# COMAR Title 10 — Maryland Department of Health

## Subtitle 11 — Maternal and Child Health

### Chapter 03 — Children's Medical Services Program

#### Regulation .03 Covered Services.

*COMAR 10.11.03.03*

A. The CMS Program shall authorize covered services when a CMP has been approved.

B. The CMP shall:

  (1) Include:

    (a) All diagnoses or suspected diagnoses;

    (b) Service requested or provided;

    (c) Specific reason for the service request;

    (d) Evaluation or treatment findings;

    (e) Follow-up plans related to the service provided by the CMS Program;

    (f) Source of primary health care; and

  (2) Be reviewed and approved by the CMS Program.

C. The CMS Program may request further information from the provider in order to:

  (1) Support the information required in §B(1) of this regulation;

  (2) Assure that all services are coordinated with other services the child is receiving through the CMS Program or other programs; and

  (3) Assure that the needs of the family are addressed in relation to meeting the medical and developmental needs of the child.

D. CMS Program eligible services shall include:

  (1) Specialty clinics;

  (2) Private office care including, but not limited to, the following:

    (a) Allergy/Immunology;

    (b) Audiology and hearing;

    (c) Cardiology;

    (d) Craniofacial;

    (e) Cystic fibrosis;

    (f) Developmental pediatrics;

    (g) Endocrine;

    (h) Gastroenterology;

    (i) Genetics;

    (j) Hematology;

    (k) Infectious disease;

    (l) Nephrology;

    (m) Neurology;

    (n) Neurosurgery;

    (o) Oncology;

    (p) Ophthalmology, optometry, and vision;

    (q) Orthopedics;

    (r) Otolaryngology;

    (s) Physical medicine;

    (t) Plastic surgery;

    (u) Pulmonology;

    (v) Rheumatology;

    (w) Speech-language pathology;

    (x) Surgery; and

    (y) Urology.

  (3) Primary physician care arranged at the discretion of the CMS Program to assure access for needed specialty diagnostic evaluation, treatment, and care coordination services;

  (4) Inpatient hospital care services, which are provided by Medical Assistance affiliated hospitals; and

  (5) Professional evaluation and treatment services, which may include, but are not limited to, the following:

    (a) Audiology;

    (b) Family training and counseling regarding medical and rehabilitation needs;

    (c) Genetic counseling;

    (d) Nursing;

    (e) Nutrition;

    (f) Occupational therapy;

    (g) Physical therapy; or

    (h) Speech-language pathology.

E. Specialized activities to facilitate a special treatment program may include, but are not limited to, the following:

  (1) Equipment to provide:

    (a) Life support;

    (b) Mobility;

    (c) Stimulation; and

    (d) Aid in activities of daily living;

  (2) Orthoses to correct or prevent orthopedic disabilities, including prescription shoes and their modifications;

  (3) Prostheses to replace a missing part or to enhance the applicant's functional performance;

  (4) Formula and medication to correct metabolic and physiologic errors;

  (5) Supplies of durable and disposable items to facilitate management of specific disorders;

  (6) Approved therapies involving specific treatment as authorized by appropriate CMS Program professional staff to cure functional deficiencies;

  (7) Life sustaining medications;

  (8) Dental services provided for children with disabling conditions; and

  (9) Hearing aids and augmentative devices to improve communication.