Regulation .06 Covered Services.
Regulation .06 Covered Services.LinkCopy Citation
A.
The ASO shall reimburse the following specialty mental health services rendered to participants when authorized by the ASO:
(1)
Medically necessary specialty mental health services delivered by providers listed in Regulation .04 of this chapter, for which the primary diagnosis is listed in COMAR 10.67.08.02M or N;
(2)
Telehealth services as defined in COMAR 10.09.49 when rendered in accordance with limitations in Regulation .07 of this chapter; and
(3)
Presumptive drug tests and definitive drug tests, when ordered by a specialty mental health provider, with a behavioral health primary diagnosis listed in COMAR 10.67.08.02M or N on the claim.
B.
Specialty mental health services billed by local school systems are covered under the following conditions:
(1)
The services are not furnished as part of an individualized education program or individualized family service plan) as defined in COMAR 10.09.50.01; and
(2)
The services are rendered by a school psychologist or school social worker that meets the qualifications described in COMAR 10.09.50.02.