Code of Maryland Regulations
Title 10 - MARYLAND DEPARTMENT OF HEALTH
Part 2
Subtitle 09 - MEDICAL CARE PROGRAMS
Chapter 10.09.94 - Special Pediatric Hospitals
Section 10.09.94.04 - Covered Services
Universal Citation: MD Code Reg 10.09.94.04
Current through Register Vol. 51, No. 19, September 20, 2024
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.
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