Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.23 - Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) Services › Section 10.09.23.01 - Incorporation by Reference

Current through Register Vol. 51, No. 14, July 12, 2024
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 Department of Health and Mental Hygiene, 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 comprehensive and preventive
				  health care pursuant to 42
				  CFR §
												441.50 et seq., as amended, and
				  other diagnostic and treatment services that are necessary to correct or
				  ameliorate defects and physical and mental illnesses in children younger than
				  21 years old.
(4) "EPSDT
				  periodicity schedule" means the State-specified listing of the minimum required
				  and recommended preventive health screening services that are to be performed
				  at specified ages.
(5) "EPSDT
				  screen" means the full scope of comprehensive well-child screening procedures,
				  required by the State periodicity schedule that a participant receives at a
				  given age.
(6) "EPSDT screening
				  provider" means a physician, nurse practitioner, or physician assistant
				  certified by the Department to provide EPSDT screens.
(7) "EPSDT treatment provider" means a health
				  care provider that is enrolled to provide services that are not otherwise
				  covered for individuals 21 years old or older.
(8) "EPSDT treatment services" means health
				  care services that are covered for children younger than 21 years old that are
				  not otherwise covered for individuals 21 years old or older.
(9) "Environmental lead investigation" means
				  an inspection of the primary dwelling of a participant that results in a report
				  characterizing the hazards associated with identified lead-containing
				  substances.
(10) Foster Care Child.
(a) "Foster care child" means a participant
				  who is in the care and custody of the Department of Human Services.
(b) "Foster care child" includes children who
				  receive kinship care.
(11) "Health care practitioner" means an
				  individual who is licensed, certified, or otherwise authorized under Health
				  Occupations Article, Annotated Code of Maryland, or under the laws of the
				  District of Columbia or another state, to provide health care
				  services.
(12) "Health care
				  service" has the meaning stated in Health-General Article, §19-132,
				  Annotated Code of Maryland.
(13)
				  "Healthy Kids Program" means the unit within the Maryland Medical Assistance
				  Program that develops guidelines for and monitors EPSDT well-child screening
				  services and certifies EPSDT screening providers.
(14) "Intermediate care facility" means a
				  facility that provides a planned regimen of 24-hour professionally directed
				  evaluation, observation, medical monitoring, and addiction treatment in an
				  inpatient setting.
(15)
				  "Jurisdiction" means a state or the District of Columbia.
(16) "Managed Care Organization (MCO)" has
				  the meaning stated in Health-General Article, §15-101, Annotated Code of
				  Maryland.
(17) "Medical Assistance
				  Program" has the meaning stated in COMAR
				  10.09.36.01C.
(18) "Medically necessary" means
				  that the service or benefit is:
(a) Directly
				  related to diagnostic, preventive, curative, palliative, rehabilitative, or
				  ameliorative treatment of an illness, injury, disability, or health
				  condition;
(b) Consistent with
				  current accepted standards of good medical practice;
(c) The most cost-efficient service that can
				  be provided without sacrificing effectiveness or access to care; and
(d) Not primarily for the convenience of the
				  consumer, family, or provider.
(19) "Participant" means a person younger
				  than 21 years old who is determined eligible for, and is receiving, Medical
				  Assistance benefits as provided in COMAR 10.09.11 or 10.09.24.
(20) "Plan of treatment" means a written
				  plan, updated at a minimum of every 6 months for ongoing care, to address
				  identified problems to include:
(a)
				  Diagnoses;
(b) Treatment
				  goals;
(c) Frequency of
				  visits;
(d) Duration of treatment;
				  and
(e) Prognosis.
(21) "Preauthorization" means the
				  approval required from the Department or its designee before services can be
				  rendered.
(22) "Preventive
				  services" means primary health care designed to:
(a) Promote normal growth and development;
				  and
(b) Detect, ameliorate, or
				  delay diseases at an early stage before complications or serious disabilities
				  develop.
(23) "Program"
				  means the Maryland Medical Assistance Program.
(24) "Screening services" means the EPSDT
				  preventive health care and laboratory procedures required at specified ages by
				  the State periodicity schedule.
(25) "Third-party payers" means insurers and
				  other entities obligated either legally or contractually to pay for or to
				  reimburse the participant for service covered in this chapter.
(26) "Vaccines for Children Program" means
				  the federal program that provides specific childhood vaccines to health care
				  providers, at no cost, for administration to participants younger than 19 years
				  old.