Regulation .06 Limitations.
Regulation .06 Limitations.LinkCopy Citation
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.