Md. Code Regs. 10.67.06.20 - Benefits - EPSDT Services

A. An MCO shall provide, to enrollees younger than 21 years old, medically necessary Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) services, including:

(1) EPSDT comprehensive well-child services provided in accordance with the EPSDT periodicity schedule and performed by an EPSDT-certified provider, including:

(a) A comprehensive health and developmental history, including an evaluation of both physical and mental health development;

(b) A comprehensive unclothed physical exam;

(c) Immunizations appropriate to age and health history;

(d) Laboratory tests, including blood lead level assessment, as appropriate to age and risk;

(e) Health education, including anticipatory guidance; and

(f) Vision, hearing, and dental screening;

(2) EPSDT partial or interperiodic well-child services; and

(3) Health care services that are:

(a) Necessary to prevent, treat, or ameliorate physical, mental, or developmental problems or conditions identified by an EPSDT-certified provider or other health professional;

(b) Sufficient in amount, duration, and scope to treat the identified condition; and

(c) Subject to limitation only on the basis of medical necessity.

B. 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:

(1) Chiropractic services;

(2) Nutrition counseling services;

(3) Private duty nursing services including:

(a) An initial assessment and development of a plan of care by a registered nurse; and

(b) On-going private duty nursing services delivered by a licensed practical nurse or a registered nurse; and

(4) Durable medical equipment; and

C. 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:

(1) The Head Start Program;

(2) The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC);

(3) School Health-Related Special Education Services;

(4) Vocational Rehabilitation; and

(5) Maternal and Child Health Services located at local health departments.

Notes

Md. Code Regs. 10.67.06.20

Regulations .20 recodified from 10.09.67.20 effective 46:22 Md. R. 976, eff. 11/1/2019