Issue Date: February 1, 2019
Volume 46 • Issue 3 • Page 111-112
MARYLAND DEPARTMENT OF HEALTH
Subtitle 09 MEDICAL CARE
Health-General Article, §§2-104(b), 15-102.8, 15-103, and 15-105, Annotated
Code of Maryland
Notice of Proposed
The Secretary of Health proposes to amend Regulations .01, .05, .07,
and .08 under COMAR 10.09.93 Chronic Hospitals.
Statement of Purpose
The purpose of this action is to:
(1) Clarify that the definition of “chronic hospital” does not
mean “long-term care facility” for purposes of Medicaid reimbursement;
(2) Clarify the nature and frequency of rehabilitation services
provided by a chronic hospital; and
(3) Establish a new period for concurrent review of the continued
medical necessity of a participant’s chronic hospital services.
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 disabilities.
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 firstname.lastname@example.org, or fax to 410-767-6483. Comments will be
accepted through March 4, 2019. A public hearing has not been scheduled.
A. (text unchanged)
B. Terms Defined.
(1)—(7) (text unchanged)
(8) Chronic Hospital.
(a) (text unchanged)
(b) “Chronic hospital” does not mean a:
(i) [long-term] Long-term care
hospital, as defined at 42 CFR §412.23(e); or
(ii) Long-term care facility, as defined at 42 CFR §483.5(a).
(9)—(15) (text unchanged)
[(16) “Level of care”
means an assessment that an individual needs the level of services provided in
a special psychiatric hospital.]
[(17)] (16)—[(25)] (24) (text
.05 Covered Services.
A. Chronic hospitals shall provide the following services:
(1)—(3) (text unchanged)
(4) For participants admitted for [intensive] medically
necessary rehabilitation services, [at least two
sessions, 5 days per week, of] physical therapy, occupational
therapy, or speech therapy [focused on language pathology], directed
by an interdisciplinary team; and
(5) (text unchanged)
B.—E. (text unchanged)
.07 Medical Eligibility.
A. General Requirements.
(1) (text unchanged)
(2) An admission to a chronic hospital is medically necessary for
a participant who [needs intensive]:
(a) Requires rehabilitation
services [other] of a lesser intensity or frequency than [those] the
acute inpatient rehabilitation services provided in a special
rehabilitation hospital; and
(b) May have comorbidities or a level of medical complexity that
preclude admission to a special rehabilitation hospital.
(3) (text unchanged)
B. (text unchanged)
.08 Utilization Review.
A. Admission and Prior Approval.
(2) For a participant to be preauthorized for services in a brain injury
community integration program, [the] a provider that
meets the requirements of Regulation .04 of this chapter shall request
a determination from the Department or its designee that the participant meets
the criteria set forth in Regulation .07B of this chapter.
B. Concurrent Review.
(2) Concurrent review shall be conducted every 14
days as long as the participant remains hospitalized[,
based on the participant’s diagnosis and condition,] to ensure the
medical necessity of the participant’s inpatient stay[, at the following
(a) After an initially authorized 30-day stay, or at the end of
the expected length of stay identified at admission, whichever comes first; and
(b) Every 14 days following the initial concurrent review,
including clinical updates, on a form determined by the Department or its
C. (text unchanged)
ROBERT R. NEALL
Secretary of Health
201 W. Preston Street, Baltimore, MD 21201-2399
(410) 767-6500 or 1-877-463-3464