Md. Code Regs. 10.09.95.04 - Covered Services

A. The Program covers the following inpatient special psychiatric hospital services:

(1) Medically necessary services for the number of days, per admission, including days certified by the Department or its designee;

(2) Medically necessary mental health services authorized in accordance with COMAR 10.09.59.08 and as set forth in Regulation .05B(4) of this chapter;

(3) Medically necessary services when these services are:

(a) Necessary for the provision of diagnostic, curative, palliative, or rehabilitative treatment; and

(b) Described in the participant's medical record in sufficient detail to support the invoices submitted for services.

(4) Administrative days for the length of time certified by the Department or its designee;

(5) Leaves of absence for therapeutic reasons or extenuating circumstances up to 12 hours per day, if the participant returns the same day, before the census check; and

(6) Observation services. B. The Program covers partial hospitalization when the hospital has:

(1) Written approval from the Office of Licensing and Certification Programs to be a provider of partial hospitalization in accordance with COMAR 10.21.02;

(2) A certificate of need from the Maryland Health Resources Planning Commission, if required, to be a provider of partial hospitalization; and

(3) Obtained preauthorization in accordance with COMAR 10.09.59.08.

Notes

Md. Code Regs. 10.09.95.04

Regulation .04 adopted effective 44:7 Md. R. 354, eff. 4/10/2017