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<regulation prefix="Regulation" num=".05" citation="COMAR 10.09.92.05" title_num="10" subtitle_num="09" chapter_num="92" heading="Limitations.">
  <text>The Program does not cover:</text>
  <paragraph num="A.">
    <text>Hospital services, procedures, drugs, or hospital admissions that are investigational or experimental;</text>
  </paragraph>
  <paragraph num="B.">
    <text>Hospital services denied by Medicare as not medically necessary;</text>
  </paragraph>
  <paragraph num="C.">
    <text>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;</text>
  </paragraph>
  <paragraph num="D.">
    <text>Elective inpatient admissions without preauthorization;</text>
  </paragraph>
  <paragraph num="E.">
    <text>Elective inpatient admissions from the emergency department for dialysis services that are the result of problems occurring with placement in a freestanding dialysis facility;</text>
  </paragraph>
  <paragraph num="F.">
    <text>Outpatient visits for one or more of the following:</text>
    <paragraph num="(1)">
      <text>Prescription drug or food supplement pick up;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Collection of specimens for laboratory procedures;</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Recording of an electrocardiogram;</text>
    </paragraph>
    <paragraph num="(4)">
      <text>Ascertaining the participant's weight; and</text>
    </paragraph>
    <paragraph num="(5)">
      <text>Administration of vaccines;</text>
    </paragraph>
  </paragraph>
  <paragraph num="G.">
    <text>Interpretation of laboratory tests or panels;</text>
  </paragraph>
  <paragraph num="H.">
    <text>Autopsies;</text>
  </paragraph>
  <paragraph num="I.">
    <text>Weight control medications;</text>
  </paragraph>
  <paragraph num="J.">
    <text>Care provided to a well newborn beyond the:</text>
    <paragraph num="(1)">
      <text>Length of the mother's stay for a normal obstetrical or uncomplicated caesarean section delivery; or</text>
    </paragraph>
    <paragraph num="(2)">
      <text>First 4 days of the newborn's life when the mother remains in the hospital due to other circumstances;</text>
    </paragraph>
  </paragraph>
  <paragraph num="K.">
    <text>Telephones, televisions, or personal comfort items or services;</text>
  </paragraph>
  <paragraph num="L.">
    <text>Duplicate care or services;</text>
  </paragraph>
  <paragraph num="M.">
    <text>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;</text>
  </paragraph>
  <paragraph num="N.">
    <text>Inpatient and outpatient diagnostic and laboratory services not ordered by the attending physician or other practitioner;</text>
  </paragraph>
  <paragraph num="O.">
    <text>Inpatient days provided in excess of the days approved by the Department or its designee;</text>
  </paragraph>
  <paragraph num="P.">
    <text>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;</text>
  </paragraph>
  <paragraph num="Q.">
    <text>Hospital services provided outside of the United States; and</text>
  </paragraph>
  <paragraph num="R.">
    <text>Ancillary services that are part of an observation stay beyond the initial 24 hours.</text>
  </paragraph>
</regulation>