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10.09.58.00.htm 10.09.58.00. Title 10 DEPARTMENT OF HEALTH AND MENTAL HYGIENE 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 for women 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) "Certified nurse practitioner" means a licensed registered nurse who:. a) By reason of certification under COMAR 10.27.07, may practice in Maryland as a nurse practitioner under the terms of those regulations; orb) Qualifies as a nurse practitioner in the state in which services are provided..
10.09.58.03.htm 10.09.58.03. 03 Licensure Requirements.. A. A certified nurse practitioner shall:. 1) Be licensed to practice registered nursing in Maryland and be certified as a nurse practitioner by the Board of Nursing; or2) Meet the nurse practitioner regulatory requirements of the state in which services are provided.. 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.C. Medical laboratories s
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 covered service being rendered.B. If required by the state in which services are provided, certified nurse practitioners shall have a written agreement with
10.09.58.05.htm 10.09.58.05. 05 Covered Services.. The following services are covered under this chapter:. A. Office medical visits and hospital outpatient department visits for family planning purposes, which include:1) Complete initial and annual physical examination including auscultation of heart and lungs;. 2) Pelvic examination, including bimanual and speculum, and Pap smears annually, unless clinical indication for more frequent examination exists;3) Breast examination;.
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 certified nurse practitioners 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
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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