Maryland Department of Health
Regulations

​PROPOSAL

Maryland Register

Issue Date:  June 7, 2019

Volume 46 • Issue 12 • Page 554-556

Title 10 
MARYLAND DEPARTMENT OF HEALTH

Subtitle 09 MEDICAL CARE PROGRAMS

10.09.65 Maryland Medicaid Managed Care Program: Managed Care Organizations

Authority: Health-General Article, §§2-104, 15-102.3, and 15-103; Insurance Article, §§15-112, 15-605, and 15-1008; Annotated Code of Maryland

Notice of Proposed Action

[19-107-P]

     The Secretary of Health proposes to amend Regulation .19 under COMAR 10.09.65 Maryland Medicaid Managed Care Program: Managed Care Organizations.

Statement of Purpose

The purpose of this action is to implement the calendar year 2019 HealthChoice Managed Care Organization capitation rates.

Comparison to Federal Standards

There is no corresponding federal standard to this proposed action.

Estimate of Economic Impact

I. Summary of Economic Impact. The HealthChoice CY 2019 MCO rate adjustment is a decrease of $12,273,269 compared to the FY 2019 appropriation and previously projected spending for the first half of FY 2020. Overall it is a 1.4 percent rate decrease.

 

 

Revenue (R+/R-)

 

II. Types of Economic Impact.

Expenditure (E+/E-)

Magnitude

 
 

A. On issuing agency:

(E-)

$12,273,269

B. On other State agencies:

NONE

C. On local governments:

NONE

 

Benefit (+)
Cost (-)

Magnitude

 
 

D. On regulated industries or trade groups:

(-)

$12,273,269

E. On other industries or trade groups:

NONE

F. Direct and indirect effects on public:

NONE

III. Assumptions. (Identified by Impact Letter and Number from Section II.)

A. For CY 2019, there is a 1.4 percent decrease, or $12,273,269 decrease, to the Department’s expenses.

D. For CY 2019, there is a 1.4 percent decrease, or $12,273,269 decrease, to the MCO’s revenue.

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 mdh.regs@maryland.gov, or fax to 410-767-6483. Comments will be accepted through July 8, 2019. A public hearing has not been scheduled.

.19 MCO Reimbursement.

A. (text unchanged)

B. Capitation Rate-Setting Methodology.

(1)—(3) (text unchanged)

(4) Except to the extent of adjustments required by §D of this regulation or by Regulations .19-1—.19-4 of this chapter, the Department shall make payments monthly at the rates specified in the following tables:

[(a)] — [(d)] (proposed for repeal)

(a) Rate Table for Families and Children Effective January 1, 2019 — December 31, 2019

Age/RAC

Gender

PMPM Baltimore City

PMPM Montgomery County

PMPM Rest of State

Under age 1 Birth Weight 1500 grams or less

Both

$10,633.45

$9,884.60

$10,042.70

Under age 1 Birth Weight over 1500 grams

Both

$503.91

$468.42

$475.91

1—5

Male

$201.37

$187.18

$190.18

Female

$171.52

$159.44

$161.99

6—14

Male

$115.66

$107.51

$109.23

Female

$110.78

$102.98

$104.63

15—20

Male

$137.88

$128.17

$130.22

Female

$189.12

$175.80

$178.62

21—44

Male

$271.41

$225.13

$235.22

Female

$384.69

$319.09

$333.38

45—64

Male

$519.10

$430.59

$449.87

Female

$638.23

$529.41

$553.12

ACG-adjusted cells

ACG 100, 200, 300, 400, 500, 600, 700, 900, 1000, 1100, 1200, 1300, 1600, 1710, 1711, 1712, 1720, 1721, 1722, 1730, 1731, 1732, 1800, 1900, 2000, 2100, 2200, 2300, 2400, 2500, 2800, 2900, 3000, 3100, 3200, 3300, 3400, 3500, 3800, 4210, 5100, 5110, 5200 5230, 5310, 5339

RAC 1F

Both

$243.24

$201.77

$210.80

ACG 800, 1740, 1741, 1742, 1750, 2700, 3600, 1750, 1751, 1752, 2700, 3600, 3700, 3900, 4000, 4100, 4220, 4310, 4410, 4510, 4610, 4710, 4720, 4810, 5340

