Md. Code Regs. 10.09.08.04

Current through Register Vol. 51, No. 22, November 1, 2024

Section 10.09.08.04 - Covered Services

A. The Program covers the services listed in §§B-E of this regulation according to the conditions and requirements indicated.

B. Medically Necessary Services. The program covers medically necessary services as described in §§C, D, and E of this regulation and in Regulation .05 of this chapter, rendered to participants by a freestanding clinic, when these services are performed by a physician or by:

(1) A registered nurse, a psychologist, or a social worker, provided that the individual performs the service within the scope of the individual's license or certification for the purpose of assisting in the provision of physicians' services;

(2) A nurse midwife, a nurse practitioner, a licensed practical nurse, or a registered physician's assistant, provided that the individual performs the services within the scope of the individual's license or certification; or

(3) An addictions counselor who meets the requirements in accordance with COMAR 10.58.07.

C. Family Planning Clinic Services.

(1) To participate in the Program as a family planning clinic, a provider shall meet the requirements of Regulation .03 of this chapter and §§B and C(2) of this regulation and shall:

(a) Participate in the Title X: National Family Planning Program; or

(b) Provide documented evidence of adherence to and compliance with standards established for family planning by the State of Maryland, Planned Parenthood, or the American College of Obstetricians and Gynecologists.

(2) Covered services include:

(a) Complete initial and annual physical examination including auscultation of heart and lungs for all patients;

(b) Pelvic examination, including bimanual and speculum, and Pap smears on all females annually, unless clinical indication for more frequent examination exists;

(c) Laboratory tests including, but not limited to:

(i) Hemoglobin or hematocrit, or both, for all patients;

(ii) Urinalysis for albumin sugar for all patients;

(iii) Sexually transmitted disease (STD) testing for all patients;

(iv) Pregnancy testing if indicated by physical examination or history, or both;

(v) Rubella titer of all females without documentation of prior rubella immunization which may be done by documented referral to a known provider of this service;

(d) Contraceptive methods and devices approved by the Federal Drug Administration, their insertion, filling, or removal, and education on proper use;

(e) Rectal examination, if indicated;

(f) Basic education regarding human sexuality and reproduction, for all patients;

(g) Advice and counseling regarding all family planning methods, including natural family planning measures and sterilization procedures, the availability and effectiveness of methods, procedures involved in each method and untoward effects and potential complications of each method when performed according to §B of this regulation;

(h) Sperm count and analysis done on premises or by appropriate documented referral;

(i) Sterilizations, including vasectomy, when coded as family planning and when the appropriate forms, as established by Program guidelines, are properly completed and attached to the claim;

(j) Post-vasectomy follow-up; and

(k) Referral mechanism and documented referral for all patients demonstrating illness, disease, or pregnancy.

D. Abortion Clinic Care.

(1) To participate in the Program as an abortion clinic, the provider shall meet the requirements of Regulations .02 and .03 of this chapter and §B of this regulation and shall:

(a) Meet all applicable state and local requirements for licensure and certification in the state or jurisdiction in which the clinic is located; and

(b) Ensure abortions are performed by a qualified provider and in compliance with all applicable Program regulations.

(2) Covered services shall include:

(a) An abortion procedure for pregnancies which shall include a pelvic examination, and preoperative and postoperative care;

(b) Laboratory tests to include pregnancy test, urinalysis for sugar and albumin, hemoglobin or hematocrit, or both, and Rh factor typing;

(c) Pap smear;

(d) Anesthesia or sedatives or analgesics or any combination of these drugs;

(e) Referral to family planning clinic for follow-up family planning;

(f) Gross and microscopic tissue examination if there is any doubt in the proper identification of the extracted product of conception concerning composition or completeness; and

(g) Obstetrical pelvic ultrasound.

E. Rural Health Clinic Services.

(1) To participate as a rural health center, the provider shall:

(a) Meet the requirements of Regulations .03 and .05A of this chapter; and

(b) Be federally certified in accordance with 42 CFR Part 491, Subpart A.

(2) Covered services include rural health clinic services as defined in 42 CFR § 440.20.

(3) The provider shall follow the general rural health center rules and regulations in accordance with 42 CFR § 405.2400 - 42 CFR § 405.2417.

Md. Code Regs. 10.09.08.04

Regulations .04A amended effective November 23, 1981 (8:23 Md. R. 1856)
Regulations .04 repealed effective October 1, 1985 (12:19 Md. R. 1849)
Regulations .04 adopted effective October 1, 1985 (12:19 Md. R. 1849)
Regulation .04 amended effective February 6, 1989 (16:2 Md. R. 159)
Regulation .04A amended effective May 28, 1990 (17:10 Md. R. 1219)
Regulation .04B amended as an emergency provision effective July 1, 1986 (13:13 Md. R. 1473); adopted permanently effective December 1, 1986 (13:19 Md. R. 2120)
Regulation .04E amended as an emergency provision effective November 1, 1985 (12:23 Md. R. 2214); adopted permanently effective May 6, 1986 (13:3 Md. R. 271)
Regulation .04E amended as an emergency provision effective September 2, 1986 (13:22 Md. R. 2394); emergency status extended to April 5, 1987 (14:4 Md. R. 412)
Regulation .04E amended effective April 6, 1987 (14:7 Md. R. 830); July 1, 1987 (14:13 Md. R. 1473)
Regulation .04F amended effective January 1, 1989 (15:26 Md. R. 2983)
Regulation .04G amended as an emergency provision effective October 1, 1986 (13:22 Md. R. 2393); adopted permanently effective February 9, 1987 (14:2 Md. R. 129)
Regulation .04G amended effective May 28, 1990 (17:10 Md. R. 1219)
Regulation .04 amended effective August 1, 1994 (21:15 Md. R. 1305)
Regulation .04B amended effective February 17, 2003 (30:3 Md. R. 179); March 5, 2012 (39:4 Md. R. 336)
Regulation .04D amended effective April 5, 2010 (37:7 Md. R. 570)
Regulation .04E amended as an emergency provision effective April 1, 1992 (19:7 Md. R. 741); amended permanently effective July 1, 1992 (19:12 Md. R. 1135)
Regulation .04E amended as an emergency provision effective July 15, 1992 (19:16 Md. R. 1468); amended permanently effective December 1, 1992 (19:23 Md. R. 2041)
Regulation .04E amended effective December 19, 1994 (21:25 Md. R. 2105)
Regulation .04B amended effective March 5, 2012 (39:4 Md. R. 336)
Regulation .04 adopted effective 42:6 Md. R. 512, eff.4/1/2015; amended effective 44:8 Md. R. 404, eff. 4/24/2017; amended effective 50:20 Md. R. 886, eff. 10/16/2023