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 10.14.02.22 - Maryland Health Insurance Plan Coverage
Universal Citation: MD Code Reg 10.14.02.22
Current through Register Vol. 51, No. 19, September 20, 2024
A. In lieu of providing direct reimbursement to participating health care providers, the Program may pay MHIP, if available, to provide health coverage for individuals enrolled in the Program who are also eligible for MHIP.
B. The Program may pay MHIP, if available, for health coverage for eligible patients, including:
(1) MHIP premiums;
(2) Pre-existing condition buy-downs;
and
(3) Any MHIP fees.
C. The Program may not pay any amount to MHIP, if available, for an eligible patient's spouse, children, or other family members enrolled in MHIP.
D. Fees Reimbursable to Participating Providers.
(1) The Program may reimburse
participating health care providers for a bill the provider submits to the
Department for patient contribution amounts and deductibles for services
directly related to the treatment of breast and cervical cancer for individuals
enrolled in MHIP through the Program, if funding is available for the payment
of patient contribution amounts and deductibles under this section.
(2) The Program's decision regarding whether
to pay for patient contribution amounts and deductibles shall be based solely
on the availability of funding and may not be contingent upon any other
factor.
(3) If MHIP does not
provide coverage for a service covered by this chapter, the Program shall
reimburse the participating health care provider as otherwise provided by this
chapter.
(4) To obtain
reimbursement, the participating health care provider shall submit to the
Program:
(a) The bill for the service on the
form designated by the Department; and
(b) A copy of the explanation of benefits or
denial from MHIP.
E. Payment to MHIP.
(1) The Department shall submit timely
payments to MHIP for premiums, pre-existing condition buy-downs, and any MHIP
fees for individuals enrolled in MHIP through the Program.
(2) The Department shall work with the
designated MHIP staff to assure timely payments of MHIP invoices for
individuals enrolled in MHIP through the Program to:
(a) Preserve MHIP coverage; and
(b) Resolve any existing issues related to
the payment of MHIP premiums.
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.
This site is protected by reCAPTCHA and the Google
Privacy Policy and
Terms of Service apply.
