Md. Code Regs. 10.09.41.10

Current through Register Vol. 51, No. 22, November 1, 2024

Section 10.09.41.10 - Covered Services

A. Except as provided in §§B and C of this regulation, a recipient in the EID coverage group is covered for medically necessary services required by the recipient, if the services are:

(1) Furnished by a provider who, with respect to the services rendered, is approved by the Department to participate in the Medical Assistance Program;

(2) Covered under the State Plan;

(3) Not covered under ESI or any other health insurance coverage besides Medical Assistance; and

(4) Not the subject of any third party liability.

B. Copayments, Deductibles, and Coinsurance. Medical Assistance does not cover any copayments, deductibles, or coinsurance applicable to the ESI coverage of a recipient in the EID coverage group.

C. An EID recipient is not entitled to:

(1) Enrollment in the Maryland Medicaid Managed Care Program (HealthChoice) in accordance with COMAR 10.09.62-10.09.75;

(2) Enrollment in Rare and Expensive Case Management (REM), in accordance with COMAR 10.09.69;

(3) Enrollment in the Program of All-Inclusive Care for the Elderly (PACE) under COMAR 10.09.44; or

(4) Long-term care facility services exceeding 30 consecutive days.

Md. Code Regs. 10.09.41.10

Regulations .10 adopted as an emergency provision effective April 1, 2006 (33:9 Md. R. 795); adopted permanently effective July 3, 2006 (33:13 Md. R. 1063)
Regulation .10C amended as an emergency provision effective October 1, 2008 (35:22 Md. R. 1955); amended permanently effective February 9, 2009 (36:3 Md. R. 208)