Code of Maryland Regulations
Title 10 - MARYLAND DEPARTMENT OF HEALTH
Part 3
Subtitle 18 - HUMAN IMMUNODEFICIENCY VIRUS (HIV) INFECTION AND ACQUIRED IMMUNODEFICIENCY SYNDROME (AIDS)
Chapter 10.18.06 - Maryland AIDS Drug Assistance Program: Pharmacy Services
Section 10.18.06.07 - Payment Procedures

Universal Citation: MD Code Reg 10.18.06.07

Current through Register Vol. 51, No. 19, September 20, 2024

A. Except as provided in §§B and C of this regulation, the Department shall pay a pharmacy in accordance with the procedures of the Medical Assistance Pharmacy Services Program set forth at COMAR 10.09.03.07.

B. If the Department or the recipient tells the pharmacy that the recipient has or may have third-party insurance coverage to offset some or all of the cost for services provided under MADAP, the pharmacy shall:

(1) Bill the third-party payer the pharmacy's usual and customary charge for the services provided; and

(2) Bill the Department for the difference between the pharmacy's usual and customary charge and the anticipated third-party receipts.

C. If the recipient has third-party insurance coverage, the Department shall pay the pharmacy the difference between the pharmacy's usual and customary charge and the anticipated third-party insurance receipts, not to exceed the amount permitted under COMAR 10.09.03.07F and G.

D. The Department shall make payments related to MADAP in accordance with any applicable policies and procedures for the administration of federal funds issued pursuant to the Ryan White HIV/AIDS Treatment Extension Act of 2009, and any subsequent modifications to the Act.

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