Issue Date: February 7, 2014
Volume 41 • Issue 3 • Page 218—220
DEPARTMENT OF HEALTH AND MENTAL HYGIENE
Subtitle 09 MEDICAL CARE PROGRAMS
10.09.88 Portable X-ray Providers
Authority: Authority: Health-General Article, §§2-104(b), 15-103, and 15-105 Annotated Code of Maryland
Notice of Proposed Action
The Secretary of Health and Mental Hygiene proposes to adopt new Regulations .01—.10 under a new chapter, COMAR 10.09.88 Portable X-ray Providers.
Statement of Purpose
The purpose of this action is to implement policies and procedures for providers that render portable X-ray services.
Comparison to Federal Standards
There is a corresponding federal standard to this proposed action, but the proposed action is not more restrictive or stringent.
Estimate of Economic Impact
The proposed action has no economic impact.
Economic Impact on Small Businesses
The proposed action has minimal or no economic impact on small businesses.
Impact on Individuals with Disabilities
The proposed action has no impact on individuals with disabilities.
Opportunity for Public Comment
Comments may be sent to Michele A. Phinney, Director, Office of Regulation and Policy Coordination, Department of Health and Mental Hygiene, 201 W. Preston Street, Room 512, Baltimore, MD 21201, or call 410-767-6499; TTY:800-735-2258, or email to email@example.com, or fax to 410-767-6483. Comments will be accepted through March 10, 2014. A public hearing has not been scheduled.
A. In this chapter, the following terms have the meanings indicated.
B. Terms Defined.
(1) “CMS” means Centers for Medicare and Medicaid Services.
(2) “Department” means the Maryland Department of Health and Mental Hygiene.
(3) “Mammography” means the radiographic examination of the soft tissues of the breast.
(4) “Medical Assistance Program” means the program of comprehensive medical and other health-related care for indigent and medically indigent persons.
(5) “Medically necessary” means medically necessary as defined in COMAR 10.09.36.01.
(6) “Medicare” means the insurance program administered by the federal government under Title XVIII of the Social Security Act, 42 U.S.C. §1395 et seq.
(7) “NPI” means National Provider Identifier.
(8) “Program” means the Medical Assistance Program.
(9) “Portable X-ray provider” means an entity that moves its portable X-ray equipment that is separate from and unattached to the vehicle to a fixed location (e.g. a physician’s office or nursing home).
(10) “Provider” means:
(a) An individual, association, partnership, corporation, unincorporated group, or any other person authorized, licensed, or certified to provide services for Program recipients and who, through appropriate agreement with the Department, has been identified as a Program provider by the issuance of an individual account number;
(b) An agent, employee, or related party of a person identified in §B(10)(a) of this regulation; or
(c) An individual or any other person with an ownership interest in a person identified in §B(10)(a) of this regulation.
(11) “Recipient” means an individual who is certified as eligible for, and is receiving, Medical Assistance benefits.
.02 License Requirements.
A. Providers of Medical Assistance Program services shall, to the extent required by law, be licensed and legally authorized to practice or deliver services in the state in which the service is provided.
B. The provider and the equipment personnel shall be licensed or registered in accordance with applicable federal, State and local laws in accordance with 42 CFR §486.100.
C. The portable X-ray provider shall be certified and registered by the Department of Environment in accordance with COMAR 26.12.01—.03
D. A portable X-ray provider that performs mammography services shall be certified by the Food and Drug Administration (FDA).
E. The driver that transports portable X-ray equipment:
(1) Shall possess a valid operator’s license appropriate for the type of vehicle that is driven;
(2) May not have violations related to the operation of a motor vehicle in the last 3 years; and
(3) May not have any violations involving alcohol or other illegal substances related to the operation of a motor vehicle in the last 10 years.
.03 Conditions for Participation.
