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<regulation prefix="Regulation" num=".01" citation="COMAR 10.09.76.01" title_num="10" subtitle_num="09" chapter_num="76" heading="Definitions.">
  <paragraph num="A.">
    <text>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, the State agency designated to administer the Maryland Medical Assistance Program under Title XIX of the Social Security Act, 42 U.S.C. §1396 et seq.</text>
    </paragraph>
    <paragraph num="(2)">
      <text>“Early and periodic screening, diagnosis and treatment (EPSDT)” means the provision of preventive health care, including medical and dental services under 42 CFR §441.50 et seq., in order to assess growth and development and to detect and treat health problems in Medical Assistance eligible individuals younger than 21 years old.</text>
    </paragraph>
    <paragraph num="(3)">
      <text>“Federally qualified health center (FQHC)” means an entity that has entered into an agreement with the Centers for Medicare and Medicaid Services (CMS) to meet Medicare requirements under 42 CFR §405.2464 and in accordance with 42 CFR §405.2401(b).</text>
    </paragraph>
    <paragraph num="(4)">
      <text>“Managed care organization (MCO)” has the meaning stated in Health-General Article, §15-101, Annotated Code of Maryland.</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, or ameliorative treatment of an illness, injury, disability, or health condition;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Consistent with currently accepted standards of good medical practice, dental practice, or both;</text>
      </paragraph>
      <paragraph num="(c)">
        <text>The most cost efficient 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 et seq.</text>
    </paragraph>
    <paragraph num="(7)">
      <text>“Participant” means an individual who is certified as eligible for, and who is receiving, Medical Assistance benefits.</text>
    </paragraph>
    <paragraph num="(8)">
      <text>“Primary care provider (PCP)” means a practitioner who is the primary coordinator of care for the participant, and whose responsibility it is to provide accessible, continuous, comprehensive, and coordinated health care services covering the full range of benefits required by the Maryland Medical Assistance Program.</text>
    </paragraph>
    <paragraph num="(9)">
      <text>“Primary health services” means a basic level of health care, including diagnostic, treatment, consultative, referral, and preventive health services, generally rendered by:</text>
      <paragraph num="(a)">
        <text>General practitioners;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Family practitioners;</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Internists;</text>
      </paragraph>
      <paragraph num="(d)">
        <text>Obstetricians;</text>
      </paragraph>
      <paragraph num="(e)">
        <text>Gynecologists;</text>
      </paragraph>
      <paragraph num="(f)">
        <text>Pediatricians;</text>
      </paragraph>
      <paragraph num="(g)">
        <text>Physician assistants; and</text>
      </paragraph>
      <paragraph num="(h)">
        <text>Nurse practitioners.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(10)">
      <text>“Program” means the Maryland Medical Assistance Program.</text>
    </paragraph>
    <paragraph num="(11)">
      <text>“Provider” means a school-based health center which has been approved by the Department.</text>
    </paragraph>
    <paragraph num="(12)">
      <text>“School-based health center (SBHC)” means a health center that:</text>
      <paragraph num="(a)">
        <text>Is located on school grounds;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Provides on-site primary and preventive health care, referrals, and follow-up services;</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Could provide on-site dental care or behavioral health care, referrals, and follow-up services; and</text>
      </paragraph>
      <paragraph num="(d)">
        <text>Has been approved by the Maryland Department of Health.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(13)">
      <text>“Specialty behavioral health” means services specified in COMAR 10.09.59.06 and 10.09.80.05.</text>
    </paragraph>
  </paragraph>
</regulation>