Sec. 10.09.29.06. Preauthorization Requirements

The following procedures or services require preauthorization:

A. Out-of-State admissions. Adequate documentation shall be provided demonstrating that the placement meets one of the conditions as follows:

(1) Effective services at an in-State facility are not available;

(2) For similar services, an inpatient placement is not currently available in Maryland; or

(3) The recipient resides out-of-State and the cost for the out-of-State service is comparable to the cost of similar services in Maryland.

B. Services which are determined by Medicare to be ineffective, unsafe, or without proven clinical value are generally presumed to be not medically necessary, but will be preauthorized if the provider can satisfactorily document sufficient medical necessity except as specified in Regulation .05C of this chapter.

C. All admissions, which shall comply with the requirements under COMAR 10.09.70.07 for preauthorization.