Maryland Department of Health 10.09.07; 10.09.20; 10.09.27; 10.09.53; 10.09.54; 10.09.56; and 10.09.84 Nursing Facility Services (MEDICAL CARE PROGRAMS)

PROPOSAL

Maryland Register

Issue Date: November 9, 2018

Volume 45 • Issue 23 • Page 1077-10.80

Title 10
MARYLAND DEPARTMENT OF HEALTH

Subtitle 09 MEDICAL CARE PROGRAMS

Notice of Proposed Action

[18-291-P]

The Secretary of Health proposes to amend:

(1) Regulation .08 under COMAR 10.09.07 Medical Day Care Services;

(2) Regulation .14 under COMAR 10.09.20 Community Personal Assistance Services;

(3) Regulation .06 under COMAR 10.09.27 Home Care for Disabled Children Under a Model Waiver;

(4) Regulation .07 under COMAR 10.09.53 Early and Periodic Screening, Diagnosis, and Treatment: Nursing Services for Individuals Younger than 21 Years Old;

(5) Regulation .22 under COMAR 10.09.54 Home and Community-Based Options Waiver;

(6) Regulation .22 under COMAR 10.09.56 Home and Community-Based Services Waiver for Children with Autism Spectrum Disorder; and

(7) Regulation .24 under COMAR 10.09.84 Community First Choice.

Statement of Purpose

The purpose of this action is to implement a 3 percent rate increase for services under these chapters in accordance with S.B. 185 (Ch. 570, Acts of 2018, FY 19 Budget Bill) and to update the indexing methodology for subsequent rate increases. This action will also implement consistent policies for maintaining fee schedules and revise an incorrect citation.

Comparison to Federal Standards

There is no corresponding federal standard to this proposed action.

Estimate of Economic Impact

I. Summary of Economic Impact. The proposed action will increase expenditures by the State based on the difference between the rate increase under existing regulatory provisions and the 3 percent increase provided in the budget.

	Revenue (R+/R-)
II. Types of Economic Impact.	Expenditure (E+/E-)	Magnitude


A. On issuing agency:	(E+)	$1,834,314
B. On other State agencies:
Maryland State Dept. of Education	(E+)	$ 118,650
C. On local governments:	NONE

	Benefit (+) Cost (-)	Magnitude


D. On regulated industries or trade groups:	(+)	$1,952,964
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. Under existing regulations, medical day care providers would receive a 2.9 percent increase based on the increase in medical care component of the July 2017 Consumer Price Index for all Urban Consumers (CPI-U), Washington-Baltimore, from the U.S. Department of Labor, Bureau of Labor Statistics, for a total FY 2019 expenditure of $127,882,452. The 3 percent increase will result in a total expenditure of $128,006,731, a difference of $124,279. Providers under the Community Personal Assistance Services program would receive an increase based on the CPI-U, capped at 2.5 percent, for a total expenditure of $4,926,062. The 3 percent increase will result in a total expenditure of $4,950,091, a difference of $24,029. Providers of nursing services under the Model Waiver and EPSDT would receive a 2.9 percent increase based on the CPI-U, for a total expenditure of $110,048,093. The 3 percent increase will result in a total expenditure of $110,155,039, a difference of $106,946. Providers under the Home and Community-Based Options Waiver would receive an increase based on the CPI-U, capped at 2.5 percent, for a total expenditure of $24,313,901. The 3 percent increase will result in a total expenditure of $24,432,505, a difference of $118,604. Providers under the Community First Choice program would receive an increase based on the CPI-U, capped at 2.5 percent, for a total expenditure of $299,393,365. The 3 percent increase will result in a total expenditure of $300,853,821, a difference of $1,460,456. The sum of these impacts is $1,834,314.
B. Providers of Autism Waiver services would receive an increase based on the CPI-U, capped at 2.5 percent, for a total expenditure of $24,323,250. The 3 percent increase will result in a total expenditure of $24,441,911, a difference of $118,650.
D. Providers of home and community-based services will receive an additional rate increase totaling $1,952,962 during Fiscal Year 2019 under the provisions of the proposed action, as described in Section IIIA and B.

