Md. Code Regs. 10.09.94.05

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

Section 10.09.94.05 - Limitations

The Program does not cover:

A. Investigational or experimental hospital services, procedures, or drugs;

B. Inpatient admissions or outpatient visits solely for the administration of injections, unless medical necessity and the participant's inability to take appropriate oral medications is documented in the participant's medical record;

C. Outpatient visits intended to accomplish one or more of the following:

(1) Prescription drug or food supplement pick-up;

(2) Collection of specimens for laboratory procedures;

(3) Recording of an electrocardiogram; or

(4) Ascertaining the participant's weight;

D. Interpretation of laboratory tests or panels;

E. Autopsies;

F. Immunizations required for travel outside the continental United States;

G. Leaves of absence beyond the period of the census check of the same day;

H. Day care;

I. Psychological evaluations and treatments except when:

(1) Ordered by a physician, and the medical necessity is documented in the participant's medical record; or

(2) Performed as mental health service, as part of the plan of treatment;

J. Duplicated care or services;

K. Elective admissions to hospitals outside of Maryland and the District of Columbia unless the Department or its designee determines that comparable services are not available in Maryland, except under certain conditions where child participants are in foster care, or are for other reasons placed outside the State and are covered under certain criteria, as determined by the Department or its designee;

L. Inpatient and outpatient diagnostic services not specifically ordered by the attending physician or other responsible practitioner;

M. Inpatient days or services provided in excess of the days approved by the Department or its designee;

N. Hospital laboratory tests which are coverable under COMAR 10.09.09.04, if the specimen is not obtained in the hospital;

O. Hospital services provided outside of the United States;

P. The completion of forms and reports;

Q. Broken or missed appointments;

R. Professional services rendered by mail or telephone; or

S. Telephones, televisions, or personal comfort items or services.

Md. Code Regs. 10.09.94.05

Regulation .05 adopted effective 44:7 Md. R. 354, eff. 4/10/2017