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<regulation prefix="Regulation" num=".04" citation="COMAR 10.09.92.04" title_num="10" subtitle_num="09" chapter_num="92" heading="Covered Services.">
  <paragraph num="A.">
    <text>The Program covers the services listed in §B of this regulation according to the conditions and requirements indicated.</text>
  </paragraph>
  <paragraph num="B.">
    <text>The Program covers the following hospital services:</text>
    <paragraph num="(1)">
      <text>Medically necessary emergency services as defined in COMAR 10.09.36.01, including triage, related ancillary services, and when necessary, observation stays of a participant who presents to a hospital emergency department;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Medically necessary services performed in an outpatient department of a hospital;</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Medically necessary services performed at a freestanding medical facility;</text>
    </paragraph>
    <paragraph num="(4)">
      <text>Medically necessary inpatient hospital services meeting the following criteria:</text>
      <paragraph num="(a)">
        <text>Inpatient days, including preoperative days, determined to be medically necessary by the Department or its designee;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Admissions from an emergency department resulting in a medically necessary inpatient stay; and</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Elective admissions that the Department or its designee determines to be medically necessary;</text>
      </paragraph>
    </paragraph>
    <paragraph num="(5)">
      <text>Inpatient stays determined to be medically necessary due to an emergent condition by the Department or its designee for a nonqualified alien;</text>
    </paragraph>
    <paragraph num="(6)">
      <text>Administrative days, which may include select ancillary services, determined to be necessary by the Department or its designee; and</text>
    </paragraph>
    <paragraph num="(7)">
      <text>Medically necessary services performed in an acute rehabilitation hospital when the participant meets the following criteria at the time of admission:</text>
      <paragraph num="(a)">
        <text>Requires active and ongoing therapeutic intervention of multiple therapy disciplines, one of which shall be physical or occupational therapy;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Requires and can reasonably be expected to actively participate in, and benefit from, the therapy, which generally consists of:</text>
        <paragraph num="(i)">
          <text>At least 3 hours of therapy a day, at least 5 days a week; or</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>In well-documented cases, at least 15 hours of intensive rehabilitation therapy within a 7 day consecutive period;</text>
        </paragraph>
      </paragraph>
      <paragraph num="(c)">
        <text>Is sufficiently stable to be able to actively participate in the therapy program; and</text>
      </paragraph>
      <paragraph num="(d)">
        <text>Requires supervision by a licensed physician, who has specialized training and experience in inpatient rehabilitation, which includes:</text>
        <paragraph num="(i)">
          <text>Conducting face-to-face visits with the patient at least 3 days a week to assess the patient both medically and functionally; and</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>Modifying the course of treatment as needed to maximize the participant's capacity to benefit from the rehabilitation process.</text>
        </paragraph>
      </paragraph>
    </paragraph>
  </paragraph>
  <paragraph num="C.">
    <text>The coverage of ancillary services during administrative days as described under §B(6) of this regulation applies to special pediatric hospitals under COMAR 10.09.94.</text>
  </paragraph>
</regulation>