Code of Maryland Regulations
Title 10 - MARYLAND DEPARTMENT OF HEALTH
Part 3
Subtitle 20 - KIDNEY DISEASE PROGRAM
Chapter 10.20.01 - General Regulations
Section 10.20.01.01 - Definitions
Universal Citation: MD Code Reg 10.20.01.01
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) "Applicant" means an individual who has
applied for, or is in the process of applying for, Kidney Disease Program
enrollment and has not yet been certified as an eligible recipient.
(2) "Certification period" means the 12-month
period during which an individual is certified as eligible to receive Kidney
Disease Program benefits.
(3)
"Certified facility" means a hospital, dialysis facility, or transplantation
center which the Department certifies meets the standards that the Commission
adopts for providing services to recipients and which is certified by
Medicare.
(4) "Commission" means
the State Commission on Kidney Disease.
(5) "Department" means the State Department
of Health and Mental Hygiene.
(6)
"Dialysis" means chronic hemodialysis or chronic peritoneal dialysis provided
in a certified facility or a facility approved by the Commission or in the
patient's home under the auspices of a certified facility or home dialysis
program approved by the Commission.
(7) "End stage renal disease (ESRD)" means
that stage of renal impairment that appears irreversible and permanent, and
requires a regular course of maintenance dialysis or kidney transplantation to
maintain life.
(8) "Family" means
the recipient and all of the following individuals sharing the same household
with the recipient:
(a) The recipient's
spouse;
(b) The recipient's natural
or adopted children who are younger than 21 years old;
(c) The recipient's natural or adoptive
parent, if the recipient is a child younger than 21 years old; and
(d) The recipient's stepchildren or
grandchildren for which the recipient has legal or presumed
guardianship.
(9)
"Liquid assets" means cash or an asset that can readily be converted to
cash.
(10) "Medical Assistance"
means the State program of comprehensive medical and other health-related care
for indigent and medically indigent persons.
(11) "Medicare" means the insurance program
administered by the federal government under Title XVIII of the Social Security
Act, 42 U.S.C. § 1395 et seq.
(12) "Poverty income guidelines" means the
federal poverty income guidelines contained in the most recent annual update of
the Department of Health and Human Services poverty income guidelines as
published in the Federal Register.
(13) "Preauthorization" means an approval
required from the Program before services are rendered to a
recipient.
(14) "Primary Adult Care
Program (PAC)" has the meaning stated in COMAR
10.09.60.02B.
(15) "Program" means the Kidney
Disease Program of Maryland.
(16)
"Program participation fee" means an annual premium which may be assessed by
the Program and is based on family income or liquid assets, or both.
(17) "Provider" means an individual,
association, partnership, corporation, or unincorporated group licensed or
certified to provide health care services for Program recipients.
(18) "Qualified alien" means an alien who:
(a) Has been fully admitted for permanent
residence in the United States under the Immigration and Nationality Act
(INA);
(b) Has been granted asylum
in the United States under § 208 of the INA;
(c) Has been admitted into the United States
as a refugee under § 207 of the INA;
(d) Has been paroled into the United States
under § 212(d)(5) of the INA for a period of at least 1 year;
(e) Has had deportation withheld under §
243(h) of the INA; or
(f) Has been
granted conditional entry into the United States under § 203(a)(7) of the
INA in effect before April 1, 1980.
(19) "Quarterly amount" means the quarterly
installment payment which is equal to 25 percent of a recipient's annual
Program participation fee.
(20)
"Recipient" means an individual who is certified for enrollment in the Kidney
Disease Program of Maryland.
(21)
"Reimbursable drug list" means the Kidney Disease Program formulary of
medications approved for payment.
(22) "Representative" means an individual
who, because of an applicant's or a recipient's mental or physical incapacity
or youth, or specified dialysis or transplant facility personnel who have been
so designated by virtue of the applicant's or recipient's voluntarily signed
authorization form, is authorized, in accordance with State law, to complete,
sign, or withdraw an application for enrollment in the Program or to activate a
hearing process.
(23) Resident.
(a) "Resident" means an individual
permanently living in Maryland whose temporary absence from the State does not
interrupt continuity of residence.
(b) "Resident" does not mean:
(i) Members or their families, or both, of
the United States armed services temporarily stationed in Maryland;
or
(ii) Foreign nationals employed
in embassies of their native country.
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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