PROPOSAL
Maryland Register
Issue Date: December 23, 2016
Volume 43 • Issue 26 • Pages 1454—1457
Title 10
DEPARTMENT OF HEALTH AND MENTAL HYGIENE
Notice of Proposed Action
[16-359-P-I]
The Secretary of Health and Mental Hygiene proposes to amend:
(1) Regulation .04 under COMAR 10.02.01 Charges for Services Provided Through the Department of Health and Mental Hygiene;
(2) Regulation .07 under COMAR 10.09.02 Physicians’ Services;
(3) Regulations .07 and .10 under COMAR 10.09.08 Freestanding Clinics;
(4) Regulation .07 under COMAR 10.09.09 Medical Laboratories;
(5) Regulation .07 under COMAR 10.09.15 Podiatry Services;
(6) Regulation .06 under COMAR 10.09.38 Healthy Start Program;
(7) Regulation .11 under COMAR 10.09.49 Telehealth Services;
(8) Regulation .07 under COMAR 10.09.50 EPSDT School Health-Related Services or Health-Related Early Intervention Services;
(9) Regulation .20 under COMAR 10.09.67 Maryland Medicaid Managed Care Program: Benefits;
(10) Regulation .07 under COMAR 10.09.87 Free-Standing Independent Diagnostic Testing Facilities;
(11) Regulation .07 under COMAR 10.09.88 Portable X-ray Providers;
(12) Regulation .14 under COMAR 10.11.03 Children’s Medical Services Program; and
(13) Regulation .07 under COMAR 10.48.01 Services.
Statement of Purpose
The purpose of this action is to replace in its entirety the Medical Assistance Provider Fee Manual and incorporate by reference the Professional Services Provider Manual and Fee Schedule. This proposal also updates references to this document in other chapters.
Comparison to Federal Standards
There is no corresponding federal standard to this proposed action.
Estimate of Economic Impact
The proposed action has no economic impact.
Economic Impact on Small Businesses
The proposed action has minimal or no economic impact on small businesses.
Impact on Individuals with Disabilities
The proposed action has no impact on individuals with disabilities.
Opportunity for Public Comment
Comments may be sent to Michele A. Phinney, Director, Office of Regulation and Policy Coordination, Department of Health and Mental Hygiene, 201 W. Preston Street, Room 512, Baltimore, MD 21201, or call 410-767-6499 (TTY 800-735-2258), or email to dhmh.regs@maryland.gov, or fax to 410-767-6483. Comments will be accepted through January 23, 2017. A public hearing has not been scheduled.
Editor’s Note on Incorporation by Reference
Pursuant to State Government Article, §7-207, Annotated Code of Maryland, the Maryland Medical Assistance Program, Professional Services Provider Manual and Fee Schedule, Effective October 2016, has been declared a document generally available to the public and appropriate for incorporation by reference. For this reason, it will not be printed in the Maryland Register or the Code of Maryland Regulations (COMAR). Copies of this document are filed in special public depositories located throughout the State. A list of these depositories was published in 43:1 Md. R. 10 (January 8, 2016), and is available online at www.dsd.state.md.us. The document may also be inspected at the office of the Division of State Documents, 16 Francis Street, Annapolis, Maryland 21401.
Subtitle 02 DIVISION OF REIMBURSEMENTS
10.02.01 Charges for Services Provided Through the Department of Health and Mental Hygiene
Authority: Health-General Article, §§16-201—16-407, Annotated Code of Maryland
.04 Setting of Charges for Local Health Departments.
A. (text unchanged)
B. CPT-Based Charge.
(1) (text unchanged)
(2) Approved Method for Determining CPT-Based Charges.
(a) (text unchanged)
(b) For any health service performed by a local health department for which a rate is not assigned in the applicable Medicare Physicians Fee Schedule, the CPT-based charge shall be equivalent to 150 percent of the Maryland Medical Assistance participating provider fee allowance for the corresponding CPT code in the [current Maryland Medical Assistance Program, Physicians’ Services Provider Fee Manual] Professional Services Provider Manual and Fee Schedule, as published by the Department and incorporated by reference in COMAR [10.09.02.07] 10.09.02.07D.
(c) For any health service performed by a local health department for which a rate is not assigned on the applicable Medicare Physicians Fee Schedule or in the [current Maryland Medical Assistance Program, Physicians’ Services Provider Fee Manual] Professional Services Provider Manual and Fee Schedule, the CPT-based charge shall be equivalent to the average hourly rate of the employees providing the service to the recipients of services,, calculated based upon current fiscal year salaries and fringe benefits, multiplied by the projected time of service with recipient of services, plus 20 percent for indirect costs.
C.—D. (text unchanged)
Subtitle 09 MEDICAL CARE PROGRAMS
10.09.02 Physicians’ Services
Authority: Health-General Article, §§2-104(b), 15-103, and 15-105, Annotated Code of Maryland
.07 Payment Procedures.
