Current through Register Vol. 51, No. 19, September 20, 2024
A. The
following medically necessary items are covered when ordered by an individual
who is enrolled as a provider in the Program on the date of service:
(1) Disposable medical supplies;
(2) Durable medical equipment;
(3) Repairs to purchased durable medical
equipment;
(4) All disposable
medical supplies and durable medical equipment for home kidney dialysis
purchased or rented for Medical Assistance recipients;
(5) Prosthetic devices which include:
(b) Breast prostheses, including surgical
brassiere; and
(c) Upper and lower
extremity, full and partial, to include stump cover or harnesses where
necessary.
(6)
Replacement of prostheses;
(7)
Individually form-fitted support stockings, leg or arm, including all fitting,
dispensing, and follow-up care, for recipients for whom these supports are
medically necessary, not to exceed two at one time, three times in a 12-month
period for recipients 21 years old or older;
(8) Evaluation for equipment that was
subsequently provided through the Department's recycling program as described
in Regulation .07O of this chapter;
(9) Speech generating, augmentative, and
alternative communication devices for recipients enrolled under fee-for-service
or a Managed Care Organization; and
(10) Enteral nutritional products given by
nasogastric, jejunostomy, or gastrostomy tube in the home.
B. The items in §A of this regulation
are covered when medically necessary for use in the recipient's:
C. Repairs under §A(3) of this
regulation are also covered for recipients in hospitals, nursing facilities,
and other medical institutions for equipment that was purchased for the
recipient while the recipient lived in the community.
D. Items in §A(5) and (6) of this
regulation are also covered for recipients in hospitals, nursing facilities,
and other medical institutions.
E.
Documentation Required.
(1) Items in A of
this regulation are covered only when adequate documentation is obtained by the
provider and kept on file as part of the permanent business records of the
provider. This documentation includes, but is not limited to the:
(a) Signed and dated prescriber order
including documentation that a face-to-face encounter occurred within 6 months
before ordering services;
(b)
Recertifications of continuous medical need;
(c) Delivery ticket signed by the recipient
or the recipient's representative where the identification of the person
signing and the exact nature of the items delivered is clearly evident on the
delivery ticket;
(d) Make, model,
and serial number of the item, as applicable; and
(e) Cost of the item to the provider for
individually considered items reimbursed under a cost-plus
methodology.
(2) For
purchased equipment, the delivery ticket shall note the identification tag
number and also include a statement which notifies the recipient that the
equipment has been purchased by the State of Maryland and remains the property
of the Department of Health and Mental Hygiene.
(3) Documentation shall be retained for 6
years and be made available upon request by the Department.
F. The Department may arrange for
the provision of any covered service listed in §A of this regulation under
an exclusive contract with a vendor or vendors that has been awarded in
accordance with State regulations and policies governing contracts and
procurements.