PROPOSAL
Maryland Register
Issue Date: April 13, 2018
Volume 45 • Issue 8 • Pages 427—428
Title 10
MARYLAND DEPARTMENT OF HEALTH
Subtitle 09 MEDICAL CARE PROGRAMS
10.09.15 Podiatry Services
Authority: Health-General Article, §§2-104(b), 15-103, and 15-105, Annotated Code of Maryland
Notice of Proposed Action
[18-080-P]
The Secretary of Health proposes to amend Regulations .01, .04—.09, and .11 under COMAR 10.09.15 Podiatry Services.
Statement of Purpose
The purpose of this action is to update the regulations to further clarify covered services and limitations of podiatric care, as well as an update of specific terms within the regulations.
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, Maryland Department of Health, 201 West Preston Street, Room 512, Baltimore, MD 21201, or call 410-767-6499 (TTY 800-735-2258), or email to mdh.regs@maryland.gov, or fax to 410-767-6483. Comments will be accepted through May 14, 2018. A public hearing has not been scheduled.
.01 Definitions.
A. In this chapter, the following terms have the meanings indicated.
B. Terms Defined.
(1)—(9) (text unchanged)
(10) “Participant” means an individual who is certified as eligible for, and is receiving, Medical Assistance benefits.
[(10)] (11)—[(14)] (15) (text unchanged)
[(15)] (16) 'Provider' means an individual, association, partnership, or an incorporated or unincorporated group of podiatrists, duly licensed to provide services for [recipients] participants, and who, through appropriate agreement with the Department, has been identified as a Program provider by the issuance of an individual account number.
[(16) 'Recipient' means a person who is certified as eligible for, and is receiving, Medical Assistance benefits.]
(17)—(18) (text unchanged)
.04 Covered Services.
The Program covers the following medically necessary services:
[A. Medically necessary services, when these services are:]
[(1)] A. [Rendered to a recipient] Podiatric services rendered in the podiatrist's office, the [recipient's] participant’s home, a hospital, a nursing facility, a free standing clinic, or elsewhere[;], when these services are:
[(2)] (1) Performed by the podiatrist or another licensed podiatrist in [his] the podiatrist’s employ;
(2) Performed on the:
(a) Human foot or ankle;
(b) Anatomical structures that attach to the human foot; or
(c) Soft tissue below the midcalf;
(3) Clearly related to the [recipient's] participant’s individual medical needs as diagnostic, curative, palliative, or rehabilitative services; and
(4) Adequately described on the [recipient's] participant’s medical record.
B. [Office, home, nursing home, or domiciliary care visits for podiatric care for recipients who are diabetic or who have a vascular disease affecting the lower extremities;] Routine podiatric care rendered in an office, home, nursing home, or licensed assisted living facility for participants who have a metabolic, neurologic, or vascular disease affecting the lower extremities, including but not limited to:
(1) Arteriosclerosis obliterans (A.S.O., arteriosclerosis of the extremities, occlusive peripheral arteriosclerosis);
(2) Buerger’s disease (thromboangiitis obliterans);
(3) Peripheral neuropathies involving the feet, associated with:
(a) Traumatic injury;
(b) Leprosy or neurosyphilis; or
(c) Hereditary disorders, such as hereditary sensory radicular neuropathy, angiokeratoma corporis diffusum (Fabry’s) and amyloid neuropathy; and
(4) The following conditions, if the patient is under the active care of a doctor of medicine or osteopathy who documents the condition:
(a) Diabetes mellitus;
(b) Chronic thrombophlebitis;
(c) Peripheral neuropathies involving the feet, associated with:
(i) Malnutrition and vitamin deficiency such as malnutrition (general and pellagra), alcoholism, malabsorption (celiac disease and tropical sprue), and pernicious anemia;
(ii) Carcinoma;
(iii) Diabetes mellitus;
(iv) Drugs and toxins;
(v) Multiple sclerosis; or
(vi) Uremia (chronic renal disease).
C.—F. (text unchanged)
.05 Limitations.
A. The Program does not cover the following under this chapter:
(1)—(7) (text unchanged)
(8) Visits by or to the podiatrist solely for the purpose of the following:
(a) Prescription or drug pick-up[,];
(b) Collection of specimens for laboratory procedures, except by venipuncture, capillary or arterial puncture[,]; and
(c) (text unchanged)
(9)—(12) (text unchanged)
[(13) Corrective shoes;
(14) Braces;]
[(15)] (13) (text unchanged)
[(16)] (14) Routine care, except visits for [recipients] participants who are diabetic or who have a vascular disease affecting the lower extremities;
[(17)] (15)—[(18)] (16) (text unchanged)
[(19)] (17) Podiatric inpatient hospital services rendered during an admission denied by the utilization control agent or during a period that is in excess of the length of stay authorized by the utilization control agent.
B. Routine podiatric care is limited to one visit every 60 days for [recipients] participants who have diabetes or peripheral vascular diseases that affect the lower extremities when rendered in the podiatrist's office, the [recipient's] participant’s home, or a nursing facility.
C. (text unchanged)
.06 Preauthorization.
A.—B. (text unchanged)
C. Preauthorization is valid only for services rendered or initiated within [60] 90 days of the date issued.
D. (text unchanged)
.07 Payment Procedures.
A.—F. (text unchanged)
G. The provider may not bill the Department or the [recipient] participant for:
(1)—(5) (text unchanged)
H. The Program will make no direct payment to [recipients] participants.
I.—J. (text unchanged)
.08 Recovery and Reimbursement.
A. If the [recipient] participant has insurance or other coverage, or if any other person is obligated, either legally or contractually, to pay for or to reimburse the [recipient] participant for services covered by this chapter, the provider shall seek payment from that source first. If an insurance carrier rejects the claim or pays less than the amount allowed by the Medical Assistance Program, the provider may submit a claim to the Program. The provider shall submit a copy of the insurance carrier's notice or remittance advice with his invoice. If payment is made by both the Program and the insurance or other source for the same service, the provider shall refund to the Department, within 60 days of receipt, the amount paid by the Program, or the insurance or other source, whichever is less.
B. (text unchanged)
.09 Cause for Suspension or Removal and Imposition of Sanctions.
A.—D. (text unchanged)
E. A provider who voluntarily withdraws from the Program, or is removed or suspended from the Program according to this regulation, shall notify [recipients] participants that he or she no longer [honors] accepts Medical Assistance [cards] before [he renders] rendering additional services.
.11 Interpretive Regulation.
Except when the language of a specific regulation indicates an intent by the Department to provide reimbursement for covered services to Program [recipients] participants without regard to the availability of federal financial participation, State regulations shall be interpreted in conformity with applicable federal statutes and regulations.
ROBERT R. NEALL
Secretary of Health
