<?xml version='1.0' encoding='utf-8'?>
<regulation prefix="Regulation" num=".04" citation="COMAR 10.09.08.04" title_num="10" subtitle_num="09" chapter_num="08" heading="Covered Services.">
  <paragraph num="A.">
    <text>The Program covers the services listed in §§B—E of this regulation according to the conditions and requirements indicated.</text>
  </paragraph>
  <paragraph num="B.">
    <text>Medically Necessary Services. The program covers medically necessary services as described in §§C, D, and E of this regulation and in Regulation .05 of this chapter, rendered to participants by a freestanding clinic, when these services are performed by a physician or by:</text>
    <paragraph num="(1)">
      <text>A registered nurse, a psychologist, or a social worker, provided that the individual performs the service within the scope of the individual’s license or certification for the purpose of assisting in the provision of physicians’ services;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>A nurse midwife, a nurse practitioner, a licensed practical nurse, or a registered physician’s assistant, provided that the individual performs the services within the scope of the individual's license or certification; or</text>
    </paragraph>
    <paragraph num="(3)">
      <text>An addictions counselor who meets the requirements in accordance with COMAR 10.58.07.</text>
    </paragraph>
  </paragraph>
  <paragraph num="C.">
    <text>Family Planning Clinic Services.</text>
    <paragraph num="(1)">
      <text>To participate in the Program as a family planning clinic, a provider shall meet the requirements of Regulation .03 of this chapter and §§B and C(2) of this regulation and shall:</text>
      <paragraph num="(a)">
        <text>Participate in the Title X: National Family Planning Program; or</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Provide documented evidence of adherence to and compliance with standards established for family planning by the State of Maryland, Planned Parenthood, or the American College of Obstetricians and Gynecologists.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(2)">
      <text>Covered services include:</text>
      <paragraph num="(a)">
        <text>Complete initial and annual physical examination including auscultation of heart and lungs for all patients;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Pelvic examination, including bimanual and speculum, and Pap smears on all females annually, unless clinical indication for more frequent examination exists;</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Laboratory tests including, but not limited to:</text>
        <paragraph num="(i)">
          <text>Hemoglobin or hematocrit, or both, for all patients;</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>Urinalysis for albumin sugar for all patients;</text>
        </paragraph>
        <paragraph num="(iii)">
          <text>Sexually transmitted disease (STD) testing for all patients;</text>
        </paragraph>
        <paragraph num="(iv)">
          <text>Pregnancy testing if indicated by physical examination or history, or both;</text>
        </paragraph>
        <paragraph num="(v)">
          <text>Rubella titer of all females without documentation of prior rubella immunization which may be done by documented referral to a known provider of this service;</text>
        </paragraph>
      </paragraph>
      <paragraph num="(d)">
        <text>Contraceptive methods and devices approved by the Federal Drug Administration, their insertion, filling, or removal, and education on proper use;</text>
      </paragraph>
      <paragraph num="(e)">
        <text>Rectal examination, if indicated;</text>
      </paragraph>
      <paragraph num="(f)">
        <text>Basic education regarding human sexuality and reproduction, for all patients;</text>
      </paragraph>
      <paragraph num="(g)">
        <text>Advice and counseling regarding all family planning methods, including natural family planning measures and sterilization procedures, the availability and effectiveness of methods, procedures involved in each method and untoward effects and potential complications of each method when performed according to §B of this regulation;</text>
      </paragraph>
      <paragraph num="(h)">
        <text>Sperm count and analysis done on premises or by appropriate documented referral;</text>
      </paragraph>
      <paragraph num="(i)">
        <text>Sterilizations, including vasectomy, when coded as family planning and when the appropriate forms, as established by Program guidelines, are properly completed and attached to the claim;</text>
      </paragraph>
      <paragraph num="(j)">
        <text>Post-vasectomy follow-up; and</text>
      </paragraph>
      <paragraph num="(k)">
        <text>Referral mechanism and documented referral for all patients demonstrating illness, disease, or pregnancy.</text>
      </paragraph>
    </paragraph>
  </paragraph>
  <paragraph num="D.">
    <text>Abortion Clinic Care.</text>
    <paragraph num="(1)">
      <text>To participate in the Program as an abortion clinic, the provider shall meet the requirements of Regulations .02 and .03 of this chapter and §B of this regulation and shall:</text>
      <paragraph num="(a)">
        <text>Meet all applicable state and local requirements for licensure and certification in the state or jurisdiction in which the clinic is located; and</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Ensure abortions are performed by a qualified provider and in compliance with all applicable Program regulations.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(2)">
      <text>Covered services shall include:</text>
      <paragraph num="(a)">
        <text>An abortion procedure for pregnancies which shall include a pelvic examination, and preoperative and postoperative care;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Laboratory tests to include pregnancy test, urinalysis for sugar and albumin, hemoglobin or hematocrit, or both, and Rh factor typing;</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Pap smear;</text>
      </paragraph>
      <paragraph num="(d)">
        <text>Anesthesia or sedatives or analgesics or any combination of these drugs;</text>
      </paragraph>
      <paragraph num="(e)">
        <text>Referral to family planning clinic for follow-up family planning;</text>
      </paragraph>
      <paragraph num="(f)">
        <text>Gross and microscopic tissue examination if there is any doubt in the proper identification of the extracted product of conception concerning composition or completeness; and</text>
      </paragraph>
      <paragraph num="(g)">
        <text>Obstetrical pelvic ultrasound.</text>
      </paragraph>
    </paragraph>
  </paragraph>
  <paragraph num="E.">
    <text>Rural Health Clinic Services.</text>
    <paragraph num="(1)">
      <text>To participate as a rural health center, the provider shall:</text>
      <paragraph num="(a)">
        <text>Meet the requirements of Regulations .03 and .05A of this chapter; and</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Be federally certified in accordance with 42 CFR Part 491, Subpart A.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(2)">
      <text>Covered services include rural health clinic services as defined in 42 CFR §440.20.</text>
    </paragraph>
    <paragraph num="(3)">
      <text>The provider shall follow the general rural health center rules and regulations in accordance with 42 CFR §405.2400—42 CFR §405.2417.</text>
    </paragraph>
  </paragraph>
</regulation>