§ 3-601. Definitions.

(a) In general.

In this subtitle, the following terms have the meanings indicated.

(b) Abnormal EPSDT screening.

"Abnormal EPSDT screening" means a medical screening done as part of an EPSDT regimen that produces:

(1) inconclusive results;

(2) ambiguous results; or

(3) results that require further testing.

"Baltimore City Public School System" or "BCPSS" means the public school district of the City of Baltimore.

(d) Early and Periodic Screening, Diagnosis, and Treatment.

"Early and Periodic Screening, Diagnosis, and Treatment" or "EPSDT" means the provision of preventive health care under 42 CFR Subpart B {"Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) of Individuals Under Age 21"}, including medical and dental services to assess growth and development and to detect and treat health problems in Medicaid beneficiaries under 21 years old.

(e) Family Planning.

"Family planing" means providing individuals with the information and means to prevent an unwanted pregnancy and to maintain reproductive health.

(f) Follow-up care.

"Follow-up care" means:

(1) any treatment or practice recommended as medically necessary to address abnormal or positive results of an EPSDT screening by a licensed healthcare professional; and

(2) the process of attempting to ascertain if the recommended services have been obtained.

(g) Maryland Healthy Kids Preventive Health Schedule.

"Maryland Healthy Kids Preventive Health Schedule" means the schedule set by the State Department of Health's Healthy Kids Program as a minimum EPSDT practice for all Maryland Medicaid recipients under 21 years of age, consisting of:

(1) standard health screenings;

(2) physical exams;

(3) laboratory tests;

(4) immunizations; and

(5) health education.

(h) Medically necessary

"Medically necessary" means that a health service is:

(1) directly related to diagnostic, preventive, curative, palliative, rehabilitative, or ameliorative treatment of an illness, injury, disability, or health condition;

(2) consistent with currently accepted standards of good medical practice;

(3) the most cost efficient service that can be provided without sacrificing effectiveness or access to care; and

(4) not primarily for the convenience of the consumer, family, or provider.

(i) Positive EPSDT screening.

"Positive EPSDT screening" means a medical screening conducted by a licensed health professional as part of an EPSDT regimen that produces positive results indicating the presence of the tested-for condition.

(j) Preventive Health Services.

"Preventive Health Services" means proactive care to detect potential health problems and protect and maintain a patient's current health, including:

(1) screenings for health conditions;

(2) counseling for chronic conditions;

(3) regular health checkups; and

(4) immunizations.

(k) Primary health services.

"Primary health services" means a basic level of health care, including diagnostic, treatment, consultative, referral, and preventive health services, generally rendered by 1 or more:

(1) general practitioners;

(2) family practitioners;

(3) internists;

(4) gynecologists;

(5) pediatricians;

(6) physician assistants; and

(7) nurse practitioners.

(l) School-based health center.

"School-based health center" means a facility providing medical care that:

(1) is located on the grounds of a BCPSS facility;

(2) provides on site primary and preventive health care, referrals, and follow-up services;

(3) may provide on site dental care or behavioral health care, referrals, and follow-up services; and

(4) has been approved by the Maryland Department of Health.

(m) School health services professional.

"School health services professional" or "school health professional" means a physician, certified nurse practitioner, or registered nurse with experience, special training, or both in working with children and families in community or school health programs and practices in accordance with the current State medical and nursing standards of care.