<?xml version='1.0' encoding='utf-8'?>
<regulation prefix="Regulation" num=".05" citation="COMAR 10.09.76.05" title_num="10" subtitle_num="09" chapter_num="76" heading="Limitations.">
  <text>The Program does not cover the following:</text>
  <paragraph num="A.">
    <text>Services not specified in Regulation .04 of this chapter;</text>
  </paragraph>
  <paragraph num="B.">
    <text>Services not medically necessary;</text>
  </paragraph>
  <paragraph num="C.">
    <text>Investigational and experimental drugs and procedures;</text>
  </paragraph>
  <paragraph num="D.">
    <text>Basic school health services as defined in COMAR 13A.05.05.05.15;</text>
  </paragraph>
  <paragraph num="E.">
    <text>Nursing or other health services provided as part of a participant's individualized educational program (IEP) as defined in COMAR 10.09.50.01B or individualized family service plan (IFSP) as defined in COMAR 10.09.50.01B;</text>
  </paragraph>
  <paragraph num="F.">
    <text>Skilled nursing services provided to enable a participant to be safely maintained in the school setting such as:</text>
    <paragraph num="(1)">
      <text>Nasogastric tube feedings;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Catheterization;</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Oral, nasotracheal, or tracheal suctioning; and</text>
    </paragraph>
    <paragraph num="(4)">
      <text>Nebulizer treatments;</text>
    </paragraph>
  </paragraph>
  <paragraph num="G.">
    <text>School health services which are required in all school settings such as:</text>
    <paragraph num="(1)">
      <text>Hearing and vision screening unless completed as part of an EPSDT well-child check-up;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Routine assessment of minor injuries;</text>
    </paragraph>
    <paragraph num="(3)">
      <text>First aid;</text>
    </paragraph>
    <paragraph num="(4)">
      <text>Administration of medications including supervision of self-administered medications;</text>
    </paragraph>
    <paragraph num="(5)">
      <text>General health promotion counseling; and</text>
    </paragraph>
    <paragraph num="(6)">
      <text>Review of health records;</text>
    </paragraph>
  </paragraph>
  <paragraph num="H.">
    <text>Vaccines supplied by Vaccines for Children (VFC);</text>
  </paragraph>
  <paragraph num="I.">
    <text>Visits for the sole purpose of:</text>
    <paragraph num="(1)">
      <text>Administering medication;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Checking blood pressure;</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Measuring weight;</text>
    </paragraph>
    <paragraph num="(4)">
      <text>Interpreting lab results; or</text>
    </paragraph>
    <paragraph num="(5)">
      <text>Group or individual health education; and</text>
    </paragraph>
  </paragraph>
  <paragraph num="J.">
    <text>Services provided outside of the physical location of the approved SBHC, unless services are rendered via telehealth in accordance with COMAR 10.09.49 and any subregulatory guidance issued by the Department.</text>
  </paragraph>
</regulation>