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<regulation prefix="Regulation" num=".03" citation="COMAR 10.67.08.03" title_num="10" subtitle_num="67" chapter_num="08" heading="Nonbehavioral Health Fee-For-Service Benefits.">
  <text>An MCO may not be required to provide any of the following benefits or services that are reimbursed directly by the Department:</text>
  <paragraph num="A.">
    <text>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;</text>
  </paragraph>
  <paragraph num="B.">
    <text>Long-term care services except for those outlined in COMAR 10.67.06.07B and COMAR 10.67.06.12A;</text>
  </paragraph>
  <paragraph num="C.">
    <text>Intermediate Care Facilities for Individuals with Intellectual Disabilities or Persons with Related Conditions (ICF/IID) services;</text>
  </paragraph>
  <paragraph num="D.">
    <text>Personal care services pursuant to COMAR 10.09.20;</text>
  </paragraph>
  <paragraph num="E.">
    <text>Medical day care services, for adults and children;</text>
  </paragraph>
  <paragraph num="F.">
    <text>The following HIV/AIDS services:</text>
    <paragraph num="(1)">
      <text>Genotypic, phenotypic, or other HIV/AIDS drug resistance testing used in the treatment of HIV/AIDS, if the service is:</text>
      <paragraph num="(a)">
        <text>Rendered by a Department-approved provider; and</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Medically necessary; and</text>
      </paragraph>
    </paragraph>
    <paragraph num="(2)">
      <text>Viral load testing used in treatment of HIV/AIDS.</text>
    </paragraph>
  </paragraph>
  <paragraph num="G.">
    <text>Physical therapy, speech therapy, and occupational therapy services when:</text>
    <paragraph num="(1)">
      <text>The enrollee is younger than 21 years old; and</text>
    </paragraph>
    <paragraph num="(2)">
      <text>The services are not part of home health services or an inpatient hospital stay;</text>
    </paragraph>
  </paragraph>
  <paragraph num="H.">
    <text>Augmentative communication devices;</text>
  </paragraph>
  <paragraph num="I.">
    <text>All dental services including but not limited to outpatient surgery fees for the facility and general anesthesia.</text>
  </paragraph>
  <paragraph num="J.">
    <text>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;</text>
  </paragraph>
  <paragraph num="K.">
    <text>Emergency transportation;</text>
  </paragraph>
  <paragraph num="L.">
    <text>Transportation services provided through grants to local governments pursuant to COMAR 10.09.19;</text>
  </paragraph>
  <paragraph num="M.">
    <text>Services provided to members participating in the State's Health Home Program as described in COMAR 10.09.33;</text>
  </paragraph>
  <paragraph num="N.">
    <text>Applied behavioral analysis (ABA) services as described in COMAR 10.09.28; and</text>
  </paragraph>
  <paragraph num="O.">
    <text>Abortions performed in accordance with Health-General Article, § 15-103, Annotated Code of Maryland.</text>
  </paragraph>
</regulation>