<?xml version='1.0' encoding='utf-8'?>
<regulation prefix="Regulation" num=".20" citation="COMAR 10.67.06.20" title_num="10" subtitle_num="67" chapter_num="06" heading="Benefits — EPSDT Services.">
  <paragraph num="A.">
    <text>An MCO shall provide, to enrollees younger than 21 years old, medically necessary Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) services, including:</text>
    <paragraph num="(1)">
      <text>EPSDT comprehensive well-child services provided in accordance with the EPSDT periodicity schedule and performed by an EPSDT-certified provider, including:</text>
      <paragraph num="(a)">
        <text>A comprehensive health and developmental history, including an evaluation of both physical and mental health development;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>A comprehensive unclothed physical exam;</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Immunizations appropriate to age and health history;</text>
      </paragraph>
      <paragraph num="(d)">
        <text>Laboratory tests, including blood lead level assessment, as appropriate to age and risk;</text>
      </paragraph>
      <paragraph num="(e)">
        <text>Health education, including anticipatory guidance; and</text>
      </paragraph>
      <paragraph num="(f)">
        <text>Vision, hearing, and dental screening;</text>
      </paragraph>
    </paragraph>
    <paragraph num="(2)">
      <text>EPSDT partial or interperiodic well-child services; and</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Health care services that are:</text>
      <paragraph num="(a)">
        <text>Necessary to prevent, treat, or ameliorate physical, mental, or developmental problems or conditions identified by an EPSDT-certified provider or other health professional;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Sufficient in amount, duration, and scope to treat the identified condition; and</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Subject to limitation only on the basis of medical necessity.</text>
      </paragraph>
    </paragraph>
  </paragraph>
  <paragraph num="B.">
    <text>The health care services described in §A(3) of this regulation shall include, at a minimum, all services described in this chapter, and the following:</text>
    <paragraph num="(1)">
      <text>Chiropractic services;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Nutrition counseling services;</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Private duty nursing services including:</text>
      <paragraph num="(a)">
        <text>An initial assessment and development of a plan of care by a registered nurse; and</text>
      </paragraph>
      <paragraph num="(b)">
        <text>On-going private duty nursing services delivered by a licensed practical nurse or a registered nurse; and</text>
      </paragraph>
    </paragraph>
    <paragraph num="(4)">
      <text>Durable medical equipment.</text>
    </paragraph>
  </paragraph>
  <paragraph num="C.">
    <text>An MCO shall provide referrals for services not covered by Medicaid, but which are furnished at little or no cost to recipients, including appropriate referrals to:</text>
    <paragraph num="(1)">
      <text>The Head Start Program;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC);</text>
    </paragraph>
    <paragraph num="(3)">
      <text>School Health-Related Special Education Services;</text>
    </paragraph>
    <paragraph num="(4)">
      <text>Vocational Rehabilitation; and</text>
    </paragraph>
    <paragraph num="(5)">
      <text>Maternal and Child Health Services located at local health departments.</text>
    </paragraph>
  </paragraph>
</regulation>