Maryland Register

Issue Date:  February 1, 2019

Volume 46 • Issue 3 • Page 111-112

Title 10 


10.09.93 Chronic Hospitals

Authority: Health-General Article, §§2-104(b), 15-102.8, 15-103, and 15-105, Annotated Code of Maryland

Notice of Proposed Action


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 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 March 4, 2019. A public hearing has not been scheduled.

.01 Definitions.

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 unchanged)

.05 Covered Services.

A. Chronic hospitals shall provide the following services:

(1)—(3) (text unchanged)

(4) For participants admitted for [intensivemedically 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 [otherof a lesser intensity or frequency than [thosethe 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.

(1) (text unchanged)

(2) For a participant to be preauthorized for services in a brain injury community integration program, [theprovider 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.

(3) (text unchanged)

B. Concurrent Review.

(1) (text unchanged)

(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 intervals:

(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 designee].

(3) (text unchanged)

C. (text unchanged)

Secretary of Health