The Program does not cover:

1. A. Hospital services, procedures, drugs, or hospital admissions that are investigational or experimental;
2. B. Hospital services denied by Medicare as not medically necessary;
3. C. Inpatient admissions or outpatient visits solely for the administration of injections, unless medical necessity and the participant's inability to take appropriate oral medications is documented in the participant's medical record;
4. D. Elective inpatient admissions without preauthorization;
5. E. Elective inpatient admissions from the emergency department for dialysis services that are the result of problems occurring with placement in a freestanding dialysis facility;

6. F. Outpatient visits for one or more of the following:

   1. (1) Prescription drug or food supplement pick up;
   2. (2) Collection of specimens for laboratory procedures;
   3. (3) Recording of an electrocardiogram;
   4. (4) Ascertaining the participant's weight; and
   5. (5) Administration of vaccines;
7. G. Interpretation of laboratory tests or panels;
8. H. Autopsies;
9. I. Weight control medications;

10. J. Care provided to a well newborn beyond the:

    1. (1) Length of the mother's stay for a normal obstetrical or uncomplicated caesarean section delivery; or
    2. (2) First 4 days of the newborn's life when the mother remains in the hospital due to other circumstances;
11. K. Telephones, televisions, or personal comfort items or services;
12. L. Duplicate care or services;
13. M. Elective admissions to hospitals outside of Maryland, except the District of Columbia, unless the Department or its designee determines that comparable services are not available in Maryland;
14. N. Inpatient and outpatient diagnostic and laboratory services not ordered by the attending physician or other practitioner;
15. O. Inpatient days provided in excess of the days approved by the Department or its designee;
16. P. Hospital laboratory tests which are coverable under COMAR 10.09.09, unless the specimen is obtained in the hospital for a participant receiving inpatient, outpatient, emergency department, or observation services;
17. Q. Hospital services provided outside of the United States; and
18. R. Ancillary services that are part of an observation stay beyond the initial 24 hours.

Authority: Health-General Article, §§2-104(b), 15-102.8, 15-103, and 15-105, Annotated Code of Maryland

Effective date: April 10, 2017 (44:7 Md. R. 354)

Regulation .04B amended effective June 24, 2024 (51:12 Md. R. 619)

Regulation .05P, Q amended effective June 24, 2024 (51:12 Md. R. 619)

Regulation .05 R adopted effective June 24, 2024 (51:12 Md. R. 619)

Regulation .07A amended effective November 18, 2019 (46:23 Md. R. 1065)