<?xml version='1.0' encoding='utf-8'?>
<regulation prefix="Regulation" num=".04" citation="COMAR 10.09.04.04" title_num="10" subtitle_num="09" chapter_num="04" heading="Covered Services.">
  <paragraph num="A.">
    <text>The Program covers the services listed in §§B and C of this regulation when the services are:</text>
    <paragraph num="(1)">
      <text>Provided upon the written order of a physician, physician assistant, certified nurse midwife, or certified nurse practitioner;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Furnished under the current plan of treatment;</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Ordered by an individual who is enrolled as a provider in the Program with an active status on the date of service;</text>
    </paragraph>
    <paragraph num="(4)">
      <text>Consistent with the current diagnosis and treatment of the participant's condition;</text>
    </paragraph>
    <paragraph num="(5)">
      <text>In accordance with accepted standards of medical practice;</text>
    </paragraph>
    <paragraph num="(6)">
      <text>Required by the medical condition rather than the convenience or preference of the participant;</text>
    </paragraph>
    <paragraph num="(7)">
      <text>Considered under accepted standards of medical practice to be a specific and effective treatment for the participant's condition;</text>
    </paragraph>
    <paragraph num="(8)">
      <text>Required on a part-time, intermittent basis;</text>
    </paragraph>
    <paragraph num="(9)">
      <text>Rendered in the participant's home, or other setting when normal life activities take the participant outside the home, by an approved provider;</text>
    </paragraph>
    <paragraph num="(10)">
      <text>Received by the participant as documented by the participant's signature or the signature of the participant's witness on the home health agency's official forms; and</text>
    </paragraph>
    <paragraph num="(11)">
      <text>Adequately described in the signed and dated progress notes.</text>
    </paragraph>
  </paragraph>
  <paragraph num="B.">
    <text>The Program covers the following services:</text>
    <paragraph num="(1)">
      <text>Skilled nursing services provided by a licensed nurse when the complexity of the services, or the condition of a participant, requires the judgment, knowledge, and skills of a licensed nurse;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Home health aide services provided by a home health aide, that include:</text>
      <paragraph num="(a)">
        <text>Assistance with activities of daily living as defined in Regulation .01B of this chapter when performed in addition to other home health services;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Other health care services properly delegated by the registered nurse pursuant to the Maryland Nurse Practice Act as set forth in Health Occupations Article, Title 8, Annotated Code of Maryland, that may include, but are not limited to:</text>
        <paragraph num="(i)">
          <text>Noninvasive parts of ostomy or catheter care;</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>Nonsterile dressing changes;</text>
        </paragraph>
        <paragraph num="(iii)">
          <text>Procedures;</text>
        </paragraph>
        <paragraph num="(iv)">
          <text>Exercises;</text>
        </paragraph>
      </paragraph>
      <paragraph num="(c)">
        <text>Reporting of the participant's condition and needs; and</text>
      </paragraph>
      <paragraph num="(d)">
        <text>Completion of appropriate records;</text>
      </paragraph>
    </paragraph>
    <paragraph num="(3)">
      <text>Physical therapy services, provided by a physical therapist:</text>
      <paragraph num="(a)">
        <text>When the condition of a participant requires the judgment, knowledge, and skills of a licensed or registered physical therapist;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>When the services are directly related to the physician's, physician assistant's, certified nurse midwife's, or certified nurse practitioner's plan of treatment, which specifies:</text>
        <paragraph num="(i)">
          <text>Body part or parts to be treated;</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>Type of modalities or treatments to be rendered;</text>
        </paragraph>
        <paragraph num="(iii)">
          <text>Expected results of physical therapy treatments;</text>
        </paragraph>
        <paragraph num="(iv)">
          <text>Frequency and duration of treatment;</text>
        </paragraph>
      </paragraph>
      <paragraph num="(c)">
        <text>When the services are of a diagnostic, rehabilitative, or therapeutic nature and:</text>
        <paragraph num="(i)">
          <text>Are provided with the expectation, based on the assessment made by a physician, physician assistant, certified nurse midwife, or certified nurse practitioner, that a participant will improve significantly in physical functioning in a reasonable and generally predictable period of time; or</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>Are necessary to the establishment of a safe and effective maintenance program required in connection with a specific disease state;</text>
