Md. Code Regs. 10.09.04.04

Current through Register Vol. 51, No. 25, December 13, 2024

Section 10.09.04.04 - Covered Services

A. The Program covers the services listed in §§B and C of this regulation when the services are:

(1) Provided upon the written order of a physician, physician assistant, certified nurse midwife, or certified nurse practitioner;

(2) Furnished under the current plan of treatment;

(3) Ordered by an individual who is enrolled as a provider in the Program with an active status on the date of service;

(4) Consistent with the current diagnosis and treatment of the participant's condition;

(5) In accordance with accepted standards of medical practice;

(6) Required by the medical condition rather than the convenience or preference of the participant;

(7) Considered under accepted standards of medical practice to be a specific and effective treatment for the participant's condition;

(8) Required on a part-time, intermittent basis;

(9) Rendered in the participant's home, or other setting when normal life activities take the participant outside the home, by an approved provider;

(10) Received by the participant as documented by the participant's signature or the signature of the participant's witness on the home health agency's official forms; and

(11) Adequately described in the signed and dated progress notes.

B. The Program covers the following services:

(1) Skilled nursing services provided by a licensed nurse when the complexity of the services, or the condition of a participant, requires the judgment, knowledge, and skills of a licensed nurse;

(2) Home health aide services provided by a home health aide, that include:

(a) Assistance with activities of daily living as defined in Regulation .01B of this chapter when performed in addition to other home health services;

(b) Other health care services properly delegated by the registered nurse pursuant to the Maryland Nurse Practice Act as set forth in Health Occupations Article, Title 8, Annotated Code of Maryland, that may include, but are not limited to:

(i) Noninvasive parts of ostomy or catheter care;

(ii) Nonsterile dressing changes;

(iii) Procedures;

(iv) Exercises;

(c) Reporting of the participant's condition and needs; and

(d) Completion of appropriate records;

(3) Physical therapy services, provided by a physical therapist:

(a) When the condition of a participant requires the judgment, knowledge, and skills of a licensed or registered physical therapist;

(b) When the services are directly related to the physician's, physician assistant's, certified nurse midwife's, or certified nurse practitioner's plan of treatment, which specifies:

(i) Body part or parts to be treated;

(ii) Type of modalities or treatments to be rendered;

(iii) Expected results of physical therapy treatments;

(iv) Frequency and duration of treatment;

(c) When the services are of a diagnostic, rehabilitative, or therapeutic nature and:

(i) Are provided with the expectation, based on the assessment made by a physician, physician assistant, certified nurse midwife, or certified nurse practitioner, that a participant will improve significantly in physical functioning in a reasonable and generally predictable period of time; or

(ii) Are necessary to the establishment of a safe and effective maintenance program required in connection with a specific disease state;

(4) Occupational therapy services, provided by an occupational therapist:

(a) When the condition of the participant requires the judgment, knowledge, and skills of a licensed occupational therapist;

(b) When the services are provided with the expectation that there will be a significant practical improvement in a participant's level of physical functioning within a reasonable period of time; and

(c) When the services fall within one or more of the following categories:

(i) Evaluation and reevaluation of a participant's level of functioning by administering diagnostic and prognostic tests;

(ii) Selection and teaching of task-oriented therapeutic activities designed to restore physical function;

(iii) Teaching of compensatory techniques to improve the level of independence in the activities of daily living;

(iv) Training in the use of supportive and adaptive equipment, and assistive devices required for independent performance;

(v) Improvement of mobility skills; and

(5) Speech-language pathology services performed by a licensed speech-language pathologist when the:

(a) Services are of a diagnostic, rehabilitative, or therapeutic nature and:

(i) Are provided with the expectation, based on the assessment made by a physician, physician assistant, certified nurse midwife, or certified nurse practitioner, that a participant will improve significantly in a reasonable and generally predictable period of time; or

(ii) Are necessary to the establishment of a safe and effective maintenance program required in connection with a specific disease state; and

(b) The condition of a recipient requires the judgment, knowledge, and skills of a speech-language pathologist.

C. The Program covers a provider's newborn early discharge assessment visit to a participant when the assessment:

(1) Is 4 hours or less;

(2) Is ordered by a physician, physician assistant, certified nurse midwife, or certified nurse practitioner;

(3) Is delivered to a participant and a participant's mother who have been discharged within 48 hours after delivery;

(4) Occurs within 36 hours after discharge;

(5) Includes:

(a) An evaluation of the presence of immediate problems of dehydration, sepsis, infection, jaundice, respiratory distress, cardiac distress, or other adverse physical symptoms of the infant;

(b) An evaluation of the presence of immediate problems of dehydration, sepsis, infection, bleeding, pain, or other adverse physical symptoms of the mother;

(c) Collection of a blood specimen for newborn screening as described in COMAR 10.52.12;

(d) An evaluation of risk factors that identify biological factors for the infant, maternal health behaviors, psychosocial environmental problems, or any other concerns or problems perceived by the nurse that are identified on a form specified by the Department; and

(e) Referrals for any continuing health care services, including skilled nursing services under COMAR 10.09.53 or home health services under this chapter; and

(6) Is conducted by a registered nurse.

D. A provider may deliver services in §B of this regulation via telehealth if:

(1) The Department expressly authorizes the provider to render services via telehealth; and

(2) The patient's plan of care specifies that the service may be delivered via telehealth.

Md. Code Regs. 10.09.04.04

Regulation .04B amended effective April 4, 1988 (15:7 Md. R. 849); November 12, 1990 (17:22 Md. R. 2656)
Regulation .04B amended effective December 27, 2010 (37:26 Md. R. 1787)
Regulation .04D amended effective March 10, 2008 (35:5 Md. R. 641); amended effective 43:19 Md. R. 1072, eff. 9/26/2016; amended effective 44:26 Md. R. 1214, eff. 1/1/2018; amended effective 48:12 Md. R. 470, eff. 6/14/2021; amended effective 50:23 Md. R. 1004, eff. 11/27/2023