Issue Date: January 18, 2019
Volume 46 • Issue 2 • Page 61
MARYLAND DEPARTMENT OF HEALTH
Subtitle 09 MEDICAL CARE
10.09.69 Maryland Medicaid Managed Care Program: Rare and
Expensive Case Management
Health-General Article, §15-102.1(b)(1) and 15-103(b)(4)(i), Annotated Code of
Notice of Proposed
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
There is no corresponding federal standard to this proposed
Estimate of Economic
The proposed action has no economic impact.
Economic Impact on Small
The proposed action has minimal or no economic impact on small
Impact on Individuals
The proposed action has no impact on individuals with
Opportunity for Public
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 email@example.com, 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
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, 2011] July 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, 2011] July 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;
(3) Level of Care 3: [$90.25] $92.96.
F. (text unchanged)
.17 Table of Rare and
Expensive Disease Diagnosis.
ICD 10 Description
Other reduction deformities of
ROBERT R. NEALL
Secretary of Health
201 W. Preston Street, Baltimore, MD 21201-2399
(410) 767-6500 or 1-877-463-3464