RAC 2F

Both

$391.81

$325.00

$339.55

ACG 1400, 1500, 1750, 1761, 1762, 1770, 1771, 1772, 2600, 4320, 4520, 4620, 4820

RAC 3F

Both

$506.38

$420.03

$438.85

ACG 4330, 4420, 4830, 4910, 4920, 5010, 5020, 5040

RAC 4F

Both

$704.46

$584.34

$610.52

ACG 4430, 4730, 4930, 5030, 5050

RAC 5F

Both

$997.30

$827.24

$864.30

ACG 4940, 5060

RAC 6F

Both

$1,281.41

$1,062.91

$1,110.52

ACG 5070

RAC 7F

Both

$2,083.82

$1,728.50

$1,805.92

ACG 100, 200, 300, 500, 600, 1100, 1600, 2000, 2400, 3400, 5100, 5110, 5200

RAC 1G

Both

$89.37

$83.08

$84.41

ACG 400, 700, 900, 1000, 1200, 1300, 1710, 1711, 1712, 1800, 1900, 2100, 2200, 2300, 2800, 2900, 3000, 3100, 5310

RAC 2G

Both

$114.64

$106.57

$108.27

ACG 1720, 1721, 1722, 1731, 1732, 1730, 2500, 3200, 3300, 3500, 3800, 4210, 5230, 5339

RAC 3G

Both

$144.33

$134.16

$136.31

ACG 800, 1740, 1741, 1742, 1750, 2700, 3600, 1750, 1751, 1752, 2700, 3600, 3700, 3900, 4000, 4100, 4220, 4310, 4410, 4510, 4610, 4710, 4720, 4810, 5340

RAC 4G

Both

$205.57

$191.09

$194.15

ACG 1400, 1500, 1750, 1761, 1762, 1770, 1771, 1772, 2600, 4320, 4520, 4620, 4820

RAC 5G

Both

$326.72

$303.71

$308.56

ACG 4330, 4420, 4830, 4910, 4920, 5010, 5020, 5040

RAC 6G

Both

$395.20

$367.37

$373.24

ACG 4430, 4730, 4930,4940, 5030, 5050, 5060, 5070

RAC 7G

Both

$1,030.02

$957.48

$972.79

SOBRA Mothers

$691.48

$573.58

$599.27

Persons with HIV

ALL

Both

$678.39

$678.39

$678.39

 

(b) Rate Table for Disabled Individuals Effective January 1, 2019 — December 31, 2019

Age/RAC

 

Gender

PMPM

Baltimore City

PMPM Montgomery County

PMPM Rest of State

 

Under Age 1

Both

$6,429.19

$6,429.19

$6,429.19

 

1—5

Male

$1,326.70

$1,326.70

$1,326.70

 

 

Female

$900.96

$900.96

$900.96

 

6—14

Male

$298.83

$298.83

$298.83

 

 

Female

$470.97

$470.97

$470.97

 

15—20

Male

$238.55

$238.55

$238.55

 

 

Female

$290.24

$290.24

$290.24

 

21—44

Male

$649.59

$471.43

$553.89

 

 

Female

$848.77

$615.99

$723.73

 

45—64

Male

$2,098.31

$1,522.84

$1,789.20

 

45—64

Female

$2,229.06

$1,617.73

$1,900.68

ACG-adjusted cells

ACG 100, 200, 300, 1100, 1300, 1400, 1500, 1600, 1710, 1711, 1712, 1720, 1721, 1722, 1730, 1731, 1732, 1900, 2400, 2600, 2900, 3400, 5100, 5110, 5200, 5310

RAC 10

Both

$296.35

$215.07

$252.69

ACG 400, 500, 700, 900, 1000, 1200, 1740, 1741, 1742, 1750, 1751, 1752 1800, 2000, 2100, 2200, 2300, 2500, 2700, 2800, 3000, 3100, 3200, 3300, 3500, 3900, 4000, 4310, 5330

