Code of Maryland Regulations
Title 10 - MARYLAND DEPARTMENT OF HEALTH
Part 2
Subtitle 09 - MEDICAL CARE PROGRAMS
Chapter 10.09.93 - Chronic Hospitals
Section 10.09.93.09 - Payment Procedures
Universal Citation: MD Code Reg 10.09.93.09
Current through Register Vol. 51, No. 19, September 20, 2024
A. Reimbursement of Maryland Chronic Hospitals.
(1) In-State chronic hospitals shall be
reimbursed according to:
(a) Rates approved
by the HSCRC pursuant to COMAR 10.37.03; or
(b) The administrative day rate as follows:
(i) For a participant who is not
ventilator-dependent, payment for approved administrative days shall be the
estimated Statewide average Medicaid nursing facility payment rate as
determined by the Department; and
(ii) For a participant who is
ventilator-dependent, payment for approved administrative days shall be the
estimated average Medicaid nursing facility payment rate for
ventilator-dependent residents as determined by the Department.
(2) State-operated
chronic hospitals shall be reimbursed according to Regulation .10 of this
chapter. The Department shall make no direct reimbursement to any
State-operated chronic hospital.
B. Reimbursement of Out-of-State Hospitals.
(1) The Department shall reimburse an
out-of-State hospital that provides a level of service equivalent to that
provided at a chronic hospital only if:
(a)
The proposed admission is first reviewed by the Department or its designee and
the out-of-State placement is determined medically necessary according to
Regulation .07A of this chapter;
(b) The hospital possesses the same
certifications and accreditations as the Program requires for a comparable
level of services and specific program in a Maryland chronic hospital;
and
(c) The hospital meets one of
the following conditions:
(i) The hospital
proposes to provide a service or specific treatment that the participant cannot
obtain in a Maryland chronic hospital; or
(ii) The hospital is located geographically
closer to the established residence of the participant than a Maryland chronic
hospital.
(2)
The Department shall reimburse an out-of-State hospital at the lesser of:
(a) The average rate established by the HSCRC
for an equivalent cost center for a Maryland chronic hospital; or
(b) The rate charged by the out-of-State
hospital pursuant to 42 CFR Part 412, Subpart O.
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