PROPOSAL

Maryland Register

Issue Date:  September 14, 2018

Volume 45 • Issue 19 • Pages 871—872

 

 

Title 10 
MARYLAND DEPARTMENT OF HEALTH

Subtitle 09 MEDICAL CARE PROGRAMS

10.09.23 Early and Periodic Screening, Diagnosis and Treatment (EPSDT) Services

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

Notice of Proposed Action

[18-241-P-I]

     The Secretary of Health proposes to amend Regulations .01-1.02.04, and .06 under COMAR 10.09.23 Early and Periodic Screening, Diagnosis and Treatment (EPSDT) Services.

Statement of Purpose

The purpose of this action is to:

(1) Update the title of the EPSDT manual to reflect its inclusion of audiology and physical therapy services;

(2) Add physician assistant as a health care practitioner the Program will consider for certification by the Healthy Kids Program as an EPSDT screening provider;

(3) Add clinically managed high intensity residential services (ASAM level 3.5) to the levels of care covered in Intermediate Care Facilities for patients under the age of 21;

(4) Remove residential rehabilitation service providers as EPSDT treatment providers;

(5) Update references to COMAR 10.63 in place of COMAR 10.47 which will be repealed by the Behavioral Health Administration (BHA); and

(6) Clarify that the Intermediate Care Facilities shall provide separate social, residential, dietary, and recreational activities for children and adolescents, if appropriate.

Comparison to Federal Standards

There is no corresponding federal standard to this proposed action.

Estimate of Economic Impact

I. Summary of Economic Impact. The Department is proposing to add clinically managed high intensity residential services (ASAM level 3.5) to the levels of care covered in Intermediate Care Facilities for patients under the age of 21 through Medicaid. Assuming 50 percent match, the State will save $686,665.50.

 

 

Revenue (R+/R-)

 

II. Types of Economic Impact.

Expenditure

(E+/E-)

Magnitude

 


 

A. On issuing agency:

(E-)

$686,665.50

B. On other State agencies:

NONE

C. On local governments:

NONE

 

 

Benefit (+)
Cost (-)

Magnitude

 


 

D. On regulated industries or trade groups:

NONE

E. On other industries or trade groups:

NONE

F. Direct and indirect effects on public:

NONE

 

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

A. The economic impact is based on the Behavioral Health Administration’s FY 2018 budget to provide this service to 55 individuals (total $1,373,331). Currently this service is provided by BHA and supported entirely with State general funds. Incorporating this service into the Medicaid program will enable the State to receive at least a 50 percent match in Medicaid federal dollars, which would generate at least a savings of $686,665.50 in State general funds. There may be additional savings because there are likely to be some participants in Intermediate Care Facilities who are enrolled in CHIP and would receive a higher federal match of 88 percent. Since there is only one provider of this service, Medicaid anticipates the number of patients will remain consistent through FY 2019.

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 W. 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 October 15, 2018. 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 Audiology, Physical Therapy, and Early Periodic, Screening, Diagnosis, and Treatment (EPSDT) Provider Manual (Effective July 2018) 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 45:1 Md. R. 8 (January 5, 2018), 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.

.01-1 Incorporation by Reference.

The Audiology, Physical Therapy, and Early Periodic, Screening, Diagnosis, and Treatment (EPSDT) Provider Manual (Maryland Medical Assistance Program, Effective [January 1, 2017] July 1, 2018) is incorporated by reference.

.02 Provider Qualifications.

A. (text unchanged)

B. In order for the Program to consider a health care practitioner for certification by the Healthy Kids Program as an EPSDT screening provider, the practitioner shall have a demonstrated history of providing services to children younger than 21 years old and shall also:

(1) (text unchanged)

(2) Be a pediatric or family nurse practitioner or a physician assistant who is licensed in good standing and certified to practice in the jurisdiction in which services are provided.

C.—D. (text unchanged)

E. EPSDT treatment providers that are covered by the Program include:

(1) The following provider types that are licensed in good standing to practice in the jurisdiction in which services are provided:

(a)—(h) (text unchanged)

(i) An intermediate care facility that provides at least one of the following:

(i) Clinically managed high intensity residential treatment; and

(ii) [medically] Medically monitored intensive inpatient treatment[, as specified in COMAR 10.47.02.09];

(2)—(5) (text unchanged)

[(6) Residential rehabilitation service providers, as specified in COMAR 10.09.28.02;]

[(7)(6)[(10)] (9) (text unchanged)

F. In order to qualify as an EPSDT treatment provider, an intermediate care facility shall:

(1) Be licensed under COMAR 10.63.03 or certified under COMAR 10.47.02, whichever is appropriate; and

(2) If appropriate, provide separate social, residential, dietary, and recreational activities for children and adolescents.

.04 Covered Services.

A.—C. (text unchanged)

D. Additional Medically Necessary Plan of Treatment Services.

(1) (text unchanged)

(2) EPSDT services covered under §D of this regulation include:

(a)—(c) (text unchanged)

(f) Medically monitored intensive inpatient treatment services provided in an intermediate care facility, as specified in COMAR 10.47.02.09 or COMAR 10.63.03.14, whichever is applicable;

(g) Clinically managed high intensity residential treatment services provided in an intermediate care facility, as specified in COMAR 10.47.02.09 or COMAR 10.63.03.13, whichever is applicable;

[(g)] (h)[(j)] (k) (text unchanged)

.06 Preauthorization.

Preauthorization is required for:

A.—F. (text unchanged)

G. Intermediate Care Facilities, as specified in COMAR 10.47.02.09 or COMAR 10.63.03.13, whichever is applicable.

ROBERT R. NEALL
Secretary of Health

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