A. A provider shall meet all conditions for participation as set forth in COMAR 10.09.36.03.
B. The provider shall also:
(1) Be certified by CMS to furnish portable X-ray services;
(2) Meet the licensure requirements as provided in Regulation .02 of this chapter;
(3) Meet performance standards in accordance with 42 CFR §410.33 (g);
(4) Ensure that portable X-ray services are rendered under the supervision of a qualified physician in accordance with 42 CFR §486.102;
(5) Ensure that portable X-ray services are rendered by a qualified technician in accordance with 42 CFR §486.104;
(6) Ensure that portable X-ray services performed for Medical Assistance recipients are ordered by a doctor of medicine or a doctor of osteopathy and records are properly preserved in accordance with 42 CFR §486.106;
(7) Ensure that inspections of all X-ray equipment and shielding are made by qualified individuals at intervals not greater than 24 months in accordance with 42 CFR §486.110; and
(8) Identify the ordering practitioner who authorized the diagnostic services by either:
(a) Recording the National Provider Identifier (NPI) number for the individual practitioner on the claim; or
(b) Recording the name and NPI of the authorized ordering practitioner on the invoice and attaching to the invoice a copy of the properly completed order that identifies the authorized ordering practitioner.
.04 Covered Services.
A. The Program covers medically necessary services rendered to recipients, when the services are:
(1) Provided according to the laws and regulations of the State and locality in which they are rendered in accordance with 42 CFR §486.100;
(2) Rendered by a physician who meets the qualification standards in accordance with 42 CFR §486.102 or qualified non-physician (technician) who meets the qualification standards in accordance to 42 CFR §486.104; and
(3) Ordered in writing by the treating physician or nurse practitioner in accordance with state law.
B. Portable X-ray services include the following:
(1) Skeletal films involving extremities, pelvis, vertebral column, and skull;
(2) Chest films which do not involve the use of contrast media;
(3) Abdominal films which do not involve the use of contrast media;
(4) Diagnostic mammograms, if approved by the FDA;
(5) Transportation of portable X-ray equipment to a patient’s home or a long term care facility (LTCF); and
(6) Electrocardiograms (EKGs/ECGs).
The Program does not cover the following:
A. Services for which the portable X-ray provider cannot provide a properly completed order identifying by name, the authorized ordering physician, or practitioner;
B. Services not adequately documented in the recipient’s medical record;
C. Services not medically necessary;
D. Procedures that are known by the provider as investigational or experimental in nature;
E. Services which are specifically included as an integral part of another service;
G. Office visits;
I. Surgeries; and
J. Therapeutic services.
.06 Preauthorization Requirements. Reserved.
.07 Payment Procedures.
A. General policies for payment that are applicable to all providers are set forth in COMAR 10.09.36.04.
B. The Department shall allow a single transportation payment for each trip the portable X-ray provider makes to a particular location.
C. The Department shall reimburse for covered services at the lower of:
(1) The provider’s usual and customary charge; or
(2) The Department’s fee schedule.
D. The Department’s fee-schedule is contained in the Maryland Medical Assistance Program Physicians’ Services Provider Fee Manual which is incorporated by reference in COMAR 10.09.02.07.
E. Payments on Medicare cross-over claims are authorized if :
(1) The provider accepts Medicare assignment;
(2) Medicare makes direct payment to the provider;
(3) Medicare has determined that the services are medically necessary;
(4) The services are covered by the program; and
(5) The initial billing is made directly to Medicare according to Medicare guidelines.
F. The Department shall make supplemental payment on Medicare claims subject to the following provisions:
(1) Coinsurance shall be paid at the lesser of:
(a) 100 percent of the coinsurance amount; or
(b) The balance remaining after the Medicare payment is subtracted from the Medicaid rate.
G. The Program may not make a direct payment to a recipient.
H. Billing time limitations are those set forth in COMAR 10.09.36.06.
I. The provider may not bill the Program or recipient for:
(1) Completion of forms and reports;
(2) Broken or missed appointments;
(3) Services which are provided at no charge to the general public;
(4) Services rendered by mail or telephone; and
(5) Providing a copy of a recipient’s medical record when requested by another licensed provider on behalf of the recipient.
.08 Recovery and Reimbursement.
General policies governing recovery and reimbursement procedures that are applicable to all providers are set forth in COMAR 10.09.36.07
.09 Cause for Suspension or Removal and Imposition of Sanctions.
General policies governing the cause for suspension and removal and imposition of sanctions procedures that are applicable to all providers are set forth in COMAR 10.09.36.08.
.10 Appeal Procedures.
General policies governing appeal procedures that are applicable to all providers are set forth in COMAR 10.09.36.09.
JOSHUA M. SHARFSTEIN, M.D.
Secretary of Health and Mental Hygiene