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<regulation prefix="Regulation" num=".01" citation="COMAR 10.09.23.01" title_num="10" subtitle_num="09" chapter_num="23" 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>“American Academy of Pediatric Dentists” means the membership organization representing the specialty of pediatric dentistry.</text>
    </paragraph>
    <paragraph num="(2)">
      <text>“Department” means the Maryland Department of Health, the single State agency designated to administer the Maryland Medical Assistance Program or its designee.</text>
    </paragraph>
    <paragraph num="(3)">
      <text>“Early and Periodic Screening, Diagnosis, and Treatment (EPSDT)” means comprehensive and preventive health care pursuant to 42 CFR §441.50 et seq., as amended, and other diagnostic and treatment services that are necessary to correct or ameliorate defects and physical and mental illnesses in children younger than 21 years old.</text>
    </paragraph>
    <paragraph num="(4)">
      <text>“EPSDT periodicity schedule” means the State-specified listing of the minimum required and recommended preventive health screening services that are to be performed at specified ages.</text>
    </paragraph>
    <paragraph num="(5)">
      <text>“EPSDT screen” means the full scope of comprehensive well-child screening procedures, required by the State periodicity schedule that a participant receives at a given age.</text>
    </paragraph>
    <paragraph num="(6)">
      <text>“EPSDT screening provider” means a physician, nurse practitioner, or physician assistant certified by the Department to provide EPSDT screens.</text>
    </paragraph>
    <paragraph num="(7)">
      <text>“EPSDT treatment provider” means a health care provider that is enrolled to provide services that are not otherwise covered for individuals 21 years old or older.</text>
    </paragraph>
    <paragraph num="(8)">
      <text>“EPSDT treatment services” means health care services that are covered for children younger than 21 years old that are not otherwise covered for individuals 21 years old or older.</text>
    </paragraph>
    <paragraph num="(9)">
      <text>“Environmental lead investigation” means an inspection of the primary dwelling of a participant that results in a report characterizing the hazards associated with identified lead-containing substances.</text>
    </paragraph>
    <paragraph num="(10)">
      <text>Foster Care Child.</text>
      <paragraph num="(a)">
        <text>“Foster care child” means a participant who is in the care and custody of the Department of Human Services.</text>
      </paragraph>
      <paragraph num="(b)">
        <text>“Foster care child” includes children who receive kinship care.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(11)">
      <text>“Health care practitioner” means an individual who is licensed, certified, or otherwise authorized under Health Occupations Article, Annotated Code of Maryland, or under the laws of the District of Columbia or another state, to provide health care services.</text>
    </paragraph>
    <paragraph num="(12)">
      <text>“Health care service” has the meaning stated in Health-General Article, §19-132, Annotated Code of Maryland.</text>
    </paragraph>
    <paragraph num="(13)">
      <text>“Healthy Kids Program” means the unit within the Maryland Medical Assistance Program that develops guidelines for and monitors EPSDT well-child screening services and certifies EPSDT screening providers.</text>
    </paragraph>
    <paragraph num="(14)">
      <text>“Intermediate care facility” means a facility that provides a planned regimen of 24-hour professionally directed evaluation, observation, medical monitoring, and addiction treatment in an inpatient setting.</text>
    </paragraph>
    <paragraph num="(15)">
      <text>“Jurisdiction” means a state or the District of Columbia.</text>
    </paragraph>
    <paragraph num="(16)">
      <text>“Managed Care Organization (MCO)” has the meaning stated in Health-General Article, §15-101, Annotated Code of Maryland.</text>
    </paragraph>
    <paragraph num="(17)">
      <text>“Medical Assistance Program” has the meaning stated in COMAR 10.09.36.01.</text>
    </paragraph>
    <paragraph num="(18)">
      <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 consumer, family, or provider.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(19)">
      <text>“Participant” means a person younger than 21 years old who is determined eligible for, and is receiving, Medical Assistance benefits as provided in COMAR 10.09.11 or 10.09.24.</text>
    </paragraph>
    <paragraph num="(20)">
      <text>“Plan of treatment” means a written plan, updated at a minimum of every 6 months for ongoing care, to address identified problems to include:</text>
      <paragraph num="(a)">
        <text>Diagnoses;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Treatment goals;</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Frequency of visits;</text>
      </paragraph>
      <paragraph num="(d)">
        <text>Duration of treatment; and</text>
      </paragraph>
      <paragraph num="(e)">
        <text>Prognosis.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(21)">
      <text>“Preauthorization” means the approval required from the Department or its designee before services can be rendered.</text>
    </paragraph>
    <paragraph num="(22)">
      <text>“Preventive services” means primary health care designed to:</text>
      <paragraph num="(a)">
        <text>Promote normal growth and development; and</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Detect, ameliorate, or delay diseases at an early stage before complications or serious disabilities develop.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(23)">
      <text>“Program” means the Maryland Medical Assistance Program.</text>
    </paragraph>
    <paragraph num="(24)">
      <text>“Screening services” means the EPSDT preventive health care and laboratory procedures required at specified ages by the State periodicity schedule.</text>
    </paragraph>
    <paragraph num="(25)">
      <text>“Third-party payers” means insurers and other entities obligated either legally or contractually to pay for or to reimburse the participant for service covered in this chapter.</text>
    </paragraph>
    <paragraph num="(26)">
      <text>“Vaccines for Children Program” means the federal program that provides specific childhood vaccines to health care providers, at no cost, for administration to participants younger than 19 years old.</text>
    </paragraph>
  </paragraph>
</regulation>