Md. Code Regs. 10.09.94.04

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

Section 10.09.94.04 - Covered Services

A. The Program covers the following inpatient services at special pediatric hospitals:

(1) A hospital admission determined to be medically necessary for a participant who is stable enough for transfer to a post-acute setting and requires medical or rehabilitative services that:

(a) Cannot be provided at a lower level of care; and

(b) Meets the medical eligibility criteria under Regulation .06 of this chapter;

(2) Administrative days for the length of time certified by the Department or its designee;

(3) Inpatient admissions for intensive occupational therapy, physical therapy, or speech therapy on a regimen which is less than 3 hours per day, 5 days per week, when these services are provided in a unit that is accredited by the Commission on Accreditation of Rehabilitation Facilities to provide rehabilitation services; and

(4) Ancillary services.

B. The Program covers the following outpatient hospital services:

(1) Medically necessary services for the provision of diagnostic, curative, palliative, or rehabilitative treatment; and

(2) For a participant younger than 21 years old, physical therapy, occupational therapy, speech therapy, and audiology services if:

(a) The therapy provider develops a written plan of treatment in collaboration with the participant's primary care physician and the participant or the parent or guardian of the participant;

(b) The service is provided according to the plan of treatment; and

(c) The services provider sends an update of the plan of treatment to the participant's primary care physician every 90 days.

Md. Code Regs. 10.09.94.04

Regulation .04 adopted effective 44:7 Md. R. 354, eff. 4/10/2017