<?xml version='1.0' encoding='utf-8'?>
<regulation prefix="Regulation" num=".06" citation="COMAR 10.09.16.06" title_num="10" subtitle_num="09" chapter_num="16" heading="Limitations.">
  <paragraph num="A.">
    <text>The Program does not cover the following:</text>
    <paragraph num="(1)">
      <text>Services not delivered in compliance with Regulation .05 of this chapter;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Services not medically necessary;</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Investigational or experimental drugs and procedures;</text>
    </paragraph>
    <paragraph num="(4)">
      <text>Services solely for the purpose of:</text>
      <paragraph num="(a)">
        <text>Prescribing medication;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Administering medication;</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Drug or supply pick-up;</text>
      </paragraph>
      <paragraph num="(d)">
        <text>Collecting laboratory specimens;</text>
      </paragraph>
      <paragraph num="(e)">
        <text>Interpreting laboratory tests or panels; or</text>
      </paragraph>
      <paragraph num="(f)">
        <text>Administering injections;</text>
      </paragraph>
    </paragraph>
    <paragraph num="(5)">
      <text>Separate reimbursement to an employee of a program for services that have been provided by and reimbursed directly to a program;</text>
    </paragraph>
    <paragraph num="(6)">
      <text>Services provided to or for the primary benefit of individuals other than the participant;</text>
    </paragraph>
    <paragraph num="(7)">
      <text>Mobile crisis team services rendered by telehealth with the exception of those specified as permissible via telehealth in Regulation .05 of this chapter;</text>
    </paragraph>
    <paragraph num="(8)">
      <text>Behavioral health crisis stabilization center services rendered by telehealth with the exception of those specified in COMAR 10.63.03.21;</text>
    </paragraph>
    <paragraph num="(9)">
      <text>Services provided to participants in a hospital inpatient setting; and</text>
    </paragraph>
    <paragraph num="(10)">
      <text>Services rendered but not appropriately documented.</text>
    </paragraph>
  </paragraph>
  <paragraph num="B.">
    <text>Providers may not be reimbursed by the Program for:</text>
    <paragraph num="(1)">
      <text>Behavioral health crisis stabilization center services exceeding 23 hours 59 minutes;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Presumptive and definitive drug testing when billed by a behavioral health crisis stabilization center; or</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Transportation costs.</text>
    </paragraph>
  </paragraph>
</regulation>