Medicaid Benefits: Online Database

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Acute Care Services

Institutional and Clinic Services

Practitioner Services

Prescription Drugs

Physical Therapy and Other Services

Products and Devices

Transportation Services

Other Services

Long-Term Care Services

Community Based Care

Institutional Care

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Benefits by State: Maryland (October 2008) Notes

Acute Care Services

Is the Benefit Covered?	Copayment Requirement	Prior Approval Requirement	Coverage Limitations	Reimbursement Methodology	Populations Covered

Institutional and Clinic Services
Clinic Services, by an organized facility or clinic not part of a hospital: Freestanding Ambulatory Surgery Center
Yes				Cost based payment	CN & MN
Clinic Services, by an organized facility or clinic not part of a hospital: Public Health and Mental Health Clinics
Yes			1 visit/day	Cost based payment for Public Health Clinics, Mental Health Clinics paid reasonable charge per visit depending on length of visit and beneficiary age	CN & MN
Federally Qualified Health Center Services
Yes			1 non-emergency visit/day	Prospective cost based rate/visit	CN & MN
Inpatient Hospital Services, other than in an Institution for Mental Diseases
Yes		Elective admissions	LOS limited by state's Utilization Review authority, 2 therapeutic leaves of less than 12 hours/admission	Cost based payment	CN & MN
Outpatient Hospital Services
Yes				Fee for service using rates approved by cost review commission	CN & MN
Rehabilitation Services: Mental Health and Substance Abuse
Yes		Yes	Mental Health service and visit limits vary based on medical need	Fee for service for mental health care, cost based payment for substance abuse treatment in most settings	CN & MN
Rural Health Clinic Services
Yes				Prospective cost based rate/visit	CN & MN
Practitioner Services
Certified Registered Nurse Anesthetist Services
Yes				Fee for service	CN & MN
Chiropractor Services
No
Dental Services
Yes			Services for non-pregnant adults limited to trauma care and emergency treatment rendered in a hospital emergency department	Fee for service	CN & MN
Medical and Remedial Care - Other Practitioners

Medical/Surgical Services of a Dentist
Yes			Services for non-pregnant adults limited to trauma care and emergency treatment rendered in a hospital emergency department	Fee for service	CN & MN
Nurse Midwife Services
Yes			1 visit/day	Fee for service	CN & MN
Nurse Practitioner Services
Yes				Fee for service	CN & MN
Optometrist Services
Yes			1 refractive exam/2 years	Fee for service	CN & MN
Physician Services
Yes		Specified surgical procedures		Fee for service	CN & MN
Podiatrist Services
Yes			1 chronic care visit/2 months, routine foot care covered only for specified systemic conditions	Fee for service	CN & MN
Psychologist Services
Yes		Yes	Service and visit limits vary based on medical need	Fee for service	CN & MN
Prescription Drugs
Prescription Drugs
Yes	$1/Rx for generic or preferred brand, $3/Rx for non-preferred brand	Specified antibiotic liquids, some nutritional supplements	Specified quantity limits for selected drugs	Lower of AWP-12% or WAC+8%, plus $3.69 dispensing fee for generic or preferred brand Rx by traditional pharmacies or $2.69 dispensing fee for non-preferred Rx, non-traditional pharmacies paid $1.00 more/Rx but only one dispensing fee/month	CN & MN
Physical Therapy and Other Services
Occupational Therapy Services
No
Physical Therapy Services
Yes				Fee for service	CN & MN
Services for Speech, Hearing and Language Disorders
No
Products and Devices
Dentures
No
Eyeglasses
No
Hearing Aids
No
Medical Equipment and Supplies
Yes		Specified med equipment and med supply items, depending on cost	Medical equipment coverage limited to one piece per need and use in home	Fee for service	CN & MN
Prosthetic and Orthotic Devices
Yes			Prosthetic replacements limited to once/3 years, orthotics not covered	Fee for service	CN & MN
Transportation Services
Ambulance Services
Yes				Fee for service	CN & MN
Non-Emergency Medical Transportation Services
Yes		Yes		See service-specific FN	CN & MN
Other Services
Diagnostic, Screening and Preventive Services
Yes				Fee for service	CN & MN
Early and Periodic Screening, Diagnosis and Treatment
See service-specific FN.
Extended Services for Pregnant Women

Family Planning Services
See service-specific FN.
Laboratory and X-Ray Services, outside Hospital or Clinic
Yes				Fee for service	CN & MN
Targeted Case Management
Yes				Fee for service	CN & MN

Long-Term Care Services


Community Based Care
Home and Community Based Services Waiver
Yes	Plan of care	Services for the following populations: 1, 2, 3, 4, 6, 7 & 8 - See service-specific FN	Dependent upon the services provided	CN & MN
Home Health Services, includes nursing services, home health aides, and medical supplies/equipment
Yes	Care cost exceeding that of average nursing facility	Visit limits vary by type of service, 1 visit/type of service/day, home health aide visits require bi-weekly RN supervisory visits	Fee for service with rates set geographically	CN & MN
Hospice Care
Yes		Two 90-day periods and one 30-day period with additional periods as necessary	Prospective rates based on Medicare methodology	CN & MN
Personal Care Services
Yes	Yes		Per diem with acuity adjustment	CN & MN
Private Duty Nursing Services
No
Program of All-Inclusive Care for the Elderly
Yes		See service-specific FN	Capitated payment	CN & MN
Institutional Care
Inpatient Hospital, Nursing Facility and Intermediate Care Facility Services In Institutions for Mental Diseases, age 65 and older
Yes		Nursing facility and intermediate care facility residents limited to 15 hosp leave days/hospitalization, 18 therapeutic leave days/year	Prospective cost set by rate commission	CN & MN
Inpatient Psychiatric Services, under age 21
Yes	Admission and continued stay	Therapeutic leave must be less than 24 hours with return before census check	Prospective cost based per diem set by rate commission	CN & MN
Intermediate Care Facility Services for the Mentally Retarded
Yes		Care rendered in state-operated institutions only	Cost based per diem up to Medicare limits	CN & MN
Nursing Facility Services, other than in an Institution for Mental Diseases
Yes		15 hosp leave days/hospitalization, 18 therapeutic leave days/year	Cost based reimbursement	CN & MN
Religious Non-Medical Health Care Institution and Practitioner Services
No

Notes: This State has an approved Section 1115 Waiver from CMS under which it extended Medicaid eligibility to a number of different populations not otherwise eligible for Medicaid in a program called HealthChoice. Services are provided primarily through managed care organizations. The waiver includes a buy-in program, called Employed Individuals with Disabilities, for working disabled adults with income at or below 300 percent of the federal poverty level (FPL). The program requires a semi-annual premium and program participants receive the full Medicaid benefit package; they are also obligated to comply with HealthChoice copayment requirements. A limited benefit package of primary and preventive care benefits is available to beneficiaries in the Primary Adult Care (PAC) program for adults with income at or below 116 percent of the FPL; copayments are set at higher levels than for beneficiaries receiving full benefits. The State’s single benefit family planning program has also been included under this waiver. The information provided in the tables does not reflect policies applicable to these limited benefit programs.