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<regulation prefix="Regulation" num=".01" citation="COMAR 10.09.17.01" title_num="10" subtitle_num="09" chapter_num="17" heading="Definitions.">
  <paragraph num="A.">
    <text>In this chapter, the following terms have the meanings indicated.</text>
  </paragraph>
  <paragraph num="B.">
    <text>Terms Defined.</text>
    <paragraph num="(1)">
      <text>“Department” means the Maryland Department of Health, which is the single State agency designated to administer the Maryland Medical Assistance Program pursuant to Title XIX of the Social Security Act, 42 U.S.C. §1396 et seq.</text>
    </paragraph>
    <paragraph num="(2)">
      <text>“Direct supervision” means that a licensed physical therapist is personally present and immediately available within the same treatment area as the physical therapy assistant to give aid, direction, and instruction when physical therapy procedures or activities are performed.</text>
    </paragraph>
    <paragraph num="(3)">
      <text>“Initial evaluation” means the determination of the participant's condition by taking a case history and the administration of appropriate tests on the first visit. Treatment provided at this visit is considered to be part of the initial evaluation.</text>
    </paragraph>
    <paragraph num="(4)">
      <text>“Medical Assistance Program” means the program of comprehensive medical and other health related care for indigent and medically indigent individuals, jointly financed by the federal and state governments and administered by states under Title XIX of the Social Security Act, 42 U.S.C. §1396 et seq., as amended.</text>
    </paragraph>
    <paragraph num="(5)">
      <text>“Medically necessary” means that the service or benefit is:</text>
      <paragraph num="(a)">
        <text>Directly related to diagnostic, preventive, curative, palliative, rehabilitative, or ameliorative treatment of an illness, injury, disability, or health condition;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Consistent with current accepted standards of good medical practice;</text>
      </paragraph>
      <paragraph num="(c)">
        <text>The most cost efficient service that can be provided without sacrificing effectiveness or access to care; and</text>
      </paragraph>
      <paragraph num="(d)">
        <text>Not primarily for the convenience of the participant, family, or provider.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(6)">
      <text>“Medicare” means the insurance program administered by the federal government under Title XVIII of the Social Security Act, 42 U.S.C. §§1395—1395ccc.</text>
    </paragraph>
    <paragraph num="(7)">
      <text>“Participant” means an individual who is certified as eligible for, and is receiving, Medical Assistance benefits.</text>
    </paragraph>
    <paragraph num="(8)">
      <text>“Patient” means a person awaiting or undergoing health care or treatment.</text>
    </paragraph>
    <paragraph num="(9)">
      <text>“Physical therapist” means an individual licensed by the Maryland Board of Physical Therapy Examiners or similarly licensed or certified by the appropriate licensing body in the state or jurisdiction in which the service is provided and within the scope of Health Occupations Article, Title 13, Annotated Code of Maryland, or within the scope established by the jurisdiction of the provided service.</text>
    </paragraph>
    <paragraph num="(10)">
      <text>“Physical therapist assistant” means an individual licensed as a physical therapy assistant, working under the direct supervision of a licensed physical therapist, and performing limited physical therapy procedures that are assigned by a licensed physical therapist within the scope of Health Occupations Article, Title 13, Annotated Code of Maryland, or who is otherwise similarly licensed or certified by the appropriate licensing body in the state or jurisdiction where the service is provided and performing therapy procedures within the scope established by the state or jurisdiction of license or certification.</text>
    </paragraph>
    <paragraph num="(11)">
      <text>“Physical therapy aide” means a nonlicensed person in the employ of a physical therapist.</text>
    </paragraph>
    <paragraph num="(12)">
      <text>“Physician” means an individual licensed to practice medicine by the state in which the physician's practice is located.</text>
    </paragraph>
    <paragraph num="(13)">
      <text>“Plan of care” means the plan of treatment aimed at achieving the anticipated functional goals.</text>
    </paragraph>
    <paragraph num="(14)">
      <text>“Prescriber” means a physician, doctor of dental surgery or of dental medicine, physician assistant, nurse practitioner, nurse midwife, or podiatrist licensed to prescribe physical therapy.</text>
    </paragraph>
    <paragraph num="(15)">
      <text>“Program” means the Medical Assistance Program.</text>
    </paragraph>
    <paragraph num="(16)">
      <text>“Progress” means the measurable improvement as related to goals.</text>
    </paragraph>
    <paragraph num="(17)">
      <text>“Provider” means an individual, association, partnership, corporation, or unincorporated group licensed or similarly licensed or certified to provide health care services for participants and who, through appropriate agreement with the Department, has been identified as a Program provider by the issuance of an individual account number.</text>
    </paragraph>
    <paragraph num="(18)">
      <text>“Treatment order” means a written prescription for physical therapy signed by a physician, doctor of dental surgery or of dental medicine, physician assistant, nurse practitioner, nurse midwife, or podiatrist.</text>
    </paragraph>
  </paragraph>
</regulation>