Current through Register Vol. 51, No. 25, December 13, 2024
Section 10.67.06.20 - Benefits - EPSDT ServicesA. 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; andC. 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.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