Code of Maryland Regulations
Title 10 - MARYLAND DEPARTMENT OF HEALTH
Part 3
Subtitle 11 - MATERNAL AND CHILD HEALTH
Chapter 10.11.03 - Children's Medical Services Program
Section 10.11.03.03 - Covered Services

Universal Citation: MD Code Reg 10.11.03.03

Current through Register Vol. 51, No. 19, September 20, 2024

A. The CMS Program shall authorize covered services when a CMP has been approved.

B. CMS may request further information from the provider in order to:

(1) Include:
(a) All diagnoses or suspected diagnoses;

(b) Service requested or provided;

(c) Specific reason for the service request;

(d) Evaluation or treatment findings;

(e) Follow-up plans related to the service provided by the CMS Program;

(f) Source of primary health care; and

(2) Be reviewed and approved by the CMS Program.

C. The CMS Program may request further information from the provider in order to:

(1) Support the information required in §B(1) of this regulation;

(2) Assure that all services are coordinated with other services the child is receiving through the CMS Program or other programs; and

(3) Assure that the needs of the family are addressed in relation to meeting the medical and developmental needs of the child.

D. CMS Program eligible services shall include:

(1) Specialty clinics;

(2) Private office care including, but not limited to, the following:
(a) Allergy/Immunology;

(b) Audiology and hearing;

(c) Cardiology;

(d) Craniofacial;

(e) Cystic fibrosis;

(f) Developmental pediatrics;

(g) Endocrine;

(h) Gastroenterology;

(i) Genetics;

(j) Hematology;

(k) Infectious disease;

(l) Nephrology;

(m) Neurology;

(n) Neurosurgery;

(o) Oncology;

(p) Ophthalmology, optometry, and vision;

(q) Orthopedics;

(r) Otolaryngology;

(s) Physical medicine;

(t) Plastic surgery;

(u) Pulmonology;

(v) Rheumatology;

(w) (text unchanged)

(x) Surgery; and

(y) Urology.

(3) Primary physician care arranged at the discretion of the CMS Program to assure access for needed specialty diagnostic evaluation, treatment, and care coordination services;

(4) Inpatient hospital care services, which are provided by Medical Assistance affiliated hospitals; and

(5) Professional evaluation and treatment services, which may include, but are not limited to, the following:
(a) Audiology;

(b) Family training and counseling regarding medical and rehabilitation needs;

(c) Genetic counseling;

(d) Nursing;

(e) Nutrition;

(f) Occupational therapy;

(g) Physical therapy; or

(h) Speech-language pathology.

E. Specialized activities to facilitate a special treatment program may include, but are not limited to, the following:

(1) Equipment to provide:
(a) Life support;

(b) Mobility;

(c) Stimulation; and

(d) Aid in activities of daily living;

(2) Orthoses to correct or prevent orthopedic disabilities, including prescription shoes and their modifications;

(3) Prostheses to replace a missing part or to enhance the applicant's functional performance;

(4) Formula and medication to correct metabolic and physiologic errors;

(5) Supplies of durable and disposable items to facilitate management of specific disorders;

(6) Approved therapies involving specific treatment as authorized by appropriate CMS Program professional staff to cure functional deficiencies;

(7) Life sustaining medications;

(8) Dental services provided for children with disabling conditions; and

(9) Hearing aids and augmentative devices to improve communication.

Disclaimer: These regulations may not be the most recent version. Maryland may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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