Chapter 58. Family Planning Program

“Advanced practice nurse” means an individual who meets the requirements in COMAR 10.09.01.

“Department” means the Maryland Department of Health as defined in COMAR 10.09.36.01.

“Early and Periodic Screening, Diagnostic and Treatment (EPSDT)” means the provision to individuals younger than 21 years old, of preventative health care under 42CFR §441.50 et seq. as amended, and other health care services, diagnostic services, and treatment services that are necessary to correct or ameliorate defects and physical and mental illnesses and conditions discovered by EPSDT screening services.

“Family planning” means providing individuals with the information and means to prevent unwanted pregnancy and maintain reproductive health.

“Free-standing clinic” means a health care facility that is not licensed as a hospital, part of a hospital, or nursing home, and is not administratively part of a physician's, dentist's, or osteopath's office, but which has a separate staff functioning under the direction of a clinic administrator or health officer and is organized and operated to provide ambulatory health services.

“Hospital” means an institution that is licensed pursuant to COMAR 10.07.01, or other applicable standards established by the state in which the service is provided.

“Local health department (LHD)” means the Baltimore City Health Department and its subgrantees, or a county health department and its subgrantees.

“Medical Assistance Program” has the meaning stated in COMAR 10.09.36.01.

“Medical laboratory” means a licensed or certified facility, place, establishment, or institution, operated for the examination of material derived from the human body, by means of one or more of the scientific disciplines, for the purpose of obtaining scientific data that may be used to determine the presence, source, progress, or identity of disease agents, and to aid in the prevention, diagnosis, treatment, and management of human disease.

“Medically necessary” has the meaning stated in COMAR 10.09.36.01.

“Medicare” means the insurance program administered by the federal government under Title XVIII of the Social Security Act, 42 U.S.C. §1395 et seq.

“Participant” means an individual who is certified as eligible for the Family Planning Program as described in COMAR 10.09.37.

“Pharmacy” means an establishment or institution requiring a permit in accordance with Health Occupations Article, Title 12, Annotated Code of Maryland, or similar establishment or institution which is legally authorized to dispense legend drugs to the public in the state in which the establishment or institution is located.

“Physician” means an individual licensed to practice medicine in the state in which the physician's practice is located.

“Physician assistant” means an individual who meets the requirements in COMAR 10.09.55.

“Physician office and other point-of-care laboratory” means a medical laboratory at a site or facility operated as a part of, or in association with, the medical practice of licensed medical practitioners permitted to perform clinical laboratory procedures, community health center, emergency treatment center, health maintenance organization, or county or local health department, where clinical laboratory procedures are performed for patients seen by the practitioner or a practitioner employed or otherwise engaged by one of these entities.

“Program” means the Maryland Medical Assistance, Family Planning Program.

“Provider” means a health care provider who:

In Maryland or out-of-State with representation or specimen pick-up in Maryland, comply with the requirements of Health-General Article, §§17-202, 17-212, and 17-214.1, Annotated Code of Maryland, and COMAR 10.10.01; or

Out-of-State without representation or specimen pick-up in Maryland, comply with other applicable standards established by the state and locality in which the services are provided.

Department pursuant to Health Occupations Article, Title 12, Annotated Code of Maryland; or

Appropriate agency in the state in which the pharmacy is located.

In Maryland, comply with the requirements of Health-General Article, Title 17, Subtitles 2 and 3, Annotated Code of Maryland, and COMAR 10.10.06; or

Out-of-State, comply with other applicable standards established by the state and locality in which the services are provided.

A physician;

An advance practice nurse; or

A physician assistant.

Focused history, physical exam, and laboratory testing necessary to evaluate and manage the participant’s choice of chemical, mechanical, or other method to prevent conception;

Basic education regarding human sexuality and reproduction;

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, and untoward effects and potential complications of each method; and

Referral mechanism and documented referral for all patients demonstrating illness, disease, or pregnancy;

Hemoglobin or hematocrit, or both;

Urinalysis for albumin sugar;

Urine culture and sensitivity studies;

Appropriate laboratory tests to screen for sexually transmitted infections;

Smear wet mount and KOH with interpretation;

Rubella titer of females without documentation of prior rubella immunization; and

Pap smear;

To prevent conception through chemical, mechanical, or other methods, which are covered by the Maryland Medical Assistance Program under COMAR 10.09.03.04; and

To treat sexually transmitted infections when diagnosed during the course of an office visit, as outlined in §A of this regulation, which are covered under COMAR 10.09.03.04 except treatment for:

Properly completed; and

Available in the medical record for review;

Services not medically necessary;

Transportation services;

EPSDT services;

Services delivered in an in-patient hospital setting or ambulatory surgical center other than:

Infertility services, including reversal of sterilization; and

Any service not listed in Regulation .05 of this chapter.