Md. Code Regs. 10.09.12.04

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

Section 10.09.12.04 - Covered Services

A. The following medically necessary items are covered when ordered by an individual who is enrolled as a provider in the Program on the date of service:

(1) Disposable medical supplies;

(2) Durable medical equipment;

(3) Repairs to purchased durable medical equipment;

(4) All disposable medical supplies and durable medical equipment for home kidney dialysis purchased or rented for Medical Assistance recipients;

(5) Prosthetic devices which include:

(a) Artificial eyes;

(b) Breast prostheses, including surgical brassiere; and

(c) Upper and lower extremity, full and partial, to include stump cover or harnesses where necessary.

(6) Replacement of prostheses;

(7) Individually form-fitted support stockings, leg or arm, including all fitting, dispensing, and follow-up care, for recipients for whom these supports are medically necessary, not to exceed two at one time, three times in a 12-month period for recipients 21 years old or older;

(8) Evaluation for equipment that was subsequently provided through the Department's recycling program as described in Regulation .07O of this chapter;

(9) Speech generating, augmentative, and alternative communication devices for recipients enrolled under fee-for-service or a Managed Care Organization; and

(10) Enteral nutritional products given by nasogastric, jejunostomy, or gastrostomy tube in the home.

B. The items in §A of this regulation are covered when medically necessary for use in the recipient's:

(1) Home;

(2) School; or

(3) Place of employment.

C. Repairs under §A(3) of this regulation are also covered for recipients in hospitals, nursing facilities, and other medical institutions for equipment that was purchased for the recipient while the recipient lived in the community.

D. Items in §A(5) and (6) of this regulation are also covered for recipients in hospitals, nursing facilities, and other medical institutions.

E. Documentation Required.

(1) Items in A of this regulation are covered only when adequate documentation is obtained by the provider and kept on file as part of the permanent business records of the provider. This documentation includes, but is not limited to the:

(a) Signed and dated prescriber order including documentation that a face-to-face encounter occurred within 6 months before ordering services;

(b) Recertifications of continuous medical need;

(c) Delivery ticket signed by the recipient or the recipient's representative where the identification of the person signing and the exact nature of the items delivered is clearly evident on the delivery ticket;

(d) Make, model, and serial number of the item, as applicable; and

(e) Cost of the item to the provider for individually considered items reimbursed under a cost-plus methodology.

(2) For purchased equipment, the delivery ticket shall note the identification tag number and also include a statement which notifies the recipient that the equipment has been purchased by the State of Maryland and remains the property of the Department of Health and Mental Hygiene.

(3) Documentation shall be retained for 6 years and be made available upon request by the Department.

F. The Department may arrange for the provision of any covered service listed in §A of this regulation under an exclusive contract with a vendor or vendors that has been awarded in accordance with State regulations and policies governing contracts and procurements.

Md. Code Regs. 10.09.12.04

Regulation .04A amended effective February 8, 1980 (7:3 Md. R. 264)
Regulation .04A amended effective July 1, 1987 (14:13 Md. R. 1473); May 29, 1989 (16:10 Md. R. 1108)
Regulation .04B amended effective July 2, 1984 (11:13 Md. R. 1176); July 11, 1988 (15:13 Md. R. 1553); May 29, 1989 (16:10 Md. R. 1108)
Regulation .04E amended effective July 2, 1984 (11:13 Md. R. 1176); August 12, 1985 (12:16 Md. R. 1606)
Regulation .04F G adopted effective June 2, 1986 (13:11 Md. R. 1273)
Regulation .04H adopted effective March 23, 1987 (14:6 Md. R. 715)
Regulation .04 amended effective August 1, 2005 (32:15 Md. R. 1320); September 11, 2006 (33:18 Md. R. 1505)
Regulation .04A amended effective April 19, 2010 (37:8 Md. R. 615)
Regulation .04E amended effective April 30, 2012 (39:8 Md. R. 533); amended effective 44:26 Md. R. 1214, eff. 1/1/2018; amended effective 48:12 Md. R. 472, eff. 6/14/2021