Regulation .03 Nonbehavioral Health Fee-For-Service Benefits.
Regulation .03 Nonbehavioral Health Fee-For-Service Benefits.LinkCopy Citation
An MCO may not be required to provide any of the following benefits or services that are reimbursed directly by the Department:
A.
The remaining days of a hospital admission following enrollment in the MCO if the recipient was admitted to the hospital before the date of the recipient's enrollment;
B.
Long-term care services except for those outlined in COMAR 10.67.06.07B and COMAR 10.67.06.12A;
C.
Intermediate Care Facilities for Individuals with Intellectual Disabilities or Persons with Related Conditions (ICF/IID) services;
D.
Personal care services pursuant to COMAR 10.09.20;
E.
Medical day care services, for adults and children;
F.
The following HIV/AIDS services:
(1)
Genotypic, phenotypic, or other HIV/AIDS drug resistance testing used in the treatment of HIV/AIDS, if the service is:
(a)
Rendered by a Department-approved provider; and
(b)
Medically necessary; and
(2)
Viral load testing used in treatment of HIV/AIDS.
G.
Physical therapy, speech therapy, and occupational therapy services when:
(1)
The enrollee is younger than 21 years old; and
(2)
The services are not part of home health services or an inpatient hospital stay;
H.
Augmentative communication devices;
I.
All dental services including but not limited to outpatient surgery fees for the facility and general anesthesia.
J.
Except when a woman has been determined eligible for Medical Assistance benefits under COMAR 10.09.11, an abortion pursuant to COMAR 10.09.02.04G;
K.
Emergency transportation;
L.
Transportation services provided through grants to local governments pursuant to COMAR 10.09.19;
M.
Services provided to members participating in the State's Health Home Program as described in COMAR 10.09.33;
N.
Applied behavioral analysis (ABA) services as described in COMAR 10.09.28; and
O.
Abortions performed in accordance with Health-General Article, § 15-103, Annotated Code of Maryland.