Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.76 - School-Based Health Centers (SBHC) › Section 10.09.76.01 - Definitions

Current through Register Vol. 51, No. 14, July 12, 2024
A. The
				  following terms have the meanings indicated.
B. Terms Defined.
(1) "Department" means the Maryland
				  Department of Health and Mental Hygiene, the State agency designated to
				  administer the Maryland Medical Assistance Program under Title XIX of the
				  Social Security Act, 42
				  U.S.C. §
												1396 et seq.
(2) "Early and periodic screening, diagnosis
				  and treatment (EPSDT)" means the provision of preventive health care, including
				  medical and dental services under
				  42 CFR §
												441.50 et seq., in order to assess growth and
				  development and to detect and treat health problems in Medical Assistance
				  eligible individuals younger than 21 years old.
(3) "Federally qualified health center
				  (FQHC)" means an entity that has entered into an agreement with the Centers for
				  Medicare and Medicaid Services (CMS) to meet Medicare requirements under
				  42 CFR §
												405.2464 and in accordance with
				  42 CFR §
												405.2401(b).
(4) "Managed care organization (MCO)" has the
				  meaning stated in Health-General Article, §15-101, Annotated Code of
				  Maryland.
(5) "Medically necessary"
				  means that the service or benefit is:
(a)
				  Directly related to diagnostic, preventive, curative, palliative, or
				  ameliorative treatment of an illness, injury, disability, or health
				  condition;
(b) Consistent with
				  currently accepted standards of good medical practice, dental practice, or
				  both;
(c) The most cost efficient
				  that can be provided without sacrificing effectiveness or access to care;
				  and
(d) Not primarily for the
				  convenience of the participant, family, or provider.
(6) "Medicare" means the insurance program
				  administered by the federal government under Title XVIII of the Social Security
				  Act, 42 U.S.C. §
												1395 et seq.
(7) "Participant" means an individual who is
				  certified as eligible for, and who is receiving, Medical Assistance
				  benefits.
(8) "Primary care
				  provider (PCP)" means a practitioner who is the primary coordinator of care for
				  the participant, and whose responsibility it is to provide accessible,
				  continuous, comprehensive, and coordinated health care services covering the
				  full range of benefits required by the Maryland Medical Assistance
				  Program.
(9) "Primary health
				  services" means a basic level of health care, including diagnostic, treatment,
				  consultative, referral, and preventive health services, generally rendered by:
(a) General practitioners;
(b) Family practitioners;
(c) Internists;
(d) Obstetricians;
(e) Gynecologists;
(f) Pediatricians;
(g) Physician assistants; and
(h) Nurse practitioners.
(10) "Program" means the Maryland Medical
				  Assistance Program.
(11) "Provider"
				  means a school-based health center which has been approved by the
				  Department.
(12) "School-based
				  health center (SBHC)" means a health center that:
(a) Is located on school grounds;
(b) Provides on-site primary and preventive
				  health care, referrals, and follow-up services;
(c) Could provide on-site dental care or
				  behavioral health care, referrals, and follow-up services; and
(d) Has been approved by the Maryland
				  Department of Health.
(13) "Specialty behavioral health" means
				  services specified in COMAR
				  10.09.59.06 and 10.09.80.05.