Md. Code Regs. 10.09.23.04

Current through Register Vol. 51, No. 25, December 13, 2024

Section 10.09.23.04 - Covered Services

A. The Program covers all medically necessary care, including all health care services to identify and correct physical and mental problems that are covered in the State Plan, or that are allowable under the federal Medicaid program as described in §1905(a) of the Social Security Act.

B. For a foster care child, the Program also covers upon entry to or moving within the foster care system:

(1) A brief initial check-up; and

(2) A comprehensive EPSDT screen as described in §C of this regulation.

C. The Program covers EPSDT comprehensive well-child services in accordance with the EPSDT periodicity schedule, which includes the following:

(1) EPSDT screening services which comprise the following:

(a) A comprehensive health and developmental history, including assessment of both physical and mental health and development;

(b) Age-appropriate immunizations;

(c) Age and risk appropriate laboratory tests, including blood lead levels that are required at specific ages regardless of risk;

(d) Comprehensive unclothed physical examination; and

(e) Health education and anticipatory guidance;

(2) Vision services that comprise:

(a) Vision screening delivered by the EPSDT screening provider according to the EPSDT periodicity schedule;

(b) Vision screening and vision services delivered by optometrists and opticians, including eyeglasses, as described in COMAR 10.09.14.04A;

(3) Hearing services that comprise:

(a) Hearing screening delivered by the EPSDT screening provider according to the EPSDT periodicity schedule; and

(b) Hearing screening and hearing aid services, as described in COMAR 10.09.51.04A; and

(4) Dental services, including:

(a) Oral health assessment by the EPSDT screening provider and referral to a dentist; and

(b) Dental services, as specified in COMAR 10.09.05.04A.

D. Additional Medically Necessary Plan of Treatment Services.

(1) The Program also covers the EPSDT treatment services listed in §D(2) of this regulation when the services are:

(a) Necessary to identify, correct, or ameliorate defects and physical and mental illnesses and conditions;

(b) Rendered in accordance with accepted professional standards; and

(c) Delivered in accordance with a plan of treatment.

(2) EPSDT services covered under §D of this regulation include:

(a) Chiropractic services;

(b) Mental health services or behavioral health services, or both, when the diagnosis of a participant is not included under the specialty mental health system, as described in COMAR 10.67.08.02;

(c) Nutritional counseling services;

(d) Occupational therapy services;

(e) Speech therapy services;

(f) Medically monitored intensive inpatient treatment services provided in an intermediate care facility, as specified in COMAR 10.47.02.09 or COMAR 10.63.03.14, whichever is applicable;

(g) Clinically managed high intensity residential treatment services provided in an intermediate care facility, as specified in COMAR 10.47.02.09 or COMAR 10.63.03.13, whichever is applicable;

(h) Environmental lead investigations, as specified in COMAR 26.16.02.04 and .05 when there is a confirmed elevated blood lead level of 5 micrograms or greater per deciliter;

(i) Private duty nursing services, as specified in COMAR 10.09.53.04A;

(j) Residential treatment services, as specified in COMAR 10.09.29.04A; and

(k) Therapeutic behavioral services, as specified in COMAR 10.09.34.03A.

Md. Code Regs. 10.09.23.04

Regulation .04A amended effective September 10, 1984 (11:18 Md. R. 1584)
Regulation .04B amended effective March 20, 1989 (16:5 Md. R. 629)
Regulations .04 repealed and new Regulations .04 adopted effective March 22, 2010 (37:6 Md. R. 477)
Regulation .04D amended effective December 27, 2010 (37:26 Md. R. 1787)
Regulation .04 amended effective 42:21 Md. R. 1300, eff.10/26/2015; amended effective 44:13 Md. R. 621, eff. 7/3/2017; amended effective 45:26 Md. R. 1243, eff. 12/31/2018; amended effective 50:15 Md. R. 681, eff. 8/7/2023