Code of Maryland Regulations
Title 10 - MARYLAND DEPARTMENT OF HEALTH
Part 3
Subtitle 14 - CANCER CONTROL
Chapter 10.14.02 - Reimbursement for Breast and Cervical Cancer Diagnosis and Treatment
Section 10.14.02.14 - Occupational Therapy Services
Universal Citation: MD Code Reg 10.14.02.14
Current through Register Vol. 51, No. 19, September 20, 2024
A. To be considered a participating occupational therapist in the Program, the provider shall:
(1) Be an occupational
therapist licensed to practice occupational therapy in Maryland or a
jurisdiction bordering Maryland;
(2) Agree to abide by the provisions set
forth in this regulation by signing and sending to the Department the
designated departmental form;
(3)
Follow standard health and safety procedures to protect an eligible patient
from potential hazards;
(4) Agree
to requirements of the Program set forth in Regulation .04A(5), (9), and (10)
of this chapter;
(5) Agree to
accept as payment in full the amount paid by the Program under §E of this
regulation, plus the amount paid by the eligible patient's health insurer, if
applicable; and
(6) Agree not to
bill an eligible patient an additional charge for the service.
B. The cost of an occupational therapist's services are covered as set forth in COMAR 10.09.04.04B(4).
C. The Program does not reimburse for services:
(1) Performed by an occupational
therapy assistant if not under the direct supervision of a licensed
occupational therapist;
(2)
Performed by an occupational therapy aide; or
(3) Not directly related to the treatment of
breast or cervical cancer.
D. The participating occupational therapist is responsible for the following:
(1)
Submitting to the Department, within 12 months of the date of service, a
request for payment on the designated form;
(2) Certifying on the invoice that a
treatment order is on file and was in effect at the time services were
rendered; and
(3) Specifying on the
invoice the type of treatment provided.
E. Reimbursement Principles.
(1) The Department shall reimburse the
participating occupational therapist:
(a) For
a covered service performed in the provider's office the amount of:
(i) The current Medical Assistance approved
rate for the State for an eligible patient who is uninsured or has insurance
that does not provide coverage for the reimbursed procedure or service; or
(ii) The outstanding deductible
and patient contribution for an eligible patient who is covered by Medicare or
other insurance; and
(b)
For covered services performed in the home of an eligible patient under
Regulation .11F of this chapter.
(2) The Department may not reimburse the
participating occupational therapist for:
(a)
Services rendered by mail or telephone;
(b) Completion of a form or report;
(c) A broken or missed appointment;
or
(d) A service which is provided
at no charge to the general public.
F. The participating occupational therapist shall obtain recovery under Regulation .17 of this chapter .
G. The Program shall reimburse for claims submitted pursuant to this regulation as set forth in Regulation .21 of this chapter.
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