Sec. 10.09.49.02. Definitions

A. In this chapter, the following terms have the meanings indicated.

B. Terms Defined.

(1) “Administrative services organization (ASO)” means an entity that manages the Public Behavioral Health System on behalf of the Department.

(2) “Community-based substance use disorder provider” means a provider licensed by the Department as a community-based substance use disorder provider in accordance with COMAR 10.09.80.

(3) “Department” means the Maryland Department of Health, which is the single State agency designated to administer the telehealth program.

(4) “Distant site” means a site at which the licensed distant site provider is located at the time the service is provided via technology-assisted communication.

(5) "Distant site provider" means the licensed provider at the distant site who provides medically necessary services to the patient at the originating site via telehealth upon request from the originating site provider.

(6) “Federally qualified health center (FQHC)” has the meaning stated in Health-General Article, §24-1301, Annotated Code of Maryland.

(7) "GT modifier" means the Healthcare Common Procedure Coding System (HCPCS) service code modifier indicating that the provider rendered a healthcare service via an interactive audio and video telecommunications system.

(8) “Medically necessary” means that the service or benefit is:

(a) Directly related to diagnostic, preventive, curative, palliative, rehabilitative, or ameliorative treatment of an illness, injury, disability, or health condition;

(b) Consistent with currently accepted standards of good medical practice;

(c) The most cost-efficient service that can be provided without sacrificing effectiveness or access to care; and

(d) Not primarily for the convenience of the participant, family, or provider.

(9) “Opioid treatment program” means a program licensed by the Department in accordance with COMAR 10.09.80.

(10) “Originating site” means the location of an eligible Medicaid participant at the time the service being furnished via technology-assisted communication occurs.

(11) “Participant” means an individual who is certified as eligible for, and is receiving, Medical Assistance benefits.

(12) “Provider” means:

(a) An individual, association, partnership, corporation, unincorporated group, or any other person authorized, licensed, or certified to provide services for Medical Assistance participants and who, through appropriate agreement with the Department, has been identified as a Maryland Medical Assistance Provider by the issuance of an individual account number;

(b) An agent, employee, or related party of a person identified in §B(12)(a) of this regulation;

(c) An individual or any other person with an ownership interest in a person identified in §B(12)(a) of this regulation.

(13) “Psychiatric nurse practitioner” means an advanced practice registered nurse whose certification and licensing indicates CRNP-PMH.

(14) “Public Behavioral Health System” means the system that provides medically necessary behavioral health services for Medical Assistance participants and certain other uninsured individuals, including mental health and substance use disorder services.

(15) “Residential crisis services site” means a facility that provides intensive mental health and support services that are:

(a) Provided to a child or an adult with mental illness who is experiencing or is at risk of a psychiatric crisis that would impair the individual’s ability to function in the community; and

(b) Designed to prevent a psychiatric inpatient admission, provide an alternative to psychiatric inpatient admission, shorten the length of inpatient stay, or reduce the pressure on general hospital emergency departments.

(16) Store and Forward Technology.

(a) “Store and forward technology” means the transmission of medical images or other media captured by the originating site provider and sent electronically to a distant site provider, who does not physically interact with the patient located at the originating site.

(b) “Store and forward technology” does not mean dermatology, ophthalmology, or radiology services according to COMAR 10.09.02.07.

(17) “Technology-assisted communication” means multimedia communication equipment permitting two-way real-time interactive communication between a patient at an originating site and a distant site provider at a distant site.

(18) “Telehealth” means the delivery of medically necessary somatic or behavioral health services to a patient at an originating site by distant site provider, through the use of technology-assisted communication.

(19) “Telehealth Program” means the program by which medically necessary somatic or behavioral health services are authorized to be delivered via technology-assisted communication between originating and distant site providers.