November 9, 2018
45 • Issue 23 • Page 1080-1081
MARYLAND DEPARTMENT OF HEALTH
09 MEDICAL CARE PROGRAMS
Nursing Facility Services
Article, §§2-104(b), 15-103, 15-105, 19-14B-01, and 19-310.1, Annotated Code of
The Secretary of Health
proposes to amend Regulations .07, .08, .11,
and .13 under COMAR 10.09.10 Nursing Facility Services.
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.
to Federal Standards
There is no corresponding
federal standard to this proposed action.
of Economic Impact
I. Summary of Economic
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.
II. Types of Economic Impact.
A. On issuing agency:
B. On other State agencies:
C. On local governments:
D. On regulated industries or trade groups:
(1) Nursing home providers
(2) Nursing home providers
E. On other industries or trade groups:
F. Direct and indirect effects on public:
III. Assumptions. (Identified by Impact Letter and Number from Section
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
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.
Impact on Small Businesses
The proposed action has a
meaningful economic impact on small business. An analysis of this economic
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.
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.
for Public Comment
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 email@example.com, or fax to 410-767-6483. Comments will be
accepted through December 10, 2018. A public hearing has not been scheduled.
A.—F. (text unchanged)
G. Final facility rates for
the period July 1,  2018 through June
30,  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.
Interim Working Capital Fund.
A.—G. (text unchanged)
H. The Interim
Working Capital Fund expires on May 1,  2019.
Providers shall repay all outstanding funds to the Department by May 1,  2019.
The Department may grant repayment extensions of not longer than 60 days under
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)
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)
ROBERT R. NEALL
Secretary of Health
201 W. Preston Street, Baltimore, MD 21201-2399
(410) 767-6500 or 1-877-463-3464