Sec. 10.14.02.11. Home Health Services

A. To be considered a participating home health services provider in the Program, the provider of home health services shall:

(1) Be a home health services provider licensed in Maryland or a jurisdiction bordering Maryland;

(2) Agree to abide by the provisions set forth in this regulation and apply for participation in the Program by signing and sending to the Department the designated Departmental form;

(3) Comply with COMAR 10.09.04.03A, B(2),(3), C(4), and D, if offering skilled nursing care;

(4) Accept, as payment in full for covered services rendered, the amount paid by the Program pursuant to §D of this regulation plus, if applicable, the amount paid by the eligible patient's health insurer and the patient contribution amount, and agree not to bill an eligible patient an additional charge for the covered services; and

(5) Maintain the patient care, medical supply, billing, and the patient contribution amount records for a minimum of 6 years and, upon request, allow the Department access to the records.

B. The Program shall reimburse for a service listed in §C of this regulation when the service is:

(1) Provided upon the written order of the participating physician and furnished under the current plan of treatment;

(2) Rendered to an eligible patient who is certified by the participating physician as homebound;

(3) Consistent with the current diagnosis and treatment of the patient condition;

(4) In accordance with accepted standards of practice;

(5) Required by the medical condition rather than the convenience or preference of the patient;

(6) Considered under accepted standards of practice to be a specific and effective treatment for the condition;

(7) Required on a part-time, intermittent basis;

(8) Rendered in the home of the eligible patient by a participating home health services provider;

(9) Adequately described in the signed and dated progress note; and

(10) Directly related to the diagnosis and treatment of breast cancer or cervical cancer.

C. The Program provides reimbursement for the following:

(1) Skilled nursing care provided by a licensed nurse when the complexity of the service requires the judgment, knowledge, and skill of a licensed nurse;

(2) Physical therapy, provided by a licensed physical therapist as specified in Regulation .07 of this chapter;

(3) Occupational therapy provided by a licensed occupational therapist as specified in Regulation .14 of this chapter;

(4) Medical supplies and equipment as specified in Regulation .10B of this chapter; and

(5) Other supplies which are used during a reimbursed home health visit as part of the treatment ordered by the participating physician.

D. The Program does not reimburse for services:

(1) Not directly related to the treatment of breast and cervical cancer; and

(2) Pursuant to COMAR 10.09.04.05A, B, D, G, N, and P;

(3) Rendered by Home Health Aides; and

(4) Rendered by social workers.

E. The participating home health services provider is responsible for:

(1) Submitting a bill for the reimbursed service provided on the form designated by the Department within 12 months of the date of service, as follows:

(a) If an eligible patient is uninsured or is insured, but the insurance does not provide coverage for a reimbursed service, the participating home health services provider shall send the Department the bill for the service; or

(b) If an eligible patient is covered by Medicare or other insurance, the participating home health services provider shall bill:

(i) Medicare or the other insurance for the procedure or service; and

(ii) The Department for the outstanding deductible and patient contribution amount; and

(2) Not billing the Department under this Program a charge in excess of that charged the general public for a similar service or for a service rendered at no charge to the general public.

F. Reimbursement Rates. A non-hospital-based participating home health services provider located in Maryland, or a participating home health services provider located in a jurisdiction bordering Maryland shall be reimbursed by the Department:

(1) Pursuant to COMAR 10.09.04.07D for an eligible patient who is uninsured or who has insurance that does not provide coverage for the reimbursement service; and

(2) For the outstanding deductible and patient contribution amount, if applicable, for an eligible patient who is covered by Medicare or other insurance.

G. The Program shall reimburse for claims submitted pursuant to this regulation as set forth in Regulation .21 of this chapter.