• English
    X

    Google Translate Disclaimer

    The Maryland Department of Information Technology (“DoIT”) offers translations of the content through Google Translate. Because Google Translate is an external website, DoIT does not control the quality or accuracy of translated content. All DoIT content is filtered through Google Translate which may result in unexpected and unpredictable degradation of portions of text, images and the general appearance on translated pages. Google Translate may maintain unique privacy and use policies. These policies are not controlled by DoIT and are not associated with DoIT’s privacy and use policies. After selecting a translation option, users will be notified that they are leaving DoIT’s website. Users should consult the original English content on DoIT’s website if there are any questions about the translated content.

    DoIT uses Google Translate to provide language translations of its content. Google Translate is a free, automated service that relies on data and technology to provide its translations. The Google Translate feature is provided for informational purposes only. Translations cannot be guaranteed as exact or without the inclusion of incorrect or inappropriate language. Google Translate is a third-party service and site users will be leaving DoIT to utilize translated content. As such, DoIT does not guarantee and does not accept responsibility for, the accuracy, reliability, or performance of this service nor the limitations provided by this service, such as the inability to translate specific files like PDFs and graphics (e.g. .jpgs, .gifs, etc.).

    DoIT provides Google Translate as an online tool for its users, but DoIT does not directly endorse the website or imply that it is the only solution available to users. All site visitors may choose to use alternate tools for their translation needs. Any individuals or parties that use DoIT content in translated form, whether by Google Translate or by any other translation services, do so at their own risk. DoIT is not liable for any loss or damages arising out of, or issues related to, the use of or reliance on translated content. DoIT assumes no liability for any site visitor’s activities in connection with use of the Google Translate functionality or content.

    The Google Translate service is a means by which DoIT offers translations of content and is meant solely for the convenience of non-English speaking users of the website. The translated content is provided directly and dynamically by Google; DoIT has no direct control over the translated content as it appears using this tool. Therefore, in all contexts, the English content, as directly provided by DoIT is to be held authoritative.

    Maryland Department of Health
    Regulations

    ​
    PROPOSAL
    Maryland Register
    Issue Date:  December 23, 2016
    Volume 43 • Issue 26 • Pages 1454—1457
     
    Title 10
    DEPARTMENT OF HEALTH AND MENTAL HYGIENE
    Notice of Proposed Action
    [16-359-P-I]
    The Secretary of Health and Mental Hygiene proposes to amend:
    (1) Regulation .04 under COMAR 10.02.01 Charges for Services Provided Through the Department of Health and Mental Hygiene;
    (2) Regulation .07 under COMAR 10.09.02 Physicians’ Services;
    (3) Regulations .07 and .10 under COMAR 10.09.08 Freestanding Clinics;
    (4) Regulation .07 under COMAR 10.09.09 Medical Laboratories;
    (5) Regulation .07 under COMAR 10.09.15 Podiatry Services;
    (6) Regulation .06 under COMAR 10.09.38 Healthy Start Program;
    (7) Regulation .11 under COMAR 10.09.49 Telehealth Services;
    (8) Regulation .07 under COMAR 10.09.50 EPSDT School Health-Related Services or Health-Related Early Intervention Services;
    (9) Regulation .20 under COMAR 10.09.67 Maryland Medicaid Managed Care Program: Benefits;
    (10) Regulation .07 under COMAR 10.09.87 Free-Standing Independent Diagnostic Testing Facilities;
    (11) Regulation .07 under COMAR 10.09.88 Portable X-ray Providers;
    (12) Regulation .14 under COMAR 10.11.03 Children’s Medical Services Program; and
    (13) Regulation .07 under COMAR 10.48.01 Services.
    Statement of Purpose
    The purpose of this action is to replace in its entirety the Medical Assistance Provider Fee Manual and incorporate by reference the Professional Services Provider Manual and Fee Schedule. This proposal also updates references to this document in other chapters.
    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 A. Phinney, Director, Office of Regulation and Policy Coordination, Department of Health and Mental Hygiene, 201 W. Preston Street, Room 512, Baltimore, MD 21201, or call 410-767-6499 (TTY 800-735-2258), or email to dhmh.regs@maryland.gov, or fax to 410-767-6483. Comments will be accepted through January 23, 2017. A public hearing has not been scheduled.
     
