<?xml version='1.0' encoding='utf-8'?>
<regulation prefix="Regulation" num=".05" citation="COMAR 10.09.94.05" title_num="10" subtitle_num="09" chapter_num="94" heading="Limitations.">
  <text>The Program does not cover:</text>
  <paragraph num="A.">
    <text>Investigational or experimental hospital services, procedures, or drugs;</text>
  </paragraph>
  <paragraph num="B.">
    <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="C.">
    <text>Outpatient visits intended to accomplish 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; or</text>
    </paragraph>
    <paragraph num="(4)">
      <text>Ascertaining the participant’s weight;</text>
    </paragraph>
  </paragraph>
  <paragraph num="D.">
    <text>Interpretation of laboratory tests or panels;</text>
  </paragraph>
  <paragraph num="E.">
    <text>Autopsies;</text>
  </paragraph>
  <paragraph num="F.">
    <text>Immunizations required for travel outside the continental United States;</text>
  </paragraph>
  <paragraph num="G.">
    <text>Leaves of absence beyond the period of the census check of the same day;</text>
  </paragraph>
  <paragraph num="H.">
    <text>Day care;</text>
  </paragraph>
  <paragraph num="I.">
    <text>Psychological evaluations and treatments except when:</text>
    <paragraph num="(1)">
      <text>Ordered by a physician, and the medical necessity is documented in the participant’s medical record; or</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Performed as mental health service, as part of the plan of treatment;</text>
    </paragraph>
  </paragraph>
  <paragraph num="J.">
    <text>Duplicated care or services;</text>
  </paragraph>
  <paragraph num="K.">
    <text>Elective admissions to hospitals outside of Maryland and the District of Columbia unless the Department or its designee determines that comparable services are not available in Maryland, except under certain conditions where child participants are in foster care, or are for other reasons placed outside the State and are covered under certain criteria, as determined by the Department or its designee;</text>
  </paragraph>
  <paragraph num="L.">
    <text>Inpatient and outpatient diagnostic services not specifically ordered by the attending physician or other responsible practitioner;</text>
  </paragraph>
  <paragraph num="M.">
    <text>Inpatient days or services provided in excess of the days approved by the Department or its designee;</text>
  </paragraph>
  <paragraph num="N.">
    <text>Hospital laboratory tests which are coverable under COMAR 10.09.09.04, if the specimen is not obtained in the hospital;</text>
  </paragraph>
  <paragraph num="O.">
    <text>Hospital services provided outside of the United States;</text>
  </paragraph>
  <paragraph num="P.">
    <text>The completion of forms and reports;</text>
  </paragraph>
  <paragraph num="Q.">
    <text>Broken or missed appointments;</text>
  </paragraph>
  <paragraph num="R.">
    <text>Professional services rendered by mail or telephone; or</text>
  </paragraph>
  <paragraph num="S.">
    <text>Telephones, televisions, or personal comfort items or services.</text>
  </paragraph>
</regulation>