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10.09.58.00.htm 10.09.58.00. Title 10 MARYLAND DEPARTMENT OF HEALTH Subtitle 09 MEDICAL CARE PROGRAMS Chapter 58 Family Planning Program Authority: Health-General Article, §2-104(b) 15-103, and 15-105, Annotated Code of Maryland
10.09.58.01.htm 10.09.58.01. 01 Purpose and Scope.. A. This chapter governs the coverage of services for the Medical Assistance Family Planning Program.. B. Eligibility shall be established according to COMAR 10.09.37..
10.09.58.02.htm 10.09.58.02. 02 Definitions.. A. In this chapter, the following terms have the meanings indicated.. B. Terms Defined.. 1) “Advanced practice nurse” means an individual who meets the requirements in COMAR 10.09.01.. 2) "Department" means the Maryland Department of Health as defined in COMAR 10.09.36.01.. 3) "Early and Periodic Screening, Diagnostic and Treatment (EPSDT) means the provision to individuals younger than 21 years old, of preventative health care under 42CFR §441.5
10.09.58.03.htm 10.09.58.03. 03 Licensure Requirements.. A. An advanced practice nurse shall be licensed to practice as described in COMAR 10.09.01.. B. A doctor of medicine or osteopath shall be licensed and legally authorized to practice medicine in the state in which the service is delivered as described in COMAR 10.09.02.C. A physician assistant must be licensed to practice as described in COMAR 10.09.55.. D. Medical laboratories shall ensure that Clinical Laboratory Improvement Amendments (CLIA) certific
10.09.58.04.htm 10.09.58.04. 04 Conditions of Participation.. A. Providers shall be enrolled as Medical Assistance Program providers and shall meet the requirements for participation in the Maryland Medical Assistance Program as set forth in COMAR 10.09.36.03, as well as the requirements for participation as set forth in the COMAR chapter defining the provider and covered service being rendered.B. Services covered in Regulation .05A―C of this chapter shall be provided by:. 1) A physician;.
10.09.58.05.htm 10.09.58.05. 05 Covered Services.. The following services are covered under this chapter:. A. Office medical visits for the primary purpose of providing age and sex appropriate family planning services, which include:1) Focused history, physical exam, and laboratory testing necessary to evaluate and manage the participant’s choice of chemical, mechanical, or other method to prevent conception;2) Basic education regarding human sexuality and reproduction;. 3) Advice and counseling
10.09.58.06.htm 10.09.58.06. 06 Limitations.. A. The following services are not covered:. 1) Services not medically necessary;. 2) Therapeutic abortion;. 3) Transportation services;. 4) EPSDT services;. 5) Services delivered in an in-patient hospital setting or ambulatory surgical center other than:. a) Permanent sterilizations; and. b) A hysterosalpingogram following the Essure procedure;. 6) Infertility services, including reversal of sterilization; and.
10.09.58.07.htm 10.09.58.07. 07 Payment Procedures.. A. Payment procedures are those set forth in COMAR 10.09.36.04.. B. Billing time limitations are those set forth in COMAR 10.09.36.06.. C. Payment procedures for advanced practice nurses are those set forth in COMAR 10.09.01.06.. D. Payment procedures for physician services in the office or home are those set forth in COMAR 10.09.02.07.E. Payment procedures for clinic services delivered in federally qualified health centers are those set forth in COMAR 10.09.
10.09.58.08.htm 10.09.58.08. 08 Recovery and Reimbursement.. Recovery and reimbursement are as set forth in COMAR 10.09.36.07..
10.09.58.09.htm 10.09.58.09. 09 Cause for Suspension or Removal and Imposition of Sanctions.. Cause for suspension or removal and imposition of sanctions are as set forth in COMAR 10.09.36.08..
10.09.58.10.htm 10.09.58.10. 10 Appeal Procedures.. The requirements related to appeal procedures under COMAR 10.09.36 and 10.09.37 apply to this chapter.
10.09.58.11.htm 10.09.58.11. 11 Fraud and Abuse.. The requirements relating to fraud and abuse under COMAR 10.09.24.14 shall apply to this chapter..
10.09.58.12.htm 10.09.58.12. 12 Interpretive Regulation.. State regulations are interpreted as set forth in COMAR 10.09.36.10..
10.09.58.9999.htm 10.09.58.9999. Administrative History Effective date:. Regulations .01―12 adopted as an emergency provision effective October 19, 1994 (21:23 Md. R. 1930) adopted permanently effective April 10, 1995 (22:7 Md. R. 536)Regulation .01B, C amended as an emergency provision effective July 1, 2003 (30:17 Md. R. 1202) amended permanently effective October 13, 2003 (30:20 Md. R. 1448)Regulation .01 repealed and new Regulation .01 adopted as an emergency provision effective January 1
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