Md. Code Regs. 10.09.16.06

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

Section 10.09.16.06 - Limitations

A. The Program does not cover the following:

(1) Services not delivered in compliance with Regulation .05 of this chapter;

(2) Services not medically necessary;

(3) Investigational or experimental drugs and procedures;

(4) Services solely for the purpose of:

(a) Prescribing medication;

(b) Administering medication;

(c) Drug or supply pick-up;

(d) Collecting laboratory specimens;

(e) Interpreting laboratory tests or panels; or

(f) Administering injections;

(5) Separate reimbursement to an employee of a program for services that have been provided by and reimbursed directly to a program;

(6) Services provided to or for the primary benefit of individuals other than the participant;

(7) Mobile crisis team services rendered by telehealth with the exception of those specified as permissible via telehealth in Regulation .05 of this chapter;

(8) Behavioral health crisis stabilization center services rendered by telehealth with the exception of those specified in COMAR 10.63.03.21;

(9) Services provided to participants in a hospital inpatient setting; and

(10) Services rendered but not appropriately documented.

B. Providers may not be reimbursed by the Program for:

(1) Behavioral health crisis stabilization center services exceeding 23 hours 59 minutes;

(2) Presumptive and definitive drug testing when billed by a behavioral health crisis stabilization center; or

(3) Transportation costs.

Md. Code Regs. 10.09.16.06

Regulation .06 repealed effective 45:14 Md. R. 697, eff. 7/16/2018; adopted effective 51:10 Md. R. 525, eff. 5/27/2024.