Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.53 - Early and Periodic Screening, Diagnosis, and Treatment: Nursing Services for Individuals Younger than 21 Years Old › Section 10.09.53.05 - Limitations

Current through Register Vol. 51, No. 14, July 12, 2024
A. Under this
				  chapter, the Program does not cover the following:
(1) Home health services that are covered
				  under COMAR 10.09.04;
(2) Services
				  rendered by a nurse, CNA, or HHA who is a member of the participant's immediate
				  family or who ordinarily resides with the participant;
(3) Custodial services;
(4) Services not deemed medically necessary
				  at the initial assessment or the most recent plan of care review;
(5) Services delivered by a nurse, CNA, or
				  HHA who is not directly supervised by a registered nurse who documents all
				  supervisory visits and activities;
(6) Services not preauthorized by the
				  Department or the Department's designee, with the exception of the initial
				  assessment;
(7) Services provided
				  to a participant in a hospital, residential treatment center, or an
				  intermediate care facility for individuals with intellectual disabilities or a
				  residence or facility where nursing services are included in the living
				  arrangement by regulation or statute, or otherwise provided for
				  payment;
(8) Services not directly
				  related to the plan of care;
(9)
				  Services specified in the plan of care, when the plan of care has not been
				  signed by the recipient or the recipient's legally authorized representative,
				  the Department or the Department's designee, and the recipient's primary
				  medical provider, when the services are covered under COMAR 10.09.27;
(10) Services described in the plan of care
				  whenever a major change occurs in the recipient's medical condition or skilled
				  nursing care needs;
(11) Services
				  not ordered by the recipient's primary medical provider as a result of a
				  partial or complete EPSDT screen;
(12) Services specified in Regulation .04 of
				  this chapter which duplicate or supplant services rendered by the recipient's
				  family caregivers or primary caregivers as well as other insurance, privilege,
				  entitlement, or program services that the recipient receives or is eligible to
				  receive;
(13) Services specified in
				  Regulation .04 of this chapter to recipients eligible for any third-party
				  liability coverage of those services;
(14) Services provided for the convenience or
				  preference of the recipient or the primary caregiver rather than as required by
				  the recipient's medical condition;
(15) Services which are not initially ordered
				  before the start of care and renewed every 60 days by the participant's primary
				  medical provider;
(16) Services
				  provided by a nurse, CNA, or HHA who does not possess a valid, current, and
				  nontemporary nursing license or certifications to provide services in the
				  jurisdiction in which services are rendered;
(17) Services provided by a nurse, CNA, or
				  HHA who does not have a current cardiopulmonary resuscitation (CPR)
				  certification for the period during which the services are rendered;
(18) Direct payment for supervisory visits
				  that do not meet acceptable standards of practice in accordance with COMAR
				  10.27.09, 10.27.10, and 10.27.11;
(19) Services rendered to a participant by a
				  nurse, CNA, or HHA in the assigned staff's home;
(20) Services not documented; and
(21) Respite services.