Md. Code Regs. 10.09.92.05

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

Section 10.09.92.05 - Limitations

The Program does not cover:

A. Hospital services, procedures, drugs, or hospital admissions that are investigational or experimental;

B. Hospital services denied by Medicare as not medically necessary;

C. Inpatient admissions or outpatient visits solely for the administration of injections, unless medical necessity and the participant's inability to take appropriate oral medications is documented in the participant's medical record;

D. Elective inpatient admissions without preauthorization;

E. Elective inpatient admissions from the emergency department for dialysis services that are the result of problems occurring with placement in a freestanding dialysis facility;

F. Outpatient visits for one or more of the following:

(1) Prescription drug or food supplement pick up;

(2) Collection of specimens for laboratory procedures;

(3) Recording of an electrocardiogram;

(4) Ascertaining the participant's weight; and

(5) Administration of vaccines;

G. Interpretation of laboratory tests or panels;

H. Autopsies;

I. Weight control medications;

J. Care provided to a well newborn beyond the:

(1) Length of the mother's stay for a normal obstetrical or uncomplicated caesarean section delivery; or

(2) First 4 days of the newborn's life when the mother remains in the hospital due to other circumstances;

K. Telephones, televisions, or personal comfort items or services;

L. Duplicate care or services;

M. Elective admissions to hospitals outside of Maryland, except the District of Columbia, unless the Department or its designee determines that comparable services are not available in Maryland;

N. Inpatient and outpatient diagnostic and laboratory services not ordered by the attending physician or other practitioner;

O. Inpatient days provided in excess of the days approved by the Department or its designee;

P. Hospital laboratory tests which are coverable under COMAR 10.09.09, unless the specimen is obtained in the hospital for a participant receiving inpatient, outpatient, emergency department, or observation services;

Q. Hospital services provided outside of the United States; and

R. Ancillary services that are part of an observation stay beyond the initial 24 hours.

Md. Code Regs. 10.09.92.05

Regulation .05 adopted effective 44:7 Md. R. 354, eff. 4/10/2017; amended effective 51:12 Md. R. 619, eff. 6/24/2024.