Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 3 › Subtitle 11 - MATERNAL AND CHILD HEALTH › Chapter 10.11.03 - Children's Medical Services Program › Section 10.11.03.02 - Definitions

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) "Agency" means a legally incorporated
				  body or governmental unit which provides services to disabled children or their
				  families, or both.
(2) "Allowable
				  cost" means the maximum amount which the Program will reimburse for the drug or
				  product portion of the prescription.
(3) "Appeal" means the process by which a child with
				  special health care needs, as defined in §B(9) of this regulation, or the
				  family on the child's behalf, obtains a review of a decision, action, or lack
				  of action on the part of the CMS Program or one of its designees.
(4) "Applicant " means a child with special
				  health care needs, as defined in §B(9) of this regulation, or the parent
				  or guardian of a child, for whom a written application has been submitted to
				  the CMS Program for services, but for whom eligibility has not yet been
				  determined.
(5) "Authorized
				  services" means that care which is approved by the CMS Program for an eligible
				  child.
(6) "Care coordination
				  services" means services to promote the effective and efficient utilization of
				  resources to assure access to necessary comprehensive services.
(7) "Care management plan (CMP)" means a
				  written document that lists recommendations for care as specified by a licensed
				  and boarded provider
(8)
				  "Children's Medical Services Program (CMS Program)" means that program which is
				  administered by the Department pursuant to Health-General Article,
				  §15-125, Annotated Code of Maryland, to:
(a) Provide for specialized medical, surgical
				  pharmacologic, and related rehabilitative evaluation and treatment services for
				  children with special health care needs younger than 22 years old who:
(i) Meet the residential, identification,
				  financial, and medical eligibility requirements; and
(ii) Are uninsured or do not have coverage in
				  their existing health insurance plans that cover certain types of medical
				  care;
(b) Provide and
				  promote family-centered, community-based coordinated care for children with
				  special health care needs, and promote development of community-based,
				  culturally competent systems of services for those children and their families
				  throughout the State; and
(c)
				  Distribute funds to cover specialty diagnostic and treatment services for
				  eligible children with special health care needs in Maryland
(9) "Children with special health
				  care needs " means individuals, birth to 22 years old, who have or who are at
				  increased risk for a chronic physical development, behavioral, or emotional
				  condition and who also require health and related services of a type or amount
				  beyond that required by children generally.
(10) "Departmenf means the Department of
				  Health and Mental Hygiene, the single State agency designated to administer the
				  CMS Program.
(11) "Disabling
				  condition" means a health-related condition or impairment that may hinder
				  achievement of normal growth and development.
(12) "Disposable medical supplies" means
				  consumable or disposable items with minimal or no potential for reuse which are
				  used to serve a medical purpose.
(13) "Durable medical equipment" means
				  equipment which satisfies all of the following requirements:
(a) It can withstand repeated use;
(b) It is used to serve a medical purpose;
				  and
(c) It is appropriate for use
				  in the home.
(14)
				  "Federal poverty level" means the poverty guidelines, as amended, which are
				  updated periodically in the Federal Register by the U.S. Department of Health
				  and Human Services.
(15)
				  "Financial eligibility guidelines" means the schedule based upon the federal
				  poverty level which is used to determine financial eligibility for the CMS
				  Program.
(16) "General hospital"
				  means an institution which falls within the jurisdiction of Health-General
				  Article, Title 19, Subtitle 3, Annotated Code of Maryland, and is licensed as a
				  general hospital by the Department of Health and Mental Hygiene, Division of
				  Licensing and Certification, in accordance with COMAR 10.07.01.
(17) "Health Services Cost Review Commission
				  (HSCRC)" means the independent organization within the Department of Health and
				  Mental Hygiene which is responsible for reviewing and approving rates for
				  hospitals pursuant to Health-General Article, Title 19, Subtitle 2, Annotated
				  Code of Maryland.
(18) "Hospital"
				  means an institution which falls within the jurisdiction of Health-General
				  Article, Title 19, Subtitle 3, Annotated Code of Maryland, and is licensed
				  pursuant to COMAR 10.07.01, or other applicable standards established by the
				  state in which the services are provided.
(19) "Income" means any property or service
				  received by a person in cash or in kind which can be applied directly to meet
				  basic needs for food, shelter, and medical expenses.
(20) "Long-term hospitalization" means an
				  inpatient stay of more than 2 weeks.
(21) "Medical assistance" has the meaning
				  stated in COMAR 10.09.24.02.
(22)"Medical care" means medical services and
				  specialized care provided by physicians and allied health professionals in
				  hospitals, convalescent facilities, clinics, private physicians' offices, in
				  home and other community-based settings. Medical care may include the services
				  rendered by dentists, nurses, medical social workers, childlife specialists,
				  nutritionists, dietitians, psychologists, physical therapists, occupational
				  therapists, speech-language pathologists, audiologists, optometrists,
				  ophthalmologists, technicians, and other pertinent personnel whose services may
				  be needed by those children who are served by the CMS Program.
(23) "Medically necessary dental care" means
				  reasonable and appropriate diagnosis, treatment, and follow-up care as
				  determined and prescribed by qualified, appropriate health care providers in
				  treating a condition, disease, injury, birth defect, or development
				  malformation to restore facial configuration or function necessary for speech,
				  swallowing, or chewing.
(24)
				  "Physician specialist" means a:
(a) Licensed
				  medical doctor who is qualified to practice medicine in a specialty area and
				  who is either board certified or board eligible and who has experience in the
				  care of children; or
(b) Resident
				  physician under the supervision of a licensed board-certified
				  physician.
(25)
				  "Preauthorization" means an approval required from the Department or its
				  designee before the provision of services.
(26) "Provider" means an individual or entity duly
				  licensed or certified to render a health care service or product pursuant to
				  these regulations through an appropriate agreement with the Department, and
				  identified as a CMS Program provider by the issuance of an individual vendor
				  number.
(27) "Residency" means
				  living in the State voluntarily with the intention of making the State the
				  individual's permanent home for an indefinite period and not for a temporary
				  purpose.