Md. Code Regs. 10.09.10.04

Current through Register Vol. 51, No. 22, November 1, 2024

Section 10.09.10.04 - Covered Services

The Program covers routine care and the following supplies, equipment, and services when appropriate to meet the needs of the recipient:

A. Those described in the Department of Health and Human Services regulations entitled "Requirements for Long Term Care Facilities", 42 CFR Part 483, Subpart B (1996), subject to limitations in Regulation .05 of this chapter.

B. Over-the-counter drugs.

C. Bed reservations for recipients who are on a leave of absence to visit with friends or relatives or to participate in State-approved therapeutic or rehabilitative programs for a maximum of 18 days in any calendar year and without any limitation on the number of days per visit.

D. Repealed.

E. Administrative days approved by the Department or its designee according to the conditions set forth in Regulation .26D of this chapter.

F. Specialized rehabilitative therapy services which meet the conditions listed below:

(1) Physical Therapy. Physical therapy services for Medical Assistance Program purposes are those services furnished to a recipient which meet all of the following conditions:

(a) The services are directly and specifically related to a plan of care designed by the physician after any needed consultation with the qualified physical therapist;

(b) The services are of such a level of complexity and sophistication or the condition of the recipient needs the judgment, knowledge, or skills of a qualified physical therapist;

The services are performed by or under the supervision of a qualified physical therapist;

(d) The services are provided with the expectation, based on the assessment made by the physician of the recipient's restorative potential after any needed consultation with the qualified physical therapist, that the recipient will improve significantly in a reasonable, and generally predictable, period of time;

(e) The services are considered under accepted standards of medical practice to be a specific and effective treatment for the recipient's condition; and

(f) The services are reasonable and necessary to the treatment of the recipient's condition.

(2) Occupational Therapy. Occupational therapy services for Medical Assistance Program purposes are those which meet the following conditions:

(a) The services are directly and specifically related to a plan of care designed by the physician after any needed consultation with the qualified occupational therapist;

(b) The services are on a level of complexity and sophistication or the condition of the recipient needs the judgment, knowledge, and skills of a qualified occupational therapist;

(c) The services are performed by a qualified occupational therapist;

(d) The services are for the purposes of improving or restoring functions which have been impaired by illness or injury or, if function has been permanently lost or reduced by illness or injury, to improve the individual's ability to perform those tasks required for independent functioning;

(e) The services are considered under accepted standards of medical practice to be a specific and effective treatment for the recipient's condition; and

(f) The services are reasonable and necessary to the treatment of the recipient's condition.

(3) Speech Therapy. Speech therapy services for Medical Assistance Program purposes are those services furnished to a recipient which meet all of the following conditions:

(a) The services are directly and specifically related to a plan of care designed by the physician after any needed consultation with the qualified speech and language pathologist;

(b) The services are of such a level of complexity and sophistication or the condition of the recipient needs the judgment, knowledge, and skills of a qualified speech and language pathologist;

(c) The services are performed by or under the supervision of a qualified speech and language pathologist;

(d) The services are provided with the expectation, based on the assessment made by the physician of the recipient's restorative potential after any needed consultation with the qualified speech and language pathologist, that the recipient will improve significantly in a reasonable, and generally predictable, period of time;

(e) The services are considered under accepted standards of medical practice to be a specific and effective treatment for the recipient's condition; and

(f) The services are reasonable and necessary to the treatment of the recipient's condition.

G. Supplies and equipment necessary to meet the needs of the recipient, including but not limited to:

(1) ABD pads.

(2) Adhesive strip bandages.

(3) Adhesive tape (regular and non-allergenic).

(4) Airways-oral and nasal.

(5) Alcohol and alcohol sponges.

(6) Ambu bags.

(7) Antiseptics and cleansing agents (over-the-counter).

(8) Applicators.

(9) Bandages.

(10) Beds, high-low, adjustable.

(11) Bed pans and urinals.

(12) Bed rails.

(13) Bibs.

(14) Body lotions (over-the-counter).

(15) Canes.

(16) Catheters (including Foley or other indwelling).

(17) Catheter trays.

(18) Chest or body restraints.

(19) Clean catch kits.

(20) Clinical medicine glasses-disposable or otherwise.

(21) Cotton and cotton balls.

(22) Covered water pitchers.

(23) Crutches.

(24) Dentifrices and denture adhesives.

(25) Denture cups.

(26) Deodorant (personal and room).

(27) Diagnostic aids (Clinitest, Acetest, Hematest, Testape, etc.).

(28) Dietary supplements (including tube feeding).

(29) Disposable diapers or incontinency care pads.

(30) Disposable wash cloths.

(31) Douche apparatus.

(32) Drainage bags and catheter tubing.

(33) Emesis basins.

(34) Enema apparatus.

(35) Enemas and douches (including prepared).