Economic Impact on Small Businesses

The proposed action has a meaningful economic impact on small business. An analysis of this economic impact follows.

Many of the providers of home and community-based services under these chapters are small businesses that will benefit from additional rate increases under the provisions of the proposed action.

Impact on Individuals with Disabilities

The proposed action has an impact on individuals with disabilities as follows:

Individuals with disabilities receive services provided under these chapters and will benefit to the extent that improved funding will enable providers to maintain quality services.

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 tomdh.regs@maryland.gov, or fax to 410-767-6483. Comments will be accepted through December 10, 2018. A public hearing has not been scheduled.

10.09.07 Medical Day Care Services

Authority: Health-General Article, §§2-104(b), 15-103, 15-105, and 15-111, Annotated Code of Maryland

.08 Payment Procedures.

A.—C. (text unchanged)

D. Per Diem Rate.

(1) Payment to a provider of medical day care services shall be on a per diem basis. The per diem rate is [$75.99] $79.84 effective July 1, [2016] 2018.

[(2) Effective July 1, 2017, subject to the limitations of the State’s budget, the per diem rate shall be adjusted annually by the percentage of the annual increase in the previous July Consumer Price Index for All Urban Consumers, medical care component, Washington-Baltimore, from U.S. Department of Labor, Bureau of Labor Statistics.

(3) Any increase in the per diem rate for medical day care services as determined under §D(2) of this regulation may not be greater than 5 percent.]

(2) The per diem rate shall increase on July 1 of each year by 3 percent, subject to the limitations of the State budget.

E.—F. (text unchanged)

10.09.20 Community Personal Assistance Services

Authority: Health-General Article, §§2-104(b), 15-103, and 15-105, Annotated Code of Maryland

.14 Payment Procedures.

A.—D. (text unchanged)

E. Effective July 1, 2018, for personal assistance services up to 12 hours per day, payment will be made in 15-minute units of service. For individuals who are determined to need more than 12 hours of personal assistance per day, a daily rate for the service will be paid.

[E.] F. Rates.

(1) (text unchanged)

(2) [The] Effective July 1, 2018, the Program’s rates as specified in the Department’s fee schedule shall increase on July 1 of each year by 3 percent, subject to the limitations of the State budget[, by the lesser of:

(a) 2.5 percent; or

(b) The percentage of the annual increase in the previous July Consumer Price Index for All Urban Consumers, medical care component, Washington-Baltimore, from U.S. Department of Labor, Bureau of Labor Statistics].

10.09.27 Home Care for Disabled Children Under a Model Waiver

Authority: Health-General Article, §§2-104(b), 15-103, and 15-105, Annotated Code of Maryland

.06 Payment Procedures.

A. [Request for Payment.

(1)] Payment procedures as set forth in COMAR 10.09.36 apply.

[(2) Requests for payment shall include all units of service, as specified in §C of this regulation.

(3) The nursing provider shall bill the Program the provider’s customary charge to the general public.

(4) Home care case management providers shall bill the Program as specified in §C(2) of this regulation.

(5) The principal physician provider shall bill the Program the provider’s customary charge to the general public.

(6) The home health aide and certified nursing assistant provider shall bill the Program the provider’s customary charge to the general public.

(7) Medical day care service providers shall bill the Program as specified in COMAR 10.09.07.

(8) If the service is free to individuals not covered by Medicaid:

(a) The provider:

(i) May charge the Program; and

(ii) Shall be reimbursed in accordance with §C of this regulation; and

(b) The provider’s reimbursement is not limited to the provider’s customary charge.]

[B.] — [D.] (proposed for repeal)

B. Payments.

(1) Payments shall be made directly to a qualified provider.

(2) Providers shall be paid the lesser of:

(a) The provider’s customary charge to the general public unless the service is free to individuals not covered by Medicaid; or

(b) The rate established according to the fee schedule published by the Department.

