielding to the urge to
urinate or defecate for persons previously having bowel or bladder control or
individuals who are lacking bowel or bladder control due to congenital
anomalies or postnatal insult.
(9)
"Invoice" means a form designated by the Department for use by providers in
submitting bills for payment.
(10)
"Maximum allowable reimbursement" means the payment limitation established by
the Department.
(11) "Medical
Assistance Program" means the Medical Assistance Program as defined in COMAR
10.09.36.01A.
(12) "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
current 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.
(13) "Medicare" means Medicare as defined in
COMAR 10.09.36.01A.
(14) "Nursing facility" means a
facility licensed as a comprehensive care or extended care facility pursuant to
COMAR 10.07.02.
(15) "Physical
therapy program" means an established program that outlines the prescribed
equipment and treatment, along with frequency, duration, and goals or expected
outcome of the recipient.
(16)
"Prepayment authorization" means the approval required from the Department or
its designee before services can be reimbursed.
(17) "Prescriber" means a physician, dentist,
podiatrist, physician's assistant, clinical nurse specialist, or nurse
practitioner licensed in the state in which the prescriber's practice is
maintained who has examined the recipient.
(18) "Prescriber order" means a document on
the prescriber's letterhead or prescription form which details the:
(a) Patient name and Medical Assistance
number;
(b) Item needed including
the accessories, adaptions, modifications, and attachments considered medically
necessary and medically appropriate by the prescriber;
(c) Estimated quantity of the item;
(d) Length of time of need;
(e) Date of face-to-face encounter and how
the health status of the recipient at the time of the face-to-face encounter is
related to the items prescribed; and
(f) Prescriber's signature.
(19) "Prescription" means a
written order for medical supplies or equipment, signed by the
prescriber.
(20) "Program" means
program as defined in COMAR
10.09.36.01A.
(21) "Provider" means provider as
defined in COMAR
10.09.36.01A.
(22) "Recipient" means recipient
as defined in COMAR
10.09.36.01A.
(23) Wholesale cost.
(a) "Wholesale cost" means the price paid by
the provider to the manufacturer or any other supplier for disposable medical
supplies or durable medical equipment after consideration of both primary
discounts and secondary volume and prompt payment discounts applicable at the
time the manufacturer's invoice is paid.
(b) "Wholesale cost" includes, but is not
limited to:
(i) Shipping;
(ii) Handling; and
(iii) Insurance costs.
(c) "Wholesale cost" does not include
associated costs such as:
(i)
Evaluation;
(ii) Assembly by the
provider;
(iii) Fitting and
adjustment; and
(iv) Delivery to
the recipient.
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