Maryland Register

Issue Date:  November 9, 2018

Volume 45 • Issue 23 • Page 1080-1081

Title 10 


10.09.10 Nursing Facility Services

Authority: Health-General Article, §§2-104(b), 15-103, 15-105, 19-14B-01, and 19-310.1, Annotated Code of Maryland

Notice of Proposed Action


The Secretary of Health proposes to amend Regulations .07.08.11, and .13 under COMAR 10.09.10 Nursing Facility Services.

Statement of Purpose

The purpose of this action is to implement a 3 percent rate increase for nursing facility services in accordance with the State’s budget for Fiscal Year 2019. In addition, the Interim Working Capital Fund will be extended for 1 year.

Comparison to Federal Standards

There is no corresponding federal standard to this proposed action.

Estimate of Economic Impact

I. Summary of Economic Impact. The proposed amendments will implement a 3 percent rate increase for Fiscal Year 2019. This will be achieved by adjusting reimbursement provisions in order to limit the net increase to 3 percent. In addition, working capital advances will result in loss of potential interest income to the State.



Revenue (R+/R-)


II. Types of Economic Impact.






A. On issuing agency:








$188, 911

B. On other State agencies:


C. On local governments:




Benefit (+)
Cost (-)




D. On regulated industries or trade groups:

(1) Nursing home providers



(2) Nursing home providers


$188, 911

E. On other industries or trade groups:


F. Direct and indirect effects on public:


III. Assumptions. (Identified by Impact Letter and Number from Section II.)

A(1). The average reimbursement for nursing facility services will increase by 3 percent in Fiscal Year 2019. Under the provisions of this amendment, the rate represents a reduction of $5.91 per day compared with the rate that providers would otherwise receive. Based on a projected 5,619,180 days of care in Fiscal Year 2019, this reduction represents a savings to the State of $33,209,354. This amount is 50 percent federal funds and 50 percent General Funds.

A(2). The interim working capital fund will provide a projected $12,195,644 to providers during Fiscal Year 2019, resulting in loss of potential interest income of $188,911 based on a rate of return of 1.549 percent. This amount is 100 percent General Funds.

D(1). Reimbursement for nursing facilities will be reduced by $33,209,354 based on the net impact of the reimbursement adjustments in this proposal, although the average per diem rate will increase by 3 percent during Fiscal Year 2019 as described in Section IIIA(1).

D(2). Providers will benefit from the State’s loss of potential interest income in the amount of $188,911 due to providing working capital advances.

Economic Impact on Small Businesses

The proposed action has a meaningful economic impact on small business. An analysis of this economic impact follows.

Seven nursing homes, which qualify as small businesses, are expected to account for 42,490 Medicaid days during Fiscal Year 2019. At an average rate reduction of $5.91 per day, the impact on small businesses is estimated as a decrease in revenue of $251,116. The amount of benefit to small businesses due to the interim working capital fund is indeterminable.

Impact on Individuals with Disabilities

The proposed action has an impact on individuals with disabilities as follows:

The proposed action affects payments for services used by individuals with disabilities, but is not expected to have an impact on availability or access to services.

Opportunity for Public Comment

Comments may be sent to Jake Whitaker, Acting Director, Office of Regulation and Policy Coordination, Maryland Department of Health, 201 West Preston Street, Room 512, Baltimore, MD 21201, or call 410-767-6499 (TTY 800-735-2258), or email, or fax to 410-767-6483. Comments will be accepted through December 10, 2018. A public hearing has not been scheduled.

.07 Prospective Rates.

A.—F. (text unchanged)

G. Final facility rates for the period July 1, [20172018 through June 30, [2018] 2019 shall be each nursing facility’s quarterly rate, exclusive of the amount identified in Regulation .13A(2) of this chapter, reduced by the budget adjustment factor of [9.652]2.387 percent, plus the Nursing Facility Quality Assessment add-on identified in Regulation .11E of this chapter and the ventilator care add-on amount identified in Regulation .13A(2) of this chapter when applicable.

.08 Interim Working Capital Fund.

A.—G. (text unchanged)

H. The Interim Working Capital Fund expires on May 1, [20182019. Providers shall repay all outstanding funds to the Department by May 1, [2018] 2019. The Department may grant repayment extensions of not longer than 60 days under extraordinary circumstances.

.11 Rate Calculation — Capital Costs.

A. (text unchanged)

B. Final Capital Cost.

(1) The determination of a provider’s allowable final Capital per diem rate for the cost items under §A of this regulation is calculated as follows:

(a)—(f) (text unchanged)

(g) Apply a maximum appraised value per bed of [$110,000$120,000;

(h)—(m) (text unchanged)

(2) (text unchanged)

C.—E. (text unchanged)

.13 Ventilator Care Nursing Facilities.

Nursing facilities with licensed nursing facility beds, which have been determined by the Department to meet the standards for ventilator care under COMAR 10.07.02, shall be reimbursed as follows:

A. Services for residents receiving ventilator care shall be reimbursed as follows:

(1) (text unchanged)

(2) An amount of [$280] $285 shall be added to the total prospective rate;

B.—F. (text unchanged)

Secretary of Health