     Editor’s Note on Incorporation by Reference
                    Pursuant to State Government Article, §7-207, Annotated Code of Maryland, the Maryland Medical Assistance Program, Professional Services Provider Manual and Fee Schedule, Effective October 2016, has been declared a document generally available to the public and appropriate for incorporation by reference. For this reason, it will not be printed in the Maryland Register or the Code of Maryland Regulations (COMAR). Copies of this document are filed in special public depositories located throughout the State. A list of these depositories was published in 43:1 Md. R. 10 (January 8, 2016), and is available online at www.dsd.state.md.us. The document may also be inspected at the office of the Division of State Documents, 16 Francis Street, Annapolis, Maryland 21401.
     
    Subtitle 02 DIVISION OF REIMBURSEMENTS
    10.02.01 Charges for Services Provided Through the Department of Health and Mental Hygiene
    Authority: Health-General Article, §§16-201—16-407, Annotated Code of Maryland
    .04 Setting of Charges for Local Health Departments.
    A. (text unchanged)
    B. CPT-Based Charge.
    (1) (text unchanged)
    (2) Approved Method for Determining CPT-Based Charges.
    (a) (text unchanged)
    (b) For any health service performed by a local health department for which a rate is not assigned in the applicable Medicare Physicians Fee Schedule, the CPT-based charge shall be equivalent to 150 percent of the Maryland Medical Assistance participating provider fee allowance for the corresponding CPT code in the [current Maryland Medical Assistance Program, Physicians’ Services Provider Fee Manual] Professional Services Provider Manual and Fee Schedule, as published by the Department and incorporated by reference in COMAR [10.09.02.07] 10.09.02.07D.
    (c) For any health service performed by a local health department for which a rate is not assigned on the applicable Medicare Physicians Fee Schedule or in the [current Maryland Medical Assistance Program, Physicians’ Services Provider Fee Manual] Professional Services Provider Manual and Fee Schedule, the CPT-based charge shall be equivalent to the average hourly rate of the employees providing the service to the recipients of services,, calculated based upon current fiscal year salaries and fringe benefits, multiplied by the projected time of service with recipient of services, plus 20 percent for indirect costs.
    C.—D. (text unchanged)
     
    Subtitle 09 MEDICAL CARE PROGRAMS
    10.09.02 Physicians’ Services
    Authority: Health-General Article, §§2-104(b), 15-103, and 15-105, Annotated Code of Maryland
    .07 Payment Procedures.
    A.—C. (text unchanged)
    D. The Maryland Medical Assistance [Program Physicians’ Services Provider Fee Manual, Revision January 2014, is] Program’s procedures for payment are contained in the [Medical Assistance Provider Fee Manual, dated October 1986] Professional Services Provider Manual and Fee Schedule (Effective October 2016). All the provisions of this document, unless specifically excepted, are incorporated by reference.
    E.—Q. (text unchanged)
     
