Code of Maryland Regulations
Title 10 - MARYLAND DEPARTMENT OF HEALTH
Part 2
Subtitle 09 - MEDICAL CARE PROGRAMS
Chapter 10.09.23 - Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) Services
Section 10.09.23.03 - Conditions for Participation
Universal Citation: MD Code Reg 10.09.23.03
Current through Register Vol. 51, No. 19, September 20, 2024
A. In order to receive payments as a Medicaid provider, providers shall meet the following general requirements:
(1) All conditions for
participation set forth in COMAR 10.09.36;
(2) If delivering services via telehealth,
comply with COMAR 10.09.49 and any subregulatory guidance issued by the
Department;
(3) The licensure and
provider qualification requirements in Regulation .02 of this chapter;
and
(4) Verify the licenses and
credentials of all professionals employed or contracted by the provider, and
keep on file documentation of how that verification was
completed.
B. To be certified to participate in the Healthy Kids Program as an EPSDT screening provider, a provider shall agree to:
(1)
Provide EPSDT comprehensive well-child services as outlined in the EPSDT
periodicity schedule and in a manner prescribed by the Department;
(2) Provide or arrange for referral,
diagnosis, treatment, and follow-up when the screening indicates a need for
additional services;
(3) Inform the
parent or guardian of the next preventive health care visit, and assist with
scheduling;
(4) Cooperate with
Departmental efforts to assure that children receive needed follow-up and
treatment services;
(5) Conform to
the equipment, facilities, and procedural standards set by the
Department;
(6) Maintain a patient
record system that is sufficiently detailed and current to allow another
physician who is unfamiliar with the patient to properly continue treatment in
the absence of the initial provider;
(7) Participate in the Vaccines for Children
Program;
(8) Permit periodic
on-site quality assurance visits by the Department or its designee following a
protocol established by the Department to:
(a)
Assure that the equipment necessary to perform required procedures is
available;
(b) Review the charts of
participants to assure delivery of EPSDT screens;
(c) Determine that required procedures are
being performed correctly and that appropriate follow-up is provided;
and
(d) Assess the need for any
follow-up provider training, staff training, technical assistance, or
in-service training; and
(9) Maintain a minimum score of 80 percent on
all Healthy Kids Program quality assurance reviews.
C. An MCO that has contracted with the Department shall ensure its enrollees have access to EPSDT comprehensive well-child services in accordance with COMAR 10.09.66.05A(3).
Disclaimer: These regulations may not be the most recent version. Maryland may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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