        </paragraph>
      </paragraph>
    </paragraph>
    <paragraph num="(4)">
      <text>Occupational therapy services, provided by an occupational therapist:</text>
      <paragraph num="(a)">
        <text>When the condition of the participant requires the judgment, knowledge, and skills of a licensed occupational therapist;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>When the services are provided with the expectation that there will be a significant practical improvement in a participant's level of physical functioning within a reasonable period of time; and</text>
      </paragraph>
      <paragraph num="(c)">
        <text>When the services fall within one or more of the following categories:</text>
        <paragraph num="(i)">
          <text>Evaluation and reevaluation of a participant's level of functioning by administering diagnostic and prognostic tests;</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>Selection and teaching of task-oriented therapeutic activities designed to restore physical function;</text>
        </paragraph>
        <paragraph num="(iii)">
          <text>Teaching of compensatory techniques to improve the level of independence in the activities of daily living;</text>
        </paragraph>
        <paragraph num="(iv)">
          <text>Training in the use of supportive and adaptive equipment, and assistive devices required for independent performance;</text>
        </paragraph>
        <paragraph num="(v)">
          <text>Improvement of mobility skills; and</text>
        </paragraph>
      </paragraph>
    </paragraph>
    <paragraph num="(5)">
      <text>Speech-language pathology services performed by a licensed speech-language pathologist when the:</text>
      <paragraph num="(a)">
        <text>Services are of a diagnostic, rehabilitative, or therapeutic nature and:</text>
        <paragraph num="(i)">
          <text>Are provided with the expectation, based on the assessment made by a physician, physician assistant, certified nurse midwife, or certified nurse practitioner, that a participant will improve significantly in a reasonable and generally predictable period of time; or</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>Are necessary to the establishment of a safe and effective maintenance program required in connection with a specific disease state; and</text>
        </paragraph>
      </paragraph>
      <paragraph num="(b)">
        <text>The condition of a recipient requires the judgment, knowledge, and skills of a speech-language pathologist.</text>
      </paragraph>
    </paragraph>
  </paragraph>
  <paragraph num="C.">
    <text>The Program covers a provider's newborn early discharge assessment visit to a participant when the assessment:</text>
    <paragraph num="(1)">
      <text>Is 4 hours or less;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Is ordered by a physician, physician assistant, certified nurse midwife, or certified nurse practitioner;</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Is delivered to a participant and a participant's mother who have been discharged within 48 hours after delivery;</text>
    </paragraph>
    <paragraph num="(4)">
      <text>Occurs within 36 hours after discharge;</text>
    </paragraph>
    <paragraph num="(5)">
      <text>Includes:</text>
      <paragraph num="(a)">
        <text>An evaluation of the presence of immediate problems of dehydration, sepsis, infection, jaundice, respiratory distress, cardiac distress, or other adverse physical symptoms of the infant;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>An evaluation of the presence of immediate problems of dehydration, sepsis, infection, bleeding, pain, or other adverse physical symptoms of the mother;</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Collection of a blood specimen for newborn screening as described in COMAR 10.52.12;</text>
      </paragraph>
      <paragraph num="(d)">
        <text>An evaluation of risk factors that identify biological factors for the infant, maternal health behaviors, psychosocial environmental problems, or any other concerns or problems perceived by the nurse that are identified on a form specified by the Department; and</text>
      </paragraph>
      <paragraph num="(e)">
        <text>Referrals for any continuing health care services, including skilled nursing services under COMAR 10.09.53 or home health services under this chapter; and</text>
      </paragraph>
    </paragraph>
    <paragraph num="(6)">
      <text>Is conducted by a registered nurse.</text>
    </paragraph>
  </paragraph>
  <paragraph num="D.">
    <text>A provider may deliver services in §B of this regulation via telehealth if:</text>
    <paragraph num="(1)">
      <text>The Department expressly authorizes the provider to render services via telehealth; and</text>
    </paragraph>
    <paragraph num="(2)">
      <text>The patient's plan of care specifies that the service may be delivered via telehealth.</text>
    </paragraph>
  </paragraph>
</regulation>