    10.09.08 Freestanding Clinics
    Authority: Health-General Article, §§2-104(b), 15-103, and 15-105, Annotated Code of Maryland
    .07 Freestanding Clinic Reimbursement Methodology.
    A. Reimbursement for Family Planning Clinics. The Department shall pay the family planning clinic the lesser of the provider’s customary charge or the provider’s acquisition cost, but no more than the maximum reimbursement allowed for similar procedures or services required in [the Maryland Medical Assistance Program Physicians’ Services Provider Fee Manual, which is incorporated by reference in COMAR 10.09.02.07] COMAR 10.09.02.07D. If the service is free to individuals not covered by Medicaid:
    (1) The provider:
    (a) (text unchanged)
    (b) Shall be reimbursed in accordance with [the Provider Fee Manual] COMAR 10.09.02.07D; and
    (2) (text unchanged)
    B. Reimbursement for Abortion Clinics. For dates of service on or after April 1, 2015, the Department shall pay the abortion clinic the lesser of the provider’s customary charge, but no more than the maximum reimbursement allowed for similar procedures or services required in [the Maryland Medical Assistance Program Physicians’ Services Provider Fee Manual, which is incorporated by reference in COMAR 10.09.02.07] COMAR 10.09.02.07D. If the service is free to individuals not covered by Medicaid:
    (1) The provider:
    (a) (text unchanged)
    (b) Shall be reimbursed in accordance with [the Provider Fee Manual] COMAR 10.09.02.07D; and
    (2) (text unchanged)
    C. (text unchanged)
    D. The Department shall pay all other freestanding clinics at the lesser of the provider’s customary charge, or the provider’s acquisition cost, but no more than the maximum reimbursement allowed for similar procedures or services required in [the Maryland Medical Assistance Program Physicians’ Services Provider Fee Manual, which is incorporated by reference in COMAR 10.09.02.07] COMAR 10.09.02.07D. If the service is free to individuals not covered by Medicaid:
    (1) The provider:
    (a) (text unchanged)
    (b) Shall be reimbursed in accordance with [the Provider Fee Manual] COMAR 10.09.02.07D; and
    (2) (text unchanged)
    .10 Payment Procedures.
    A.—B. (text unchanged)
    C. The provider shall bill the Program the provider’s customary charge to the general public for similar services. If the service is free to individuals not covered by Medicaid:
    (1) The provider:
    (a) (text unchanged)
    (b) Shall be reimbursed in accordance with [the Provider Fee Manual] COMAR 10.09.02.07D; and
    (2) (text unchanged)
    D.—I. (text unchanged)
     
    10.09.09 Medical Laboratories
    Authority: Health-General Article, §§2-104(b), 15-103, and 15-105, Annotated Code of Maryland
    .07 Payment Procedures.
    A.—C. (text unchanged)
    D. [The fee schedule is contained in the Medical Assistance Provider Fee Manual, dated October 1, 1986, which is used in conjunction with “Physician’s Current Procedural Terminology”, and the Health Care Financing Administration’s Common Procedure Code System (HCPCS). All the provisions of these documents, unless specifically noted, are incorporated by reference in this section, with the Medical Laboratories 2011 Provider Manual and Fee Schedule.] Providers are reimbursed according to COMAR 10.09.02.07D.
    E.—P. (text unchanged)
     
    10.09.15 Podiatry Services
    Authority: Health-General Article, §§2-104(b), 15-103, and 15-105, Annotated Code of Maryland
    .07 Payment Procedures.
    A.—C. (text unchanged)
    D. The Program shall pay for medically necessary covered services at the lower of the provider’s amount billed to the Program or the maximum reimbursement rates set forth [on the physicians’ fee schedule according to COMAR 10.09.02.07] in COMAR 10.09.02.07D.
    E.—J. (text unchanged)
     
    10.09.38 Healthy Start Program
    Authority: Health-General Article, §§2-104(b), 15-103, and 15-105, Annotated Code of Maryland
    .06 Payment Procedures.
    A.—B. (text unchanged)
    C. Payments shall be made:
    (1)—(3) (text unchanged)
    (4) For high-risk nutrition counseling as follows:
    (a)—(c) (text unchanged)
    (d) To all other eligible providers, according to [the current fee-for-service schedule specified in the Program Physicians’ Provider Fee Manual which is contained in the Medical Assistance Provider Fee Manual, dated October 1986, all the provisions of which, unless specifically excepted, are incorporated by reference in COMAR 10.09.02.07] COMAR 10.09.02.07D.
     
    10.09.49 Telehealth Services
    Authority: Health-General Article, §§2-104(b) and 15-105.2(b), Annotated Code of Maryland; Ch. 280, Acts of 2013
    .11 Reimbursement.
    A.—B. (text unchanged)
    C. Originating Site Transmission Fee.
    (1) The telehealth transmission fee is set:
    (a) In [the Maryland Medical Assistance Program Physicians’ Services Provider Fee Manual, which is incorporated by reference in COMAR 10.09.02.07] COMAR 10.09.02.07D; or
    (b) (text unchanged)
    (2) (text unchanged)
    D. Distant Site Professional Fee.
    (1) The distant site professional fee shall be:
    (a) For somatic services provided via telehealth, as set forth in [the Maryland Medical Assistance Program Physicians’ Services Provider Fee Manual, which is incorporated by reference in COMAR 10.09.02.07] COMAR 10.09.02.07D; or
    (b) For behavioral health services provided via telehealth, as set forth in [the Departmental fee schedule for Public Mental Health System Reimbursement, which is incorporated by reference in] COMAR 10.09.59.09.
    (2) (text unchanged)
     
