Sec. 10.09.96.05. Participant Eligibility for Services

A. A participant is eligible to receive remote patient monitoring services if:

(1) The participant is enrolled in the Maryland Medical Assistance Program on the date the service is rendered;

(2) The participant consents to remote patient monitoring services and has the capability to utilize the monitoring tools and take actions to improve self-management of the chronic disease;

(3) The participant has the internet connections necessary to host the equipment in the home;

(4) The participant is at high risk for avoidable hospital utilization due to poorly controlled:

(a) Chronic obstructive pulmonary disease;

(b) Congestive heart failure;

(c) Diabetes type 1; or

(d) Diabetes type 2; and

(5) The provision of remote patient monitoring may reduce the risk of preventable hospital utilization and promote improvement in control of the chronic condition.

B. Participants with the conditions described in §A(4) of this regulation are eligible for an episode of remote patient monitoring if the participant had:

(1) Two hospital admissions within the prior 12 months with the same qualifying medical condition as the primary diagnosis;

(2) Two emergency department visits within the prior 12 months with the same qualifying medical condition as the primary diagnosis; or

(3) One hospital admission and one separate emergency department visit within the prior 12 months with the same qualifying condition as the primary diagnosis.