PROPOSAL
Maryland Register
Issue Date: January 5, 2018
Volume 45• Issue 1 • Pages 34—35
Title 10
MARYLAND DEPARTMENT OF HEALTH
Subtitle 09 MEDICAL CARE PROGRAMS
10.09.70 Maryland Medicaid Managed Care Program: Non-Capitated Covered Services
Authority: Health-General Article, §§2-104(b), 15-103, and 15-105, Annotated Code of Maryland
Notice of Proposed Action
[18-008-P]
The Secretary of Health proposes to amend Regulation .02 under COMAR 10.09.70 Maryland Medicaid Managed Care Program: Non-Capitated Covered Services.
Statement of Purpose
The purpose of this action is to:
(1) Update the regulations to include the current procedure codes for buprenorphine;
(2) Clarify that in-office drug testing laboratory services billed by physicians are carved out; and
(3) Update the list of carved out diagnoses.
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 February 5, 2018. A public hearing has not been scheduled.
.02 Behavioral Health Non-Capitated Covered Services.
A. An MCO is not responsible for reimbursing for the following substance use disorder services, regardless of diagnosis:
(1) Services delivered by a community-based provider as described in COMAR 10.09.80 with the following procedure codes:
|
H0001—J8499 |
(text unchanged) |
|
J0571 |
Buprenorphine, oral, 1 mg |
|
J0572 |
Buprenorphine/naloxone, oral, less than or equal to 3 mg of buprenorphine |
|
J0573 |
Buprenorphine/naloxone, oral, greater than 3 mg, but less than or equal to 6 mg buprenorphine |
|
J0574 |
Buprenorphine/naloxone, oral, greater than 6 mg, but less than or equal to 10 mg buprenorphine |
(2) (text unchanged)
B.—D. (text unchanged)
E. An MCO is not responsible for reimbursing for mental health services with a primary diagnosis listed in §M of this regulation when the services are provided by a hospital and the services are the result of the treatment of mental health diagnosis.
[E.] F.—[F.] G. (text unchanged)
[G.] H. An MCO is not responsible for reimbursing the behavioral poisoning diagnoses listed in [§N] §O of this regulation in an emergency department setting.
[H.] I. An MCO is not responsible for services billed by specialty mental health providers listed in COMAR 10.09.59 when the bill includes the specialty behavioral health diagnoses listed in [§K] §L or [L] M in the primary diagnosis field.
[I.] J. (text unchanged)
[J.] K. An MCO is not responsible for reimbursing for services billed by a physician related to prescribing buprenorphine or Vivitrol when the following conditions are met:
(1)—(4) (text unchanged)
(5) The procedure code listed on the claims is one of the following:
|
99201—J2315 |
(text unchanged) |
|
J0571 |
Buprenorphine, oral, 1 mg |
|
J0572 |
Buprenorphine/naloxone, oral, less than or equal to 3 mg of buprenorphine |
|
J0573 |
Buprenorphine/naloxone, oral, greater than 3 mg, but less than or equal to 6 mg buprenorphine |
|
J0574 |
Buprenorphine/naloxone, oral, greater than 6 mg, but less than or equal to 10 mg buprenorphine |
|
80305 |
Drug test(s), presumptive, any number of drug classes; any number of devices or procedures, (e.g., immunoassay) capable of being read by direct optical observation only (e.g., dipsticks, cups, cards, cartridges), includes sample validation when performed, per date of service |
|
80307 |
Drug test(s), presumptive, any number of drug classes; any number of devices or procedures by instrumented chemistry analyzers (e.g., immunoassay, enzyme assay, TOF, MALDI, LDTD, DESI, DART, GHPC, GC mass spectrometry), includes sample validation when performed, per date of service (when provider has appropriately licensed and has adequate instrumentation) |
[K.] L. (text unchanged)
[L.] M. Table of mental health diagnoses:
(1) (text unchanged)
(2) For dates of service on or after October 1, 2015:
|
F200—F5081 |
(text unchanged) |
|
F5082 |
Avoidant/restrictive food intake disorder |
|
F5089—Z046 |
(text unchanged) |
[M.] N.—[N.] O. (text unchanged)
DENNIS SCHRADER
Secretary of Health
