Md. Code Regs. 10.09.23.02

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

Section 10.09.23.02 - Provider Qualifications

A. EPSDT screening and treatment providers shall meet all of the licensure and certification requirements specified in this or any other applicable chapter of COMAR, statute, or policy for the service that the provider renders.

B. In order for the Program to consider a health care practitioner for certification by the Healthy Kids Program as an EPSDT screening provider, the practitioner shall have a demonstrated history of providing services to children younger than 21 years old and shall also:

(1) Be a doctor of medicine or osteopathy who is:

(a) Licensed in good standing and legally authorized to practice medicine and surgery in the jurisdiction in which the service is provided; and

(b) Board-certified in one of the following:

(i) Pediatrics;

(ii) Family practice; or

(iii) Internal medicine; or

(2) Be a pediatric or family nurse practitioner or a physician assistant who is licensed in good standing and certified to practice in the jurisdiction in which services are provided.

C. A freestanding clinic as defined in COMAR 10.09.08 shall be considered for certification by the Healthy Kids Program as an EPSDT screening provider if the clinic employs or contracts with one or more of the licensed health care practitioners listed in §B of this regulation.

D. Any health care practitioner whose professional services are recognized in § 1905(a) of the Social Security Act may apply to the Program to be an EPSDT treatment provider.

E. EPSDT treatment providers that are covered by the Program include:

(1) The following provider types that are licensed in good standing to practice in the jurisdiction in which services are provided:

(a) Chiropractors;

(b) Nurse psychotherapists;

(c) Nutritionists or dietitians;

(d) Occupational therapists;

(e) Professional counselors;

(f) Psychologists;

(g) Social workers;

(h) Speech therapists; or

(i) An intermediate care facility that provides at least one of the following:

(i) Clinically managed high intensity residential treatment; and

(ii) Medically monitored intensive inpatient treatment;

(2) Lead paint risk assessors who are accredited by the Maryland Department of the Environment in accordance with COMAR 26.16.01.16;

(3) Audiologists and hearing aid providers, as specified in COMAR 10.09.51.02C;

(4) Dentists as specified in COMAR 10.09.05.02C;

(5) Private duty nurses, as specified in COMAR 10.09.53.02C;

(6) Residential treatment centers, as specified in COMAR 10.09.29.02C;

(7) Therapeutic behavioral service providers, as specified in COMAR 10.09.34.02C; and

(8) Vision care and optical providers, as specified in COMAR 10.09.14.02C.

(9) Therapeutic nursery service providers, as specified in COMAR 10.21.18.03C.

F. In order to qualify as an EPSDT treatment provider, an intermediate care facility shall:

(1) Be licensed under COMAR 10.63.03 or certified under COMAR 10.47.02, whichever is appropriate; and

(2) If appropriate, provide separate social, residential, dietary, and recreational activities for children and adolescents.

Md. Code Regs. 10.09.23.02

Regulations .02 adopted effective March 22, 2010 (37:6 Md. R. 477)
Regulation .02E amended effective December 27, 2010 (37:26 Md. R. 1787); amended effective 45:26 Md. R. 1243, eff. 12/31/2018; amended effective 46:17 Md. R. 726, eff. 8/26/2019