Code of Maryland Regulations
Title 10 - MARYLAND DEPARTMENT OF HEALTH
Part 2
Subtitle 09 - MEDICAL CARE PROGRAMS
Chapter 10.09.95 - Special Psychiatric Hospitals
Section 10.09.95.01 - Definitions
Universal Citation: MD Code Reg 10.09.95.01
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) "Administrative day" means a day of
medical services delivered to a participant who no longer requires the level of
care which the provider is licensed to deliver and is awaiting placement in a
nursing home or residential care facility.
(2) "Admission" means the formal acceptance
by a specialty psychiatric hospital of a patient who is to be provided with
room, board, and medically necessary services in an area of the hospital where
patients stay at least overnight.
(3) "Ancillary services" means diagnostic and
therapeutic services, provided exclusive of room and board, including but not
limited to:
(a) Radiology;
(b) Laboratory tests;
(c) Pharmacy services; and
(d) Physical therapy services.
(4) "Appropriate facility" means:
(a) A facility located within a 25-mile
radius of the participant's residence; or
(b) If acceptable to the participant, a more
distant facility, which is licensed and certified to render the participant's
required level of care, except when the only facility or facilities that
provide the level of care and specialized services required by the participant
exceed that distance.
(5) "Concurrent review" means a periodic
reauthorization of continued eligibility for the level of services provided by
a special psychiatric hospital which allows for close monitoring of the
participant's progress, treatment goals, and objectives during an inpatient
hospitalization.
(6) "Date of
service" means:
(a) For inpatient
hospitalizations, the date of admission into a special psychiatric hospital up
to, but not including, the date of discharge;
(b) For outpatient services, the date
services are rendered in the outpatient department of the special psychiatric
hospital; and
(c) For observation
services, the date or dates the services are rendered in a special psychiatric
hospital, which are ordered by a medical staff practitioner to determine the
need for inpatient admission.
(7) "Department" means the State Department
of Health and Mental Hygiene, which is 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.
(8) "Designee" means any entity designated to
act on behalf of the Department.
(9) "Electronic signature" means a secure
electronic identification of an individual who authorizes an electronic record
or transaction.
(10) "Emergent
condition" means a disease, illness, or injury characterized by sudden onset
and symptoms of sufficient severity, including severe pain, that the absence of
immediate medical attention could reasonably be expected by a prudent
layperson, who possesses an average knowledge of health and medicine, to result
in:
(a) Placing the participant's health or,
with respect to a pregnant woman, the health of the woman or unborn child in
serious jeopardy;
(b) Serious
impairment of bodily functions; or
(c) Serious dysfunction of any bodily organ
or part.
(11) "Health
Services Cost Review Commission (HSCRC)" means the independent organization
within the Department of Health and Mental Hygiene which is responsible for
reviewing and approving rates for hospitals pursuant to Health-General Article,
Title 19, Subtitle 2, Annotated Code of Maryland.
(12) "Level of care" means an assessment that
an individual needs the level of services provided in a special psychiatric
hospital.
(13) "Maryland Medical
Assistance Program" means the program of comprehensive medical and other
health-related care for indigent and medically indigent persons.
(14) "Medicaid" means the Maryland Medical
Assistance Program.
(15) "Medically
necessary" means that the service or benefit is:
(a) Directly related to diagnostic,
preventative, curative, palliative, rehabilitative, or ameliorative treatment
of an illness, injury, disability, or health condition;
(b) Consistent with 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 participant, family, or
provider.
(16)
"Medicare" means the medical insurance program administered by the federal
government under Title XVIII of the Social Security Act,
42 U.S.C. § 1395 et seq.
(17) "Mental health services" means those
services described in COMAR
10.09.59.06 rendered to treat the
diagnoses set forth in COMAR 10.09.70.02.
(18) "Nonqualified alien" means a
foreign-born resident who:
(a) Is not a
naturalized U.S. citizen; and
(b)
Is eligible for federal Medical Assistance coverage of only emergency medical
services, as specified under COMAR
10.09.24.05-2A.
(19) "Observation services" means
the medically necessary diagnostic services used to assess the participant's
outpatient condition to determine the need for possible admission to an
inpatient special psychiatric care setting.
(20) "Organ" means a part of an organism that
is typically self-contained and has a specific vital function, such as a heart
or liver.
(21) "Out-of-State
hospital" means any hospital outside of Maryland, except for hospitals located
in the District of Columbia.
(22)
"Outpatient services" means services provided to the participant on the
hospital campus that do not require hospital admission.
(23) "Partial hospitalization" means
outpatient, intensive, nonresidential psychiatric treatment, which is an
alternative to inpatient acute general hospitalization, for any part of a
24-hour day for a minimum of 4 consecutive hours per day.
(24) "Participant" means a person who is
certified as eligible for and is receiving Medical Assistance
benefits.
(25) "Patient" means an
individual awaiting or undergoing health care or treatment.
(26) "Plan of treatment" means a written
plan, developed to address the referred problem or problems, which includes:
(a) Diagnosis;
(b) Treatment goals;
(c) Frequency of visits for each type of
service ordered;
(d) Duration of
treatment of each type of service ordered;
(e) Prognosis; and
(f) Other appropriate items.
(27) "Preauthorization" means the
approval required from the Department or its designee before a service can be
rendered by the provider and reimbursed.
(28) "Program" means the Maryland Medical
Assistance Program.
(29) "Provider"
means a special psychiatric hospital which through agreement with the
Department has been identified as a Program provider by the issuance of a
provider number.
(30)
"Retrospective review" means the process of determining medical necessity of an
inpatient admission after the participant has been discharged from the
hospital.
(31) "Special psychiatric
hospital" means an institution that:
(a)
Provides short-term services for psychiatric illnesses in a hospital setting
with facilities, medical staff, and all necessary personnel to provide
diagnosis, care, and treatment;
(b)
Falls within the jurisdiction of Health-General Article, Title 19, Subtitle 3,
Annotated Code of Maryland; and
(c)
Is licensed pursuant to COMAR 10.07.01 or other applicable standards
established by the state in which the service is provided.
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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