C. Rates.

(1) The Department shall publish a fee schedule for services covered under this chapter that shall be publicly available and updated at least annually or upon any changes made by the Department.

(2) Effective July 1, 2018, the Program’s rates as specified in the Department’s fee schedule shall increase on July 1 of each year by 3 percent, subject to the limitations of the State budget.

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

.07 Payment Procedures.

A. (text unchanged)

[B.] — [E.] (proposed for repeal)

B. Payments.

(1) Payments shall be made directly to a qualified provider.

(2) Providers shall be paid the lesser of:

(a) The provider’s customary charge to the general public unless the service is free to individuals not covered by Medicaid; or

(b) The rate established according to the fee schedule published by the Department.

C. Rates.

(1) The Department shall publish a fee schedule for services covered under this chapter that shall be publicly available and updated at least annually or upon any changes made by the Department.

(2) Effective July 1, 2018, the Program’s rates as specified in the Department’s fee schedule shall increase on July 1 of each year by 3 percent, subject to the limitations of the State budget.

[F.] D. (text unchanged)

10.09.54 Home and Community-Based Options Waiver

Authority: Health-General Article, §§2-104(b), 15-103, 15-105, and 15-132, Annotated Code of Maryland

.22 Payment Procedures.

A.—C. (text unchanged)

D. Rates.

(1) (text unchanged)

(a) 2.5 percent; or

10.09.56 Home and Community-Based Services Waiver for Children with Autism Spectrum Disorder

Authority: Health-General Article, §§2-104(b), 15-103, 15-105, and 15-130, Annotated Code of Maryland

.22 Payment Procedures.

A.—C. (text unchanged)

D. Payments.

(1) (text unchanged)

[(2) The Program shall pay according to the following fee-for-service schedule:

(a) Residential habilitation services and retainer payments: reimbursed at one of the following all-inclusive, maximum rates for a participant:

(i) $201.70 per unit for the regular level of service; or

(ii) $403.42 per unit for the intensive level of service;

(b) Therapeutic integration services: reimbursed at the maximum rate of $12.23 per unit;

(d) Intensive individual support services: reimbursed at the maximum rate of $15.28 per unit;

(e) Respite care: reimbursed at the maximum rate of $11.94 per unit;

(f) Family consultation: reimbursed at the maximum rate of $50.17 per unit;

(g) Adult life planning services: reimbursed at the maximum rate of $50.17 per unit;

(h) Environmental accessibility adaptations: reimbursed at the amount billed by the provider, which shall be the lesser of the:

(i) Amount authorized by the State Department of Education; or

(ii) Actual cost of the job.

(3) The program shall only pay for services at the lesser of:

(a) The fee for service schedule; or

(b) The actual cost.]

(2) Providers shall be paid the lesser of:

(a) The provider’s customary charge to the general public unless the service is free to individuals not covered by Medicaid; or

(b) The rate established according to the fee schedule published by the Department.

E. Rates.

(1) The Department shall publish a fee schedule for services covered under this chapter that shall be publicly available and updated at least annually or upon any changes made by the Department.

[(4)] (2) [The] Effective July 1, 2018, the Program’s rates as specified in [§D(2)(a)—(g) of this regulation shall be effective January 1, 2015 and] the Department’s fee schedule shall increase on July 1 of each year by 3 percent, subject to the limitations of the State budget[, by the lesser of:

(a) 2.5 percent; or

(b) The change from March to March in the medical care component of the Consumer Price Index for all urban consumers (CPI-U) for the Washington-Baltimore area].

10.09.84 Community First Choice

Authority: Health-General Article, §§2-104(b), 15-103, and 15-105, Annotated Code of Maryland

.24 Payment Procedures.

A.—E. (text unchanged)

F. Rates.

(1) (text unchanged)

(2) [The] Effective July 1, 2018, the Program’s rates for covered services under Regulations .14—.16, [.18E] .18D, .19, and .20 of this chapter shall increase on July 1 of each year by 3 percent, subject to the limitations of the State budget[, by the lesser of:

(a) 2.5 percent; or

ROBERT R. NEALL
Secretary of Health

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