A.—C. (text unchanged)
D. The Maryland Medical Assistance [Program Physicians’ Services Provider Fee Manual, Revision January 2014, is] Program’s procedures for payment are contained in the [Medical Assistance Provider Fee Manual, dated October 1986] Professional Services Provider Manual and Fee Schedule (Effective October 2016). All the provisions of this document, unless specifically excepted, are incorporated by reference.
E.—Q. (text unchanged)
10.09.08 Freestanding Clinics
Authority: Health-General Article, §§2-104(b), 15-103, and 15-105, Annotated Code of Maryland
.07 Freestanding Clinic Reimbursement Methodology.
A. Reimbursement for Family Planning Clinics. The Department shall pay the family planning clinic the lesser of the provider’s customary charge or the provider’s acquisition cost, but no more than the maximum reimbursement allowed for similar procedures or services required in [the Maryland Medical Assistance Program Physicians’ Services Provider Fee Manual, which is incorporated by reference in COMAR 10.09.02.07] COMAR 10.09.02.07D. If the service is free to individuals not covered by Medicaid:
(1) The provider:
(a) (text unchanged)
(b) Shall be reimbursed in accordance with [the Provider Fee Manual] COMAR 10.09.02.07D; and
(2) (text unchanged)
B. Reimbursement for Abortion Clinics. For dates of service on or after April 1, 2015, the Department shall pay the abortion clinic the lesser of the provider’s customary charge, but no more than the maximum reimbursement allowed for similar procedures or services required in [the Maryland Medical Assistance Program Physicians’ Services Provider Fee Manual, which is incorporated by reference in COMAR 10.09.02.07] COMAR 10.09.02.07D. If the service is free to individuals not covered by Medicaid:
(1) The provider:
(a) (text unchanged)
(b) Shall be reimbursed in accordance with [the Provider Fee Manual] COMAR 10.09.02.07D; and
(2) (text unchanged)
C. (text unchanged)
D. The Department shall pay all other freestanding clinics at the lesser of the provider’s customary charge, or the provider’s acquisition cost, but no more than the maximum reimbursement allowed for similar procedures or services required in [the Maryland Medical Assistance Program Physicians’ Services Provider Fee Manual, which is incorporated by reference in COMAR 10.09.02.07] COMAR 10.09.02.07D. If the service is free to individuals not covered by Medicaid:
(1) The provider:
(a) (text unchanged)
(b) Shall be reimbursed in accordance with [the Provider Fee Manual] COMAR 10.09.02.07D; and
(2) (text unchanged)
.10 Payment Procedures.
A.—B. (text unchanged)
C. The provider shall bill the Program the provider’s customary charge to the general public for similar services. If the service is free to individuals not covered by Medicaid:
(1) The provider:
(a) (text unchanged)
(b) Shall be reimbursed in accordance with [the Provider Fee Manual] COMAR 10.09.02.07D; and
(2) (text unchanged)
D.—I. (text unchanged)
10.09.09 Medical Laboratories
Authority: Health-General Article, §§2-104(b), 15-103, and 15-105, Annotated Code of Maryland
.07 Payment Procedures.
A.—C. (text unchanged)
D. [The fee schedule is contained in the Medical Assistance Provider Fee Manual, dated October 1, 1986, which is used in conjunction with “Physician’s Current Procedural Terminology”, and the Health Care Financing Administration’s Common Procedure Code System (HCPCS). All the provisions of these documents, unless specifically noted, are incorporated by reference in this section, with the Medical Laboratories 2011 Provider Manual and Fee Schedule.] Providers are reimbursed according to COMAR 10.09.02.07D.
E.—P. (text unchanged)
10.09.15 Podiatry Services
Authority: Health-General Article, §§2-104(b), 15-103, and 15-105, Annotated Code of Maryland
.07 Payment Procedures.
A.—C. (text unchanged)
D. The Program shall pay for medically necessary covered services at the lower of the provider’s amount billed to the Program or the maximum reimbursement rates set forth [on the physicians’ fee schedule according to COMAR 10.09.02.07] in COMAR 10.09.02.07D.
E.—J. (text unchanged)
10.09.38 Healthy Start Program
Authority: Health-General Article, §§2-104(b), 15-103, and 15-105, Annotated Code of Maryland
.06 Payment Procedures.
A.—B. (text unchanged)
C. Payments shall be made:
(1)—(3) (text unchanged)
(4) For high-risk nutrition counseling as follows:
(a)—(c) (text unchanged)
(d) To all other eligible providers, according to [the current fee-for-service schedule specified in the Program Physicians’ Provider Fee Manual which is contained in the Medical Assistance Provider Fee Manual, dated October 1986, all the provisions of which, unless specifically excepted, are incorporated by reference in COMAR 10.09.02.07] COMAR 10.09.02.07D.
10.09.49 Telehealth Services
Authority: Health-General Article, §§2-104(b) and 15-105.2(b), Annotated Code of Maryland; Ch. 280, Acts of 2013
.11 Reimbursement.
