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 10.18.07 - Maryland AIDS Drug Assistance Program: Health Insurance (MADAP-PLUS)
Section 10.18.07.07 - Payment Procedures
Universal Citation: MD Code Reg 10.18.07.07
Current through Register Vol. 51, No. 19, September 20, 2024
A. A recipient, recipient's representative, health care provider, insurer, employer, or health plan administrator, as applicable:
(1) May request payment costs allowed under
this chapter on behalf of the recipient according to procedures established by
the Department ;
(2) Shall submit a
payment request that is:
(a) An invoice for
the recipient's health or prescription drug plan insurance premium, copays,
coinsurance, and deductibles for core medical services issued by an insurer, an
employer, a health plan administrator, prescription drug plan administrator, or
a health care provider; and
(b)
Submitted timely to allow for payment in accordance with §§A(3) and
B(4) of this regulation; and
(3) Shall make the initial request for the
payment of costs within the time frames established by the health or
prescription drug insurance policy.
B. The Department:
(1) Shall process a payment request as
required by this chapter;
(2) Shall
inform a recipient or the recipient's representative if an invoice is not
paid;
(3) Shall make payments in
accordance with any applicable policies and procedures for the administration
of federal funds issued pursuant to the Ryan White CARE Act Amendments of 1996,
P. L.
104-146, and any subsequent modifications to the
Act; and
(4) Shall make subsequent
payments:
(a) As permitted under a health or
prescription drug plan; or
(b) Upon
agreement between the Department and the:
(i)
Insurer;
(ii) Employer;
(iii) Health plan administrator;
(iv) Prescription drug plan administrator;
or
(iv) Health care provider.
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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