Sec. 10.09.92.04. Covered Services

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

B. The Program covers the following hospital services:

(1) Medically necessary emergency services as defined in COMAR 10.09.36.01, including triage, related ancillary services, and when necessary, observation stays of a participant who presents to a hospital emergency department;

(2) Medically necessary services performed in an outpatient department of a hospital;

(3) Medically necessary services performed at a freestanding medical facility;

(4) Medically necessary inpatient hospital services meeting the following criteria:

(a) Inpatient days, including preoperative days, determined to be medically necessary by the Department or its designee;

(b) Admissions from an emergency department resulting in a medically necessary inpatient stay; and

(c) Elective admissions that the Department or its designee determines to be medically necessary;

(5) Inpatient stays determined to be medically necessary due to an emergent condition by the Department or its designee for a nonqualified alien;

(6) Administrative days determined to be necessary by the Department or its designee; and

(7) Medically necessary services performed in an acute rehabilitation hospital when the participant meets the following criteria at the time of admission:

(a) Requires active and ongoing therapeutic intervention of multiple therapy disciplines, one of which shall be physical or occupational therapy;

(b) Requires and can reasonably be expected to actively participate in, and benefit from, the therapy, which generally consists of:

(i) At least 3 hours of therapy a day, at least 5 days a week; or

(ii) In well-documented cases, at least 15 hours of intensive rehabilitation therapy within a 7 day consecutive period;

(c) Is sufficiently stable to be able to actively participate in the therapy program; and

(d) Requires supervision by a licensed physician, who has specialized training and experience in inpatient rehabilitation, which includes:

(i) Conducting face-to-face visits with the patient at least 3 days a week to assess the patient both medically and functionally; and

(ii) Modifying the course of treatment as needed to maximize the participant’s capacity to benefit from the rehabilitation process.