Regulation .05 Limitations.

Hospital services, procedures, drugs, or hospital admissions that are investigational or experimental;

Hospital services denied by Medicare as not medically necessary;

Inpatient admissions or outpatient visits solely for the administration of injections, unless medical necessity and the participant's inability to take appropriate oral medications is documented in the participant's medical record;

Elective inpatient admissions without preauthorization;

Elective inpatient admissions from the emergency department for dialysis services that are the result of problems occurring with placement in a freestanding dialysis facility;

Outpatient visits for one or more of the following:

Interpretation of laboratory tests or panels;

Autopsies;

Weight control medications;

Care provided to a well newborn beyond the:

Telephones, televisions, or personal comfort items or services;

Duplicate care or services;

Elective admissions to hospitals outside of Maryland, except the District of Columbia, unless the Department or its designee determines that comparable services are not available in Maryland;

Inpatient and outpatient diagnostic and laboratory services not ordered by the attending physician or other practitioner;

Inpatient days provided in excess of the days approved by the Department or its designee;

Hospital laboratory tests which are coverable under COMAR 10.09.09, unless the specimen is obtained in the hospital for a participant receiving inpatient, outpatient, emergency department, or observation services;

Hospital services provided outside of the United States; and

Ancillary services that are part of an observation stay beyond the initial 24 hours.