RAC 11

Both

$364.82

$264.76

$311.07

ACG 600, 1760, 1761, 1762, 3600, 3700, 4100, 4320, 4410, 4710, 4810, 4820

RAC 12

Both

$699.42

$507.60

$596.38

ACG 3800, 4210, 4220, 4330, 4420, 4720, 4910, 5320

RAC 13

Both

$783.85

$568.51

$667.95

ACG 800, 4430, 4510, 4610, 5040, 5340

RAC 14

Both

$1,096.47

$795.76

$934.94

ACG 1770, 1771, 1772, 4520, 4620, 4830, 4920, 5050

RAC 15

Both

$1,381.88

$1,002.89

$1,178.30

ACG 4730, 4930, 5010

RAC 16

Both

$1,423.21

$1,032.88

$1,213.54

ACG 4940, 5020, 5060

RAC 17

Both

$2,170.47

$1,575.21

$1,850.72

ACG 5030, 5070

RAC 18

Both

$3,872.14

$2,810.08

$3,301.70

Persons with AIDS

All

Both

$1,982.61

$1,269.36

$1,269.36

Persons with HIV

All

Both

$1,997.41

$1,997.41

$1,997.41

 

(c) Rate Table for Supplemental Payments for Delivery/Newborn and Hepatitis C Therapy Effective January 1, 2019 — December 31, 2019

Age

Gender

Baltimore City

Montgomery County

Rest of State

Supplemental Payment Cells

 

 

 

 

 

Delivery/Newborn-all births except live birth weight 1,500 grams or less and gestational age of 21 weeks or more

All

Both

$16,395.64

$12,953.96

$14,130.96

Delivery/Newborn — live birth weight 1,500 grams or less and a gestational age of 21 weeks or more

All

Both

$86,211.08

$86,211.08

$86,211.08

Delivery/Newborn by same enrollee — subsequent live birth weight 1,500 grams or less with a gestational age less than 21 weeks or does not meet the requirements in §B(4)(i) of this regulation

All

Both

$16,395.64

$12,953.96

$14,130.96

Hepatitis C Therapy

All

Both

$20,598.22

$20,598.22

$20,598.22

 

(d) Rate Table for Childless Adult Population Effective January 1, 2019 — December 31, 2019

 

Age/RAC

Gender

PMPM Baltimore City

Montgomery County

PMPM Rest of State

 

19—44

Male

$347.86

$277.04

$316.60

 

19—44

Female

$412.94

$328.87

$375.82

 

45—64

Male

$940.05

$748.66

$855.56

 

45—64

Female

$865.06

$688.94

$787.30

ACG-adjusted cells

 

 

 

 

 

ACG 100, 200, 300, 400, 500, 600, 700, 900, 1000, 1100, 1200, 1300, 1600, 1710, 1711, 1712, 1720, 1721, 1722, 1730, 1731, 1732, 1800, 1900, 2000, 2100, 2200, 2300, 2400, 2500, 2800, 2900, 3000, 3100, 3200, 3300, 3400, 3500, 3800, 4210, 5100, 5110, 5200 5230, 5310, 5339

RAC 1H

Both

$308.54

$245.72

$280.81

ACG 800, 1740, 1741, 1742, 1750, 2700, 3600, 1750, 1751, 1752, 2700, 3600, 3700, 3900, 4000, 4100, 4220, 4310, 4410, 4510, 4610, 4710, 4720, 4810, 5340

RAC 2H

Both

$464.28

$369.75

$422.55

ACG 1400, 1500, 1750, 1761, 1762, 1770, 1771, 1772, 2600, 4320, 4520, 4620, 4820

RAC 3H

Both

$483.85

$385.02

$439.99

ACG 4330, 4420, 4830, 4910, 4920, 5010, 5020, 5040

RAC 4H

Both

$838.59

$667.86

$763.22

ACG 4430, 4730, 4930, 5030, 5050

RAC 5H

Both

$1,049.48

$835.81

$955.15

ACG 4940, 5060

RAC 6H

Both

$1,356.64

$1,080.43

$1,234.70

ACG 5070

RAC 7H

Both

$2,178.60

$1,735.05

$1,982.78

HIV

19—64

Both

$577.22

$577.22

$577.22

(e)—(i) (text unchanged)

(5) (text unchanged)

C.—D. (text unchanged)

ROBERT R. NEALL
Secretary of Health

 ​