PROPOSAL
Maryland Register
Issue Date: October 27, 2017
Volume 44• Issue 22 • Pages 1043—1044
Title 10
MARYLAND DEPARTMENT OF HEALTH
Subtitle 09 MEDICAL CARE PROGRAMS
Notice of Proposed Action
[17-259-P]
The Secretary of Health proposes to amend:
(1) Regulations .04, .05, and .07 under COMAR 10.09.04 Home Health Services;
(2) Regulations .04, .05, and .07 under COMAR 10.09.09 Medical Laboratories;
(3) Regulations .04, .05, and .07 under COMAR 10.09.53 Early and Periodic Screening, Diagnosis, and Treatment: Nursing Services for Individuals Younger than 21 Years Old;
(4) Regulations .04, .05, and .07 under COMAR 10.09.87 Free-Standing Independent Diagnostic Testing Facilities; and
(5) Regulations .04, .05, and .07 under COMAR 10.09.88 Portable X-ray Providers.
Statement of Purpose
The purpose of this action is to require providers of home health, medical laboratory, private duty nursing, diagnostic testing, and X-ray services to identify the ordering provider by National Provider Identifier (NPI) on the claim. In addition, the ordering provider shall be an individual enrolled in the Program with an active status on the date of service, in order for the claim to be paid.
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 November 27, 2017. A public hearing has not been scheduled.
10.09.04 Home Health Services
Authority: Health-General Article, §§2-104(b), 15-103, and 15-105, Annotated Code of Maryland
.04 Covered Services.
A. The Program covers the services listed in §§B and C of this regulation when the services are:
(1) Provided upon the written order of the attending physician [and furnished];
(2) Furnished under the current plan of treatment;
(3) Ordered by an individual who is enrolled as a provider in the Program with an active status on the date of service;
[(2)] (4)—[(9)] (11) (text unchanged)
B.—C. (text unchanged)
.05 Limitations.
The Program does not cover the following:
A.—R. (text unchanged)
S. Newborn early discharge services provided more than one time to a recipient; [and]
T. A newborn early discharge visit provided on the same day as another skilled nursing visit billed under this chapter[.]; and
U. Home health services ordered by an:
(1) Individual who is not enrolled as a provider in the Program with an active status on the date of service; and
(2) Entity, facility, or another provider that is not an individual.
.07 Payment Procedures.
A.—H. (text unchanged)
I. The home health provider shall identify the individual who ordered the home health services by recording the individual practitioner’s National Provider Identifier (NPI) number on the claim.
10.09.09 Medical Laboratories
Authority: Health-General Article, §§2-104(b), 15-103, and 15-105, Annotated Code of Maryland
.04 Covered Services.
The Program covers the following services:
A. Medically necessary laboratory services, when the services are:
(1)—(3) (text unchanged)
(4) Adequately documented in the provider’s files; [and]
(5) Clinical and diagnostic services for which certification by the [Health Care Financing Administration (HCFA)] Centers for Medicare and Medicaid Services (CMS) under CLIA exists, if required; and
(6) Ordered by an individual who is enrolled as a provider in the Program with an active status on the date of service;
B.—C. (text unchanged)
.05 Limitations.
The following are not covered:
A. Services for which the medical laboratory provider cannot supply a properly completed order or standing order identifying the [authorized ordering practitioner] individual practitioner who ordered the laboratory services;
B.—F. (text unchanged)
G. Medical laboratory services related to autopsies; [and]
H. Medical laboratory services for which there was insufficient quantity of specimen, improper specimen handling, or other circumstances that would render the results unreliable; and
I. Laboratory services ordered by an:
(1) Individual who is not enrolled as a provider in the Program with an active status on the date of service; and
(2) Entity, facility, or another provider that is not an individual.
.07 Payment Procedures.
A. (text unchanged)
B. Medical laboratory providers shall identify the [authorized ordering practitioner who authorized the medical laboratory services by either:] individual who ordered the laboratory services by recording the individual practitioner’s National Provider Identifier (NPI) number on the claim.
[(1) Recording the Maryland Medical Assistance Program individual practitioner identification number on the invoice; or
(2) Recording the name of the authorized ordering practitioner on the invoice and attaching to the invoice a copy of the properly completed order that identifies the authorized ordering practitioner.]
C.—P. (text unchanged)
10.09.53 Early and Periodic Screening, Diagnosis, and Treatment: Nursing Services for Individuals Younger than 21 Years Old
Authority: Health-General Article, §§2-104(b), 15-103, and 15-105, Annotated Code of Maryland
.04 Covered Services.
A.—H. (text unchanged)
I. The Program shall cover nursing services ordered by the participant’s primary medical provider when the primary medical provider is an individual who is enrolled as a provider in the Program with an active status on the date of service.
.05 Limitations.
A.—D. (text unchanged)
E. The Program does not cover nursing services ordered by an:
(1) Individual who is not enrolled as a provider in the Program with an active status on the date of service; and
(2) Entity, facility, or another provider that is not an individual.
.07 Payment Procedures.
A.—E. (text unchanged)
F. The nursing services provider shall identify the individual who ordered the nursing services by recording the individual practitioner’s National Provider Identifier (NPI) number on the claim.
10.09.87 Free-Standing Independent Diagnostic Testing Facilities
Authority: Health-General Article, §§2-104(b), 15-103, and 15-105, Annotated Code of Maryland
.04 Covered Services.
A. The Program covers medically necessary radiology services rendered to a recipient in an IDTF when the services are:
(1)—(3) (text unchanged)
(4) Ordered in writing by the treating physician or non-physician practitioner, in accordance with State law, who is enrolled as a provider in the Program with an active status on the date of service; and
(5) (text unchanged)
B.—C. (text unchanged)
.05 Limitations.
The Program does not cover the following:
A. Services for which the IDTF provider cannot supply a properly completed order identifying [by name,] the authorized ordering practitioner by National Provider Identifier (NPI);
B. IDTF services ordered by an:
(1) Individual who is not enrolled as a provider in the Program with an active status on the date of service; and
(2) Entity, facility, or another provider that is not an individual.
[B.] C.—[J.] K. (text unchanged)
.07 Payment Procedures.
A. (text unchanged)
B. IDTF providers shall identify the [ordering] individual who [authorized] ordered the diagnostic services by either:
(1) — (2) (text unchanged)
C.—I. (text unchanged)
10.09.88 Portable X-ray Providers
Authority: Health-General Article, §§2-104(b) 15-103, and 15-105, Annotated Code of Maryland
.04 Covered Services.
A. The Program covers medically necessary services rendered to recipients, when the services are:
(1)—(2) (text unchanged)
(3) Ordered in writing by the treating physician or nurse practitioner who is enrolled as a provider in the Program with an active status on the date of service in accordance with State law.
B. (text unchanged)
.05 Limitations.
The Program does not cover the following:
A. Services for which the portable X-ray provider cannot provide a properly completed order identifying [by name,] the authorized ordering physician[,] or practitioner by National Provider Identifier (NPI);
B.—J. (text unchanged)
K. X-ray services ordered by an:
(1) Individual who is not enrolled as a provider in the Program with an active status on the date of service; and
(2) Entity, facility, or another provider that is not an individual.
.07 Payment Procedures.
A.—I. (text unchanged)
J. The portable X-ray provider shall identify the individual who ordered the portable X-ray services by recording the individual practitioner’s National Provider Identifier (NPI) number on the claim.
DENNIS SCHRADER
Secretary of Health
