Code of Maryland Regulations
Title 10 - MARYLAND DEPARTMENT OF HEALTH
Part 3
Subtitle 21 - MENTAL HYGIENE REGULATIONS
Chapter 10.21.17 - Community Mental Health Programs-Definitions and Administrative Requirements
Section 10.21.17.03 - Authorization and Payment
Universal Citation: MD Code Reg 10.21.17.03
Current through Register Vol. 51, No. 19, September 20, 2024
A. Authorization for Services.
(1) The program
shall comply with the provisions of this regulation when the program provides
services to:
(a) A Medicaid recipient;
or
(b) An individual for whom,
because of the severity of the mental illness and, based on the
Administration's determination of the individual's ability to pay, the cost of
care is subsidized, wholly or in part, through the public mental health
system.
(2) Before
rendering services to an individual, a provider shall notify the
Administration's administrative services organization (ASO), or for those
services approved by the CSA, the CSA of the jurisdiction where the individual
resides, as appropriate, and receive preauthorization for services, according
to the provisions of COMAR 10.09.70.07A.
(3) When the Administration's ASO contacts a
program directly to refer an individual, and the individual does not make an
initial appointment or does not keep the initial appointment, program staff
shall:
(a) Attempt to reschedule an initial
appointment for the individual; and
(b) If that fails, notify the
Administration's ASO that the individual has not received services.
(4) Preauthorization is not
required before a provider renders services in an emergency.
(5) If a program discontinues admissions, the
program director shall notify the CSA and the Administration's ASO, if
appropriate.
B. Payment for Services.
(1) Fee Schedule. The
Administration shall reimburse an eligible provider for rendering authorized
services:
(a) In accordance with the State
budget;
(b) According to the
provisions of and at the rates established under COMAR 10.21.25; or
(c) Pursuant to grants or contracts funded by
the State or the CSAs.
(2) If an individual is not a Medicaid
recipient and, because of the severity of the individual's mental illness and
financial need, the cost of the individual's care is subsidized wholly or in
part with public funds, the provider shall:
(a) Receive payment if the individual meets
eligibility criteria established by the Administration;
(b) Collect information from an individual to
assess the individual's ability to pay, including information regarding any
applicable insurance benefits;
(c)
Assess the individual's ability to pay and determine the required co-payment;
and
(d) Make collections of the
co-payment according to the requirements in Health-General Article,
§§16-201 -16-204, Annotated Code of Maryland.
(3) Medicare Recipients.
(a) If a provider renders services to
individuals who are Medicare recipients, the provider shall comply with all
federal Medicare requirements.
(b)
If a provider does not comply with all Medicare requirements, the provider may
not seek reimbursement by the PMHS.
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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