COMAR 10.09.95.03. Conditions for Participation

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

B. To participate in the Program as a special psychiatric hospital services provider, the provider shall:

(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) Meet the following staffing requirements 24 hours per day, 7 days per week:

(a) On-call or on-site physician services including psychiatric physicians;

(b) On-site registered nurses;

(c) On-site advanced cardiac life support services;

(3) If licensed to provide inpatient psychiatric services for individuals younger than 21 years old:

(a) Meet the requirements for participation as defined in 42 CFR §440.160; and

(b) Provide acute psychiatric services as defined in 42 CFR Part 441, Subpart D;

(4) Directly provide or make available through contractual arrangements or transfer agreements, medically necessary covered services;

(5) Accept payment by the Program as payment in full for the covered service;

(6) 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;

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

(a) Date of service;

(b) A plan of treatment as defined in Regulation .01B of this chapter ;

(c) The participant’s chief medical complaint or reason for visit;

(d) A description of the services provided, including:

(i) Progress notes;

(ii) Imaging studies;

(iii) Laboratory results;

(iv) Medication administration records; and

(v) Discharge summary; and

medical record, which, at a minimum, includes:

(a) Date of service;

(b) A plan of treatment as defined in Regulation .01B of this chapter ;

(c) The participant’s chief medical complaint or reason for visit;

(d) A description of the services provided, including:

(i) Progress notes;

(ii) Imaging studies;

(iii) Laboratory results;

(iv) Medication administration records; and

(v) Discharge summary; and

(e) A signature, electronic or handwritten, along with the printed or typed name of the individual providing care, with the appropriate title;

(8) Submit to the Department or its designee within 5 months of the close of the hospital’s fiscal year, as required by the Department, a hospital cost report for outpatient services which are subject to cost settlement in accordance with Regulation .11 of this chapter ;

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

(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) Comply with applicable regulations of this chapter and COMAR 10.09.36 .