Code of Maryland Regulations
Title 10 - MARYLAND DEPARTMENT OF HEALTH
Part 2
Subtitle 09 - MEDICAL CARE PROGRAMS
Chapter 10.09.76 - School-Based Health Centers (SBHC)
Section 10.09.76.01 - Definitions
Universal Citation: MD Code Reg 10.09.76.01
Current through Register Vol. 51, No. 19, September 20, 2024
A. The following terms have the meanings indicated.
B. Terms Defined.
(1) "Department" means the Maryland
Department of Health and Mental Hygiene, the State agency designated to
administer the Maryland Medical Assistance Program under Title XIX of the
Social Security Act, 42
U.S.C. § 1396 et seq.
(2) "Early and periodic screening, diagnosis
and treatment (EPSDT)" means the provision of preventive health care, including
medical and dental services under
42 CFR § 441.50 et seq., in order to assess growth and
development and to detect and treat health problems in Medical Assistance
eligible individuals younger than 21 years old.
(3) "Federally qualified health center
(FQHC)" means an entity that has entered into an agreement with the Centers for
Medicare and Medicaid Services (CMS) to meet Medicare requirements under
42 CFR § 405.2464 and in accordance with
42 CFR § 405.2401(b).
(4) "Managed care organization (MCO)" has the
meaning stated in Health-General Article, §15-101, Annotated Code of
Maryland.
(5) "Medically necessary"
means that the service or benefit is:
(a)
Directly related to diagnostic, preventive, curative, palliative, or
ameliorative treatment of an illness, injury, disability, or health
condition;
(b) Consistent with
currently accepted standards of good medical practice, dental practice, or
both;
(c) The most cost efficient
that can be provided without sacrificing effectiveness or access to care;
and
(d) Not primarily for the
convenience of the participant, family, or provider.
(6) "Medicare" means the insurance program
administered by the federal government under Title XVIII of the Social Security
Act, 42 U.S.C. § 1395 et seq.
(7) "Participant" means an individual who is
certified as eligible for, and who is receiving, Medical Assistance
benefits.
(8) "Primary care
provider (PCP)" means a practitioner who is the primary coordinator of care for
the participant, and whose responsibility it is to provide accessible,
continuous, comprehensive, and coordinated health care services covering the
full range of benefits required by the Maryland Medical Assistance
Program.
(9) "Primary health
services" means a basic level of health care, including diagnostic, treatment,
consultative, referral, and preventive health services, generally rendered by:
(a) General practitioners;
(b) Family practitioners;
(c) Internists;
(d) Obstetricians;
(e) Gynecologists;
(f) Pediatricians;
(g) Physician assistants; and
(h) Nurse practitioners.
(10) "Program" means the Maryland Medical
Assistance Program.
(11) "Provider"
means a school-based health center which has been approved by the
Department.
(12) "School-based
health center (SBHC)" means a health center that:
(a) Is located on school grounds;
(b) Provides on-site primary and preventive
health care, referrals, and follow-up services;
(c) Could provide on-site dental care or
behavioral health care, referrals, and follow-up services; and
(d) Has been approved by the Maryland
Department of Health.
(13) "Specialty behavioral health" means
services specified in COMAR
10.09.59.06 and 10.09.80.05.
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