(36) Eye pads.

(37) First aid supplies.

(38) Gauzes.

(39) Hot water bottles and covers.

(40) Hydraulic lifts.

(41) Ice bags.

(42) Infusionarm boards.

(43) Intermittent positive pressure breathing machines (I.P.P.B.).

(44) Intravenous poles, portable.

(45) Irrigation trays.

(46) Levine tubes (plastic or regular).

(47) Lubricants and oils.

(48) Mouth washes.

(49) Nasal atomizers.

(50) Needles (cardiac, clysis or intravenous, permanent or disposable).

(51) Oxygen for occasional and emergency use. Continuous oxygen is covered under the provisions of COMAR 10.09.18 Oxygen and Related Respiratory Equipment Services.

(52) Oxygen masks, cannulas, catheters, and related equipment, including portable equipment for use with occasional or emergency oxygen. Equipment used for continuous use oxygen is covered under the provision of COMAR 10.09.18 Oxygen and Related Respiratory Equipment Services.

(53) Paper tissues.

(54) Personal toilet items (toothbrush, soap, shampoo, razor, shaving cream, sanitary pads).

(55) Petroleum jelly.

(56) Powder, medicated or non-medicated-over-the-counter.

(57) Pumps, aspiration and suction.

(58) Rectal tubes.

(59) Rubber or plastic gloves and finger cots.

(60) Rubber or plastic pants.

(61) Rubber or plastic sheeting.

(62) Rubber or sponge rings.

(63) Sand bags.

(64) Scales, including chair scales.

(65) Sheepskin, natural or synthetic.

(66) Slings.

(67) Special mattresses for decubiti care.

(68) Sphygmomanometers.

(69) Stethoscopes.

(70) Stryker and Foster frames.

(71) Suction machines, gastric and tracheal.

(72) Suction tubing.

(73) Surgical dressings, including sterile sponges.

(74) Suture removal kits.

(75) Suture trays.

(76) Syringes, plastic, glass, or bulb.

(77) Tape removers.

(78) Thermometers, oral, rectal, universal, bath.

(79) Tongue depressors.

(80) Tracheostomy equipment and supplies.

(81) Traction equipment.

(82) Trapeze and bed frame equipment.

(83) Trays, cut-down.

(84) Tubing.

(85) Walkers and walkerettes.

(86) Wheel chairs.

H. Administration of enemas.

I. Administration of oxygen.

J. Back rubs.

K. Decubiti care and over-the-counter medication.

L. Colostomy, ileostomy, and nephrostomy care.

M. Hand feeding or self-help eating devices.

N. Incontinency care.

O. Personal laundry.

P. Personal toilet (routine shaving, hair washing and arranging, routine toenail clipping, adequate bathing).

Q. Private room for isolation purposes.

R. Special diets, including diabetic.

S. Tray service.

T. Tube feeding.

U. Portable X-ray services.

V. Respirator management in licensed comprehensive care beds which have been determined by the Department to meet the standards for respiratory care units under COMAR 10.07.02.

W. Intravenous therapy and venipuncture.

X. Noninvasive traction apparatus services (cervical, Buck's extension, pelvic).

Y. Emergency resuscitation procedures, including coronary pulmonary procedures.

Z. Restorative nursing care.

AA. Physician-ordered physical restraints and protective devices.

BB. Negative pressure wound therapy.

Md. Code Regs. 10.09.10.04

Regulations .04G; amended effective December 14, 1979 (6:25 Md. R. 1980)
Regulation .04G amended effective October 29, 1984 (11:21 Md. R. 1812)
Regulations .04 amended as an emergency provision effective July 1, 2005 (32:19 Md. R. 1584); emergency status expired August 31, 2005
Regulations .04, amended as an emergency provision effective July 3, 1990 (17:16 Md. R. 1986); amended permanently effective November 1, 1990 (17:21 Md. R. 2529)
Regulations .04 amended and new Regulation .09-1 adopted as an emergency provision effective October 1, 1999 (26:23 Md. R. 1775); adopted permanently effective January 9, 2000 (26:27 Md. R. 2015)
Regulation .04 amended effective August 15, 1994 (21:16 Md. R. 1383); December 29, 1997 (24:26 Md. R. 1758)
Regulation .04D repealed effective March 18, 2013 (40:5 Md. R. 411)
Regulation .04E amended effective December 9, 2005 (32:24 Md. R. 1904); March 18, 2013 (40:5 Md. R. 411)
Regulation .04BB adopted as an emergency provision effective April 1, 2008 (35:9 Md. R. 892); emergency status expired September 3, 2008
Regulation .04BB adopted effective September 22, 2008 (35:19 Md. R. 1716)
Regulations .04 amended effective 42:7 Md. R. 567, eff.4/13/2015; amended effective 45:13 Md. R. 664, eff. 7/2/2018