PROPOSAL
Maryland Register
Issue Date: August 5, 2016
Volume 43 • Issue 16 • Page 910
Title 10
DEPARTMENT OF HEALTH AND MENTAL HYGIENE
Subtitle 09 MEDICAL CARE PROGRAMS
Notice of Proposed Action
[16-204-P]
The Secretary of Health and Mental Hygiene proposes to amend:
(1) Regulation .06 under COMAR 10.09.02 Physicians’ Services;
(2) Regulation .06 under COMAR 10.09.03 Pharmacy Services;
(3) Regulation .06 under COMAR 10.09.06 Hospital Services; and
(4) Regulation .05 under COMAR 10.09.09 Medical Laboratories.
Statement of Purpose
The purpose of this action is to align Medicaid coverage of gender reassignment with the Maryland State Employees’ Health Benefit program and recent changes in Medicare policy.
Comparison to Federal Standards
There is a corresponding federal standard to this proposed action, but the proposed action is not more restrictive or stringent.
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, Department of Health and Mental Hygiene, 201 West 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 September 6, 2016. A public hearing has not been scheduled.
10.09.02 Physicians' Services
Authority: Health-General Article, §§2-104(b), 15-103, and 15-105, Annotated Code of Maryland
.06 Preauthorization Requirements.
A. The following procedures or services require preauthorization:
(1)—(5) (text unchanged)
(6) Surgical procedures for the treatment of obesity; [and]
(7) Surgical procedures for the purpose of gender reassignment; and
[(7)] (8) (text unchanged)
B.—F. (text unchanged)
10.09.03 Pharmacy Services
Authority: Health-General Article, §§2-104(b), 15-103, 15-103.1, 15-105, and 15-118, Annotated Code of Maryland
.06 Preauthorization Requirements.
A. The provider shall obtain preauthorization from the Department or its designee for any prescription for:
(1)—(3) (text unchanged)
[(4) Male hormones for biologic females;]
[(5)] (4) Female hormones for biologic males when used for treating sexual aggression;
[(6)] (5)—[(12)] (11) (text unchanged)
B.—F. (text unchanged)
10.09.06 Hospital Services
Authority: Health-General Article, §§2-104(b), 15-102.8, 15-103, and 15-105, Annotated Code of Maryland
.06 Preauthorization Requirements.
A. The following procedures or services require preauthorization:
(1) Inpatient:
(a)—(g) (text unchanged)
(h) All evaluations, procedures, and treatments related [in any way to sex] to gender reassignment.
[(i) Medical Assistance prescriptions and injections for male hormones for biologic females and female hormones for biologic males.]
[(j)] (i)—[(o)] (n) (text unchanged)
(2) (text unchanged)
B.—F. (text unchanged)
10.09.09 Medical Laboratories
Authority: Health-General Article, §§2-104(b), 15-103, and 15-105, Annotated Code of Maryland
.05 Limitations.
The following are not covered:
A.—F. (text unchanged)
G. Medical laboratory services related to autopsies; and
[H. Medical laboratory services associated with sex change, unless the procedure has been preauthorized under one or more Medical Care Programs regulations; and]
[I.] H. (text unchanged)
VAN T. MITCHELL
Secretary of Health and Mental Hygiene