PROPOSAL
Maryland Register
Issue Date: July 8, 2016
Volume 43 • Issue 14 • Pages 786—787
Title 10
DEPARTMENT OF HEALTH AND MENTAL HYGIENE
Subtitle 09 MEDICAL CARE PROGRAMS
Notice of Proposed Action
[16-172-P]
The Secretary of Health and Mental Hygiene proposes to amend:
(1) Regulation .04 under COMAR 10.09.04 Home Health Services;
(2) Regulation .07 under COMAR 10.09.23 Early and Periodic Screening, Diagnosis and Treatment (EPSDT) Services;
(3) Regulation .07 under COMAR 10.09.50 EPSDT School Health-Related Services or Health-Related Early Intervention Services; and
(4) Regulation .06 under COMAR 10.09.55 Physician Assistants.
Statement of Purpose
The purpose of this action is to update language regarding the previous limitation prohibiting providers from billing Medicaid for services provided free of charge to other patients. This language aligns with a recent federal policy clarification on “Free Care 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
I. Summary of Economic Impact. This amendment will allow DHMH to reimburse providers for services given at no charge to the general public. Previously, these services were not reimbursable.
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Revenue (R+/R-) |
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II. Types of Economic Impact. |
Expenditure (E+/E-) |
Magnitude |
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A. On issuing agency: |
(E+) |
Indeterminable |
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B. On other State agencies: |
NONE |
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C. On local governments: |
NONE |
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Benefit (+)
Cost (-) |
Magnitude |
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D. On regulated industries or trade groups: |
(+) |
Indeterminable |
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E. On other industries or trade groups: |
NONE |
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F. Direct and indirect effects on public: |
NONE |
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III. Assumptions. (Identified by Impact Letter and Number from Section II.) |
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A. and D. The fiscal impact is indeterminable, but the Department believes it will be minimal since few providers deliver free services. |
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 August 8, 2016. 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.—B. (text unchanged)
[C. The Program covers medical and other supplies which are used during a covered home health visit as part of the treatment ordered by the recipient's attending physician at a rate that is the lesser of the:
(1) Provider's customary charge to the general public; or
(2) Medicaid rate for the supply or pharmaceutical under COMAR 10.09.12 and 10.09.03.]
[D.] C. (text unchanged)
10.09.23 Early and Periodic Screening, Diagnosis and Treatment (EPSDT) 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. Reimbursement of Medically Monitored Intensive Inpatient Treatment Services Provided in an Intermediate Care Facility.
(1) (text unchanged)
(2) The Department shall pay the intermediate care facility the [lower] lesser of [the]:
(a) The provider’s [usual and] customary charge unless the service is free to individuals not covered by Medicaid; or [the]
(b) The provider’s per diem costs for covered services according to the principles established under Title XVIII of the Social Security Act, up to a maximum of $400 per day.
(3) The [$400 per day] maximum payment in §D(2)(b) of this regulation will be updated annually by the Centers for Medicare and Medicaid Service’s published federal fiscal year market basket increase percentage relating to hospitals excluded from the prospective payment system.
[(3)] (4)—[(4)] (5) (text unchanged)
E.—F. (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. (text unchanged)
B. Providers may not bill the Program for:
(1)—(2) (text unchanged)
(3) Broken or missed appointments; or
[(4) Services which are provided at no charge to the general public, except for IEP and IFSP related services; or]
[(5)] (4) (text unchanged)
C.—E. (text unchanged)
10.09.55 Physician Assistants
Authority: Health-General Article, §§2-104(b), 15-103, and 15-105, Annotated Code of Maryland
.06 Payment Procedures.
A.—B. (text unchanged)
C. [A physician assistant] The provider shall charge the Program [their usual and] the provider’s customary charge to the general public for similar services and charge [their] the provider’s acquisition cost for injectable drugs or dispensed medical supplies. If the service is free to individuals not covered by Medicaid:
(1) The provider:
(a) May charge the Program; and
(b) Shall be reimbursed in accordance with §D of this regulation; and
(2) The provider’s reimbursement is not limited to the provider’s customary charge.
D. The Department shall reimburse the physician assistant for covered services at the [lower] lesser of [their usual and]:
(1) The provider’s customary charge unless the service is free to individuals not covered by Medicaid; or [the]
(2) The maximum rates according to COMAR 10.09.02.07E.
E. Payments on Medicare claims are authorized, if:
(1)—(5) (text unchanged)
[E.] F. (text unchanged)
[F.] G. The provider may not bill the Program for:
(1)—(2) (text unchanged)
(3) Professional services rendered by mail or telephone; and
[(4) Services which are provided to the general public at no charge; and]
[(5)] (4) (text unchanged)
[G.] H.—[I.] J. (text unchanged)
VAN T. MITCHELL
Secretary of Health and Mental Hygiene
