Md. Code Regs. 10.67.08.03 - Nonbehavioral Health Fee-For-Service Benefits

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 10.67.67.07B and COMAR 10.67.67.12A;

C. Intermediate Care Facilities for Individuals with Intellectual Disabilities or Persons with Related Conditions (ICF/IID) services;

D. Personal care services pursuant to COMAR 10.67.20;

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 FflV/AIDS

(3) Antiretroviral drugs in American Hospital Formulary Service therapeutic class 8:18:08 used in the 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 10.67.11, an abortion pursuant to COMAR 10.67.02.04G;

K. Emergency transportation;

L. Transportation services provided through grants to local governments pursuant to COMAR 10.67.19;

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.

Notes

Md. Code Regs. 10.67.08.03

Regulations .03 recodified from 10.09.70.03 effective 46:22 Md. R. 976, eff. 11/1/2019; amended effective 47:10 Md. R. 515, eff. 5/18/2020; amended effective 51:12 Md. R. 620, eff. 6/24/2024; amended effective 52:6 Md. R. 268, eff. 3/31/2025.