1. A. The Program covers the following inpatient services at special pediatric hospitals:

   1. (1) A hospital admission determined to be medically necessary for a participant who is stable enough for transfer to a post-acute setting and requires medical or rehabilitative services that:

      1. (a) Cannot be provided at a lower level of care; and
      2. (b) Meets the medical eligibility criteria under Regulation .06 of this chapter;
   2. (2) Administrative days for the length of time certified by the Department or its designee;
   3. (3) Inpatient admissions for intensive occupational therapy, physical therapy, or speech therapy on a regimen which is less than 3 hours per day, 5 days per week, when these services are provided in a unit that is accredited by the Commission on Accreditation of Rehabilitation Facilities to provide rehabilitation services; and
   4. (4) Ancillary services.

2. B. The Program covers the following outpatient hospital services:

   1. (1) Medically necessary services for the provision of diagnostic, curative, palliative, or rehabilitative treatment; and

   2. (2) For a participant younger than 21 years old, physical therapy, occupational therapy, speech therapy, and audiology services if:

      1. (a) The therapy provider develops a written plan of treatment in collaboration with the participant’s primary care physician and the participant or the parent or guardian of the participant;
      2. (b) The service is provided according to the plan of treatment; and
      3. (c) The services provider sends an update of the plan of treatment to the participant’s primary care physician every 90 days.

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)