1. A. A provider shall meet all conditions for participation as set forth in COMAR 10.09.36.03.

2. B. To participate in the Program as an acute hospital services provider, the provider shall:

   1. (1) Meet the requirements of Title XIX of the Social Security Act for participation as a hospital, as issued by the Department of Health and Human Services;
   2. (2) Directly provide or make available through contractual arrangements or transfer agreements, medically necessary covered services;
   3. (3) Accept payment by the Program as payment in full for the covered service;
   4. (4) Make available to the Department or its designee the participant’s medical record for review and certification of medical necessity for admission and continuation of stay;

   5. (5) Maintain documentation of each contact with the participant as part of the complete medical record, which, at a minimum, includes:

      1. (a) Date of service;
      2. (b) The participant’s chief medical complaint or reason for visit;

      3. (c) A description of the services provided, including:

         1. (i) Progress notes;
         2. (ii) Imaging studies;
         3. (iii) Laboratory results;
         4. (iv) Medication administration records; and
         5. (v) Discharge summary; and
      4. (d) A signature, electronic or handwritten, along with the printed or typed name of the individual providing care, with the appropriate title; and
   6. (6) If the hospital provider is the only hospital within the county, participate with each participating HealthChoice Managed Care Organization in the county.

3. C. If an out-of-State or District of Columbia hospital, the hospital shall:

   1. (1) Unless a waiver has been granted by the Secretary of Health and Human Services, have in effect a utilization review plan applicable to all participants who receive Medical Assistance under Title XVII of the Social Security Act which meets the requirements of §1861(k) of the Social Security Act; and
   2. (2) Comply with applicable regulations of this chapter and COMAR 10.09.36.

Authority: Health-General Article, §§2-104(b), 15-102.8, 15-103, and 15-105, Annotated Code of Maryland

Effective date: April 10, 2017 (44:7 Md. R. 354)

Regulation .04B amended effective June 24, 2024 (51:12 Md. R. 619)

Regulation .05P, Q amended effective June 24, 2024 (51:12 Md. R. 619)

Regulation .05 R adopted effective June 24, 2024 (51:12 Md. R. 619)

Regulation .07A amended effective November 18, 2019 (46:23 Md. R. 1065)