<?xml version='1.0' encoding='utf-8'?>
<regulation prefix="Regulation" num=".04" citation="COMAR 10.09.94.04" title_num="10" subtitle_num="09" chapter_num="94" heading="Covered Services.">
  <paragraph num="A.">
    <text>The Program covers the following inpatient services at special pediatric hospitals:</text>
    <paragraph num="(1)">
      <text>A hospital admission determined to be medically necessary for a participant who is stable enough for transfer to a post-acute setting and requires medical or rehabilitative services that:</text>
      <paragraph num="(a)">
        <text>Cannot be provided at a lower level of care; and</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Meets the medical eligibility criteria under Regulation .06 of this chapter;</text>
      </paragraph>
    </paragraph>
    <paragraph num="(2)">
      <text>Administrative days for the length of time certified by the Department or its designee;</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Inpatient admissions for intensive occupational therapy, physical therapy, or speech therapy on a regimen which is less than 3 hours per day, 5 days per week, when these services are provided in a unit that is accredited by the Commission on Accreditation of Rehabilitation Facilities to provide rehabilitation services; and</text>
    </paragraph>
    <paragraph num="(4)">
      <text>Ancillary services.</text>
    </paragraph>
  </paragraph>
  <paragraph num="B.">
    <text>The Program covers the following outpatient hospital services:</text>
    <paragraph num="(1)">
      <text>Medically necessary services for the provision of diagnostic, curative, palliative, or rehabilitative treatment; and</text>
    </paragraph>
    <paragraph num="(2)">
      <text>For a participant younger than 21 years old, physical therapy, occupational therapy, speech therapy, and audiology services if:</text>
      <paragraph num="(a)">
        <text>The therapy provider develops a written plan of treatment in collaboration with the participant’s primary care physician and the participant or the parent or guardian of the participant;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>The service is provided according to the plan of treatment; and</text>
      </paragraph>
      <paragraph num="(c)">
        <text>The services provider sends an update of the plan of treatment to the participant’s primary care physician every 90 days.</text>
      </paragraph>
    </paragraph>
  </paragraph>
</regulation>