A.—B. (text unchanged)
C. Originating Site Transmission Fee.
(1) The telehealth transmission fee is set:
(a) In [the Maryland Medical Assistance Program Physicians’ Services Provider Fee Manual, which is incorporated by reference in COMAR 10.09.02.07] COMAR 10.09.02.07D; or
(b) (text unchanged)
(2) (text unchanged)
D. Distant Site Professional Fee.
(1) The distant site professional fee shall be:
(a) For somatic services provided via telehealth, as set forth in [the Maryland Medical Assistance Program Physicians’ Services Provider Fee Manual, which is incorporated by reference in COMAR 10.09.02.07] COMAR 10.09.02.07D; or
(b) For behavioral health services provided via telehealth, as set forth in [the Departmental fee schedule for Public Mental Health System Reimbursement, which is incorporated by reference in] COMAR 10.09.59.09.
(2) (text unchanged)
10.09.50 EPSDT School Health-Related Services or Health-Related Early Intervention Services
Authority: Health-General Article, §§2-104(b), 15-103, and 15-124, Annotated Code of Maryland
.07 Payment Procedures.
A.—D. (text unchanged)
E. Reimbursement for health-related services and health-related early intervention services is contained in [the Maryland Medical Assistance Program Physicians’ Services Provider Fee Manual, Revision January 2014, contained in the Medical Assistance Provider Fee Manual, dated October 1986, the provisions of which, unless specifically excepted, are incorporated by reference in COMAR 10.09.02.07] COMAR 10.09.02.07D. The State portion of reimbursement is provided by the Maryland State Department of Education.
10.09.67 Maryland Medicaid Managed Care Program: Benefits
Authority: Health-General Article, Title 15, Subtitle 1, Annotated Code of Maryland
.20 Benefits — EPSDT Services.
A. (text unchanged)
B. The health care services described in §A(3) of this regulation shall include, at a minimum, all services described in this chapter, and the following:
(1)—(2) (text unchanged)
(3) Audiology services, as listed in the Maryland Medical Assistance Audiology Procedure Code and Fee Schedule[: contained in the Medical Assistance Provider Fee Manual, all the provisions of which, unless specifically excepted are incorporated by reference in], according to COMAR 10.09.51.04A(4);
(4)—(6) (text unchanged)
C. (text unchanged)
10.09.87 Free-Standing Independent Diagnostic Testing Facilities
Authority: Health-General Article, §§2-104(b), 15-103, and 15-105, Annotated Code of Maryland
.07 Payment Procedures.
A.—C. (text unchanged)
D. The Department’s fee-schedule is contained in [the Maryland Medical Assistance Program Physicians’ Services Provider Fee Manual which is incorporated by reference in COMAR 10.09.02.07] COMAR 10.09.02.07D.
E.—I. (text unchanged)
10.09.88 Portable X-ray Providers
Authority: Health-General Article, §§2-104(b), 15-103, and 15-105, Annotated Code of Maryland
.07 Payment Procedures.
A.—C. (text unchanged)
D. The Department’s fee-schedule is contained in [the Maryland Medical Assistance Program Physicians’ Services Provider Fee Manual which is incorporated by reference in COMAR 10.09.02.07] COMAR 10.09.02.07D.
E.—I. (text unchanged)
Subtitle 11 MATERNAL AND CHILD HEALTH
10.11.03 Children’s Medical Services Program
Authority: Health-General Article, §15-125, Annotated Code of Maryland
.14 Billing Procedures for Physician Office Services.
A. (text unchanged)
B. The CMS Program shall:
(1) Use the fee schedule contained in the Maryland Medical Assistance [Provider Fee Manual] Program’s Professional Services Provider Manual and Fee Schedule, which is incorporated by reference in COMAR [10.09.02.07 and 10.09.09.07] 10.09.02.07D;
(2) (text unchanged)
(3) Reimburse the provider for:
(a) (text unchanged)
(b) Injectable drugs at rates promulgated by the [Medical Assistance fee schedule for physician services] Professional Services Provider Manual and Fee Schedule referenced in §B(1) of this regulation.
C. (text unchanged)
Subtitle 48 CHILD ABUSE AND NEGLECT MEDICAL REIMBURSEMENT PROGRAM
10.48.01 Services
Authority: Family Law Article, §§5-701—5-910, Annotated Code of Maryland
.07 Payment Procedures.
A.—C. (text unchanged)
D. The fee schedule for covered services except hospital services shall be the same as is contained in the [July 1, 1982, Medical Assistance Provider Fee Manual, as amended, the provisions of] Maryland Medical Assistance Program’s Professional Services Provider Manual and Fee Schedule which [are] is incorporated by reference [under] in COMAR [10.09.02, 10.09.03, and 10.09.09] 10.09.02.07D.
E.—L. (text unchanged)
VAN T. MITCHELL
Secretary of Health and Mental Hygiene
