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Regulation Forms (MDH Employees Only)
June 9, 2017
Volume 44 • Issue 12 • Pages 590—591
DEPARTMENT OF HEALTH AND MENTAL HYGIENE
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
Notice of Proposed Action
The Secretary of Health and Mental Hygiene proposes to amend Regulations
COMAR 10.09.02 Physicians’ Services
Statement of Purpose
The purpose of this action is to update the Professional Services Provider Manual and Fee Schedule (formerly The Physicians’ Services Fee Schedule) to the January 2017 version. Rates that exceeded 100 percent of the Medicare rate have been decreased to 100 percent of the 2017 Medicare rates for protected specialties (obstetrics/gynecology, neurosurgery, and orthopedic services). Other specialties with rates higher than Medicare rates were reduced to 90 percent of the corresponding 2017 Medicare rates. As a result of the reduction in rates of other specialties, the lowest rates of reimbursement have been increased to 72 percent of the 2017 Medicare rate. In addition, this proposal updates language regarding the scope of practice for the nurse practitioners.
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 Phinney, Director, Office of Regulation and Policy Coordination, Department of Health and Mental Hygiene, 201 West Preston Street, Room 512, Baltimore, MD 21201, or call 410-767-6499 (TTY 800-735-2258), or email to email@example.com, or fax to 410-767-6483. Comments will be accepted through July 10, 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 Professional Services Provider Manual and Fee Schedule (Maryland Medical Assistance Program Effective January 1, 2017) 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 44:1 Md. R. 9 (January 6, 2017), 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.
.03 Conditions for Participation.
A. (text unchanged)
B. Specific requirements for participation in the Program as a physicians’ services provider require that the provider:
(1)—(5) (text unchanged)
(6) Shall agree to identify by the individual physician practitioner’s identification number each physician assistant
or nurse practitioner
who is authorized by the physician to request
laboratory services; and
(7) (text unchanged)
.04 Covered Services.
The Program covers the following medically necessary services rendered to recipients:
A. Physicians’ services rendered in the physician’s office, the recipient’s home, a hospital, a skilled or intermediate care nursing facility, a freestanding clinic, or elsewhere when these services are:
(1) Performed by the physician or one of the following:
(a)—(b) (text unchanged)
(c) A certified nurse midwife
or a certified nurse practitioner provided that the individual performs the services within the scope of the individual’s license or certification
who performs medically necessary services within the provider’s scope of practice as described in COMAR 10.27.05
(d) A certified nurse practitioner who performs medically necessary services within the provider’s scope of practice as described in COMAR 10.27.07.
(2)—(3) (text unchanged)
B.—I. (text unchanged)
.06 Preauthorization Requirements.
A.—D. (text unchanged)
E. Preauthorization normally required by the Program is waived when the service is covered and approved by Medicare.
However, if the entire or any part of a claim is rejected by Medicare, and the claim is referred to the Program for payment, payment will be made for services covered by the Program only if authorization for those services has been obtained before billing.
Non-Medicare claims require preauthorization according to §§A—D of this regulation.
F. (text unchanged)
.07 Payment Procedures.
C. (text unchanged)
D. The Maryland Medical Assistance Program’s procedures for payment are contained in the Professional Services Provider Manual and Fee Schedule (Effective
). All the provisions of this document, unless specifically excepted, are incorporated by reference.
Q. (text unchanged)
DENNIS R. SCHRADER
Secretary of Health and Mental Hygiene
201 W. Preston Street, Baltimore, MD 21201-2399
(410) 767-6500 or 1-877-463-3464
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