COMAR 10.09.29.05. Limitations

The Program does not cover the following:

A. Services not specified in Regulation .04 of this chapter ;

B. Services not medically necessary;

C. Investigational and experimental drugs and procedures;

D. A day of inpatient care solely for the purpose of performing diagnostic tests that can be performed on an outpatient basis;

E. Admissions with a primary diagnosis of alcoholism, drug addiction, or severe brain damage, or the following diagnoses in the ICD-9-CM,

(1) 294.0—Amnestic syndrome,

(2) 294.8—Other specified organic brain syndromes (chronic),

(3) 294.9—Unspecified organic brain syndromes (chronic),

(4) 299.00—299.8—Psychoses with origin specific to childhood,

(5) 301.7—Antisocial personality disorder,

(6) 302.70—302.79—Psychosexual dysfunction,

(7) 306.0—306.9—Physiological malfunction arising from mental factor,

(8) 307.0—Special symptoms or syndromes, not elsewhere classified (NEC),

(9) 307.2 —Tics,

(10) 307.40—307.49—Specific disorders of sleep of nonorganic origin,

(11) 307.9—Other and unspecified special symptoms or syndromes (NEC), or

(12) 316—Psychic factors associated with disease classified elsewhere;

F. Days of care for recipients remaining in the residential treatment center beyond the length of stay certified by the team which develops the individual plan of care;

G. Psychiatric services to recipients over 21 years old except as specified in Regulation .01B(16) of this chapter .

Cross References 10.09.29.06B