Skip to Main Content
<< Back | Return to Main COMAR Search Page

14 records match your request.

FileAbstract
10.09.23.00.htm 10.09.23.00. Title 10 MARYLAND DEPARTMENT OF HEALTH Subtitle 09 MEDICAL CARE PROGRAMS Chapter 23 Early and Periodic Screening, Diagnosis and Treatment (EPSDT) Services Authority: Health-General Article, §2-104(b) 15-103, and 15-105, Annotated Code of Maryland
10.09.23.01.htm 10.09.23.01. 01 Definitions.. A. In this chapter, the following terms have the meanings indicated.. B. Terms Defined.. 1) "American Academy of Pediatric Dentists" means the membership organization representing the specialty of pediatric dentistry.2) "Department" means the Maryland Department of Health, the single State agency designated to administer the Maryland Medical Assistance Program or its designee.3) "Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) means co
10.09.23.01-1.htm 10.09.23.01-1. 01-1 Incorporation by Reference.. The Early Periodic, Screening, Diagnosis, and Treatment (EPSDT) Provider Manual (Maryland Medical Assistance Program, Effective January 1, 2017) is incorporated by reference.
10.09.23.02.htm 10.09.23.02. 02 Provider Qualifications.. A. EPSDT screening and treatment providers shall meet all of the licensure and certification requirements specified in this or any other applicable chapter of COMAR, statute, or policy for the service that the provider renders.B. In order for the Program to consider a health care practitioner for certification by the Healthy Kids Program as an EPSDT screening provider, the practitioner shall have a demonstrated history of providing services to chil
10.09.23.03.htm 10.09.23.03. 03 Conditions for Participation.. A. In order to receive payments as a Medicaid provider, providers shall meet the following general requirements:1) All conditions for participation set forth in COMAR 10.09.36;. 2) The licensure and provider qualification requirements in Regulation .02 of this chapter; and. 3) Verify the licenses and credentials of all professionals employed or contracted by the provider, and keep on file documentation of how that verification was completed.
10.09.23.04.htm 10.09.23.04. 04 Covered Services.. A. The Program covers all medically necessary care, including all health care services to identify and correct physical and mental problems that are covered in the State Plan, or that are allowable under the federal Medicaid program as described in §1905(a) of the Social Security Act.B. For a foster care child, the Program also covers upon entry to or moving within the foster care system:1) A brief initial check-up; and.
10.09.23.05.htm 10.09.23.05. 05 Limitations.. A. Any Program limits on services or treatments identified in this regulation are not applicable for individuals younger than 21 years old if it is shown that the treatments or services are medically necessary to correct or ameliorate identified or suspected health problems.B. The dental covered services specified in COMAR 10.09.05.04, which follow the periodicity schedule issued by the American Academy of Pediatric Dentists, are limited to one d
10.09.23.06.htm 10.09.23.06. 06 Preauthorization.. Preauthorization is required for:. A. Certain audiology and hearing aid services, as specified in COMAR 10.09.51.06;. B. Certain dental services, as specified in COMAR 10.09.05.06;. C. Certain vision services, as specified in COMAR 10.09.14.06;. D. Private duty nursing services, as specified in COMAR 10.09.53.06;. E. Residential treatment services, as specified in COMAR 10.09.29.06;. F. Therapeutic behavioral services, as specified in COMAR 10.09.34.05; and.
10.09.23.07.htm 10.09.23.07. 07 Payment Procedures.. A. Request for payment of services shall be submitted in accordance with COMAR 10.09.36.04.. B. Billing time limitations for claims submitted pursuant to this chapter as set forth in COMAR 10.09.36.06.C. Rates for services provided by chiropractors, speech therapists, occupational therapists, and nutritionists covered under this chapter are included in the Early Periodic, Screening, Diagnosis, and Treatment (EPSDT) Provider Manual.D. Reimbursement of Medic
10.09.23.08.htm 10.09.23.08. 08 Recovery and Reimbursement.. A. Regardless of whether the recipient has other third-party insurance coverage, EPSDT screening providers shall bill the Program directly for the following components of an EPSDT screen:1) Comprehensive unclothed physical examinations;. 2) Immunizations when the vaccine is not covered by the Vaccines for Children Program;. 3) Vaccine administration; and. 4) Objective screenings for:. a) Developmental assessment;. b) Hearing; and. c) Vision..
10.09.23.09.htm 10.09.23.09. 09 Cause for Suspension or Removal and Imposition of Sanctions.. A. Cause for suspension or removal and impositions of sanctions are as set forth in COMAR 10.09.36.08.B. If during a quality assessment, the Department staff determines that the provider does not meet the standards established by the Department, the Department may decertify the provider as an EPSDT screening provider.
10.09.23.10.htm 10.09.23.10. 10 Appeal Procedures.. Appeal procedures are as set forth in COMAR 10.09.36.09..
10.09.23.11.htm 10.09.23.11. 11 Interpretive Regulations.. State regulations are interpreted as set forth in COMAR 10.09.36.10..
10.09.23.9999.htm 10.09.23.9999. Administrative History Effective date: January 1, 1983 (9:25 Md. R. 2483). Regulation .01 amended effective March 20, 1989 (16:5 Md. R. 629). Regulation .01B amended effective March 12, 1984 (11:5 Md. R. 463) October 1, 1985 (12:19 Md. R. 1849)Regulation .04A amended effective September 10, 1984 (11:18 Md. R. 1584). Regulation .04B amended effective March 20, 1989 (16:5 Md. R. 629). Regulation .05 amended effective March 20, 1989 (16:5 Md. R. 629). Regulation .05B amended a
<< Back | Return to Main COMAR Search Page