Maryland Register

Issue Date:  January 18, 2019

Volume 46 • Issue 2 • Page 61

Title 10 


10.09.69 Maryland Medicaid Managed Care Program: Rare and Expensive Case Management

Authority: Health-General Article, §15-102.1(b)(1) and 15-103(b)(4)(i), Annotated Code of Maryland

Notice of Proposed Action


     The Secretary of Health proposes to amend Regulations .04.14, and .17 under COMAR 10.09.69 Maryland Medicaid Managed Care Program: Rare and Expensive Case Management.

Statement of Purpose

The purpose of this action is to correct a reference to the chapter regarding an individual’s right to appeal an MCO’s determination. Additionally, this proposal implements a 3 percent rate increase for case management services under this chapter in accordance with the State’s budget for Fiscal Year 2019 and incorporates a new REM diagnosis code.

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 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 to, or fax to 410-767-6483. Comments will be accepted through February 19, 2019. A public hearing has not been scheduled.

.04 Participant Enrollment and Disenrollment.

A.—E. (text unchanged)

F. Election to Remain in MCO.

(1)—(4) (text unchanged)

(5) If the Department determines that the MCO cannot appropriately meet the individual’s needs, the Department shall issue a written determination to the individual and the MCO which includes:

(a) (text unchanged)

(b) An explanation of the individual’s right to appeal the determination according to the procedures set forth in COMAR [10.09.72] 10.01.04.

(6) (text unchanged)

G.—J. (text unchanged)

.14 Payment Procedures — Request for Payment.

A.—C. (text unchanged)

D. Effective [July 1, 2011July 1, 2018, the Department shall pay [$388.55$400.21 for a case management assessment, as described in Regulation .05C of this chapter.

E. Effective [July 1, 2011July 1, 2018, the Department shall make payments monthly for case management services at one of the rates specified below:

(1) Level of Care 1: [$286.90$295.51;

(2) Level of Care 2: [$171$176.13; or

(3) Level of Care 3: [$90.25$92.96.

F. (text unchanged)

.17 Table of Rare and Expensive Disease Diagnosis.


ICD 10 Description

Age Limit


(text unchanged)

(text unchanged)


Other reduction deformities of brain



(text unchanged)

(text unchanged)

Secretary of Health