    10.09.50 EPSDT School Health-Related Services or Health-Related Early Intervention Services
    Authority: Health-General Article, §§2-104(b), 15-103, and 15-124, Annotated Code of Maryland
    .07 Payment Procedures.
    A.—D. (text unchanged)
    E. Reimbursement for health-related services and health-related early intervention services is contained in [the Maryland Medical Assistance Program Physicians’ Services Provider Fee Manual, Revision January 2014, contained in the Medical Assistance Provider Fee Manual, dated October 1986, the provisions of which, unless specifically excepted, are incorporated by reference in COMAR 10.09.02.07] COMAR 10.09.02.07D. The State portion of reimbursement is provided by the Maryland State Department of Education.
     
    10.09.67 Maryland Medicaid Managed Care Program: Benefits
    Authority: Health-General Article, Title 15, Subtitle 1, Annotated Code of Maryland
    .20 Benefits — EPSDT Services.
    A. (text unchanged)
    B. The health care services described in §A(3) of this regulation shall include, at a minimum, all services described in this chapter, and the following:
    (1)—(2) (text unchanged)
    (3) Audiology services, as listed in the Maryland Medical Assistance Audiology Procedure Code and Fee Schedule[: contained in the Medical Assistance Provider Fee Manual, all the provisions of which, unless specifically excepted are incorporated by reference in], according to COMAR 10.09.51.04A(4);
    (4)—(6) (text unchanged)
    C. (text unchanged)
    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
    .07 Payment Procedures.
    A.—C. (text unchanged)
    D. The Department’s fee-schedule is contained in [the Maryland Medical Assistance Program Physicians’ Services Provider Fee Manual which is incorporated by reference in COMAR 10.09.02.07] COMAR 10.09.02.07D.
    E.—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
    .07 Payment Procedures.
    A.—C. (text unchanged)
    D. The Department’s fee-schedule is contained in [the Maryland Medical Assistance Program Physicians’ Services Provider Fee Manual which is incorporated by reference in COMAR 10.09.02.07] COMAR 10.09.02.07D.
    E.—I. (text unchanged)
     
    Subtitle 11 MATERNAL AND CHILD HEALTH
    10.11.03 Children’s Medical Services Program
    Authority: Health-General Article, §15-125, Annotated Code of Maryland
    .14 Billing Procedures for Physician Office Services.
    A. (text unchanged)
    B. The CMS Program shall:
    (1) Use the fee schedule contained in the Maryland Medical Assistance [Provider Fee Manual] Program’s Professional Services Provider Manual and Fee Schedule, which is incorporated by reference in COMAR [10.09.02.07 and 10.09.09.07] 10.09.02.07D;
    (2) (text unchanged)
    (3) Reimburse the provider for:
    (a) (text unchanged)
    (b) Injectable drugs at rates promulgated by the [Medical Assistance fee schedule for physician services] Professional Services Provider Manual and Fee Schedule referenced in §B(1) of this regulation.
    C. (text unchanged)
     
    Subtitle 48 CHILD ABUSE AND NEGLECT MEDICAL REIMBURSEMENT PROGRAM
    10.48.01 Services
    Authority: Family Law Article, §§5-701—5-910, Annotated Code of Maryland
    .07 Payment Procedures.
    A.—C. (text unchanged)
    D. The fee schedule for covered services except hospital services shall be the same as is contained in the [July 1, 1982, Medical Assistance Provider Fee Manual, as amended, the provisions of] Maryland Medical Assistance Program’s Professional Services Provider Manual and Fee Schedule which [are] is incorporated by reference [under] in COMAR [10.09.02, 10.09.03, and 10.09.09] 10.09.02.07D.
    E.—L. (text unchanged)
    VAN T. MITCHELL
    Secretary of Health and Mental Hygiene