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10.09.51.00.htm 10.09.51.00. Title 10 MARYLAND DEPARTMENT OF HEALTH Subtitle 09 MEDICAL CARE PROGRAMS Chapter 51 Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) Audiology Services Authority: Health-General Article, §2-104(b) 15-103, and 15-105, Annotated Code of Maryland
10.09.51.01.htm 10.09.51.01. 01 Definitions.. A. In this chapter, the following terms have the meanings indicated.. B. Terms Defined.. 1) "Acquisition cost" means the actual cost of a product to a provider.. 2) "At risk for hearing impairment" means the condition of a recipient with a suspect or positive hearing screening or who possesses a risk factor listed on the High Risk Questionnaire as defined in COMAR 10.11.02.03.3) "Audiological assessment" means procedures performed by an audiologist t
10.09.51.02.htm 10.09.51.02. 02 Licensure and Certification Requirements.. A. In order to provide services as an audiologist under this chapter, an audiologist:. 1) Shall be licensed by the State Board of Examiners for Audiologists, Hearing Aid Dispensers, and Speech-Language Pathologists to practice audiology, as defined in Health Occupations Article, Title 2, Annotated Code of Maryland, or by the appropriate licensing body in the jurisdiction in which the audiological services are2) If providing services
10.09.51.03.htm 10.09.51.03. 03 Conditions for Participation.. A. To participate in the EPSDT Audiology Services Program, audiologists, audiological centers, audiological groups, and hearing aid dispensers shall comply with the criteria set forth in COMAR 10.09.36.B. To participate in the EPSDT Audiology Services Program, an audiologist or an audiological center shall:1) Agree to on-site visits by departmental staff, following a protocol established by the Department for the purpose of deter
10.09.51.04.htm 10.09.51.04. 04 Covered Services.. The Program covers the following services for EPSDT recipients who are at risk for hearing impairment:A. Medically necessary audiological services, as follows:. 1) Audiological assessments;. 2) Electrophysiological measures such as auditory brainstem response (ABR) otoacoustic emissions, and brainstem auditory evoked response for recipients, when one of the following criteria is met:a) Failure of the recipient to provide consistent behavioral responses to a
10.09.51.05.htm 10.09.51.05. 05 Limitations.. A. Covered audiology and postoperative cochlear implant services are limited to:. 1) Recipients under 21 years old who are referred for the service or have had cochlear implant surgery;2) One audiological assessment per year, unless the time limitations are waived by the Program;. 3) One monaural or binaural hearing aid every 3 years unless the Program approves more frequent replacement;4) Replacement of hearing aids that have been lost, stolen, or damaged beyo
10.09.51.06.htm 10.09.51.06. 06 Preauthorization Requirements.. A. The Department shall issue preauthorization for EPSDT Audiology Services when the provider:. 1) Meets Program procedures and limitations; and. 2) Submits to the Department adequate documentation demonstrating that the services to be preauthorized are necessary, as stated in COMAR 10.09.23.07.B. The Program requires preauthorization for the following audiology services:. 1) Certain hearing aids;. 2) Unlisted hearing aid accessories; and.
10.09.51.07.htm 10.09.51.07. 07 Payment Procedures.. A. Providers shall submit requests for payment for audiology services as stated in COMAR 10.09.36.04.B. Audiology services are reimbursed according to COMAR 10.09.23.01-1.. C. Audiologists, audiological centers, and hearing aid dispensers shall charge the Program customary charges, not exceeding those charged to the general public for similar professional services. If the service is free to individuals not covered by Medicaid:1) The provider:.
10.09.51.08.htm 10.09.51.08. 08 Recovery and Reimbursement.. Recovery and reimbursement requirements are as set forth in COMAR 10.09.36.07..
10.09.51.09.htm 10.09.51.09. 09 Cause for Suspension or Removal and Imposition of Sanctions.. Cause for suspension or removal and imposition of sanctions is as set forth in COMAR 10.09.36.08..
10.09.51.10.htm 10.09.51.10. 10 Appeal Procedures.. Appeal procedures are as set forth in COMAR 10.09.36.09..
10.09.51.11.htm 10.09.51.11. 11 Interpretation of State Regulations.. State regulations are interpreted as set forth in COMAR 10.09.36.10..
10.09.51.9999.htm 10.09.51.9999. Administrative History Effective date: August 16, 1993 (20:16 Md. R. 1277) ―. Chapter revised effective June 21, 2004 (31:12 Md. R. 911). Regulation .01B amended effective July 18, 2005 (32:14 Md. R. 1275) January 16, 2006 (33:1 Md. R. 36)Regulation .02A amended effective January 16, 2006 (33:1 Md. R. 36). Regulation .04 amended effective April 4, 2011 (38:7 Md. R. 431). Regulation .04A amended effective January 16, 2006 (33:1 Md. R. 36).
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