PROPOSAL
Maryland Register
Issue Date: November 28, 2016
Volume 43 • Issue 24 • Pages 1354—1355
Title 10
DEPARTMENT OF HEALTH AND MENTAL HYGIENE
Subtitle 09 MEDICAL CARE PROGRAMS
Notice of Proposed Action
[16-300-P]
The Secretary of Health and Mental Hygiene proposes to amend:
(1) Regulation .03 under COMAR 10.09.23 Early and Periodic Screening, Diagnosis and Treatment (EPSDT) Services;
(2) Regulation .19-3 under COMAR 10.09.65 Maryland Medicaid Managed Care Program: Managed Care Organizations; and
(3) Regulations .01, .07, and .12 under COMAR 10.09.67 Maryland Medicaid Managed Care Program: Benefits.
Statement of Purpose
The purpose of this action is to:
(1) Increase the minimum score requirement on Healthy Kids Program quality assurance reviews from 70 to 80 percent;
(2) Remove the requirement that an MCO be Statewide in order to receive a portion of any outstanding funds after the initial rural access incentive is paid;
(3) Clarify that MCOs must provide the services covered under the State Plan; and
(4) Increase from 30 to 90 the number of days an MCO is responsible for long term care admissions.
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 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 December 28, 2016. A public hearing has not been scheduled.
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
.03 Conditions for Participation.
A. (text unchanged)
B. To be certified to participate in the Healthy Kids Program as an EPSDT screening provider, a provider shall agree to:
(1)—(8) (text unchanged)
(9) Maintain a minimum score of [70] 80 percent on all Healthy Kids Program quality assurance reviews.
C. (text unchanged)
10.09.65 Maryland Medicaid Managed Care Program: Managed Care Organizations
Authority: Health-General Article, §§2-104 and 15-103 Annotated Code of Maryland
.19-3 MCO Rural Access Incentive.
A.—B. (text unchanged)
C. Amount of Rural Access Incentive.
(1) [Effective January 1, 2015, the] The Department shall allocate a maximum of $11,000,000 for each of the payments in §B(1) and (2) of this regulation, among each of the rural counties specified in §D of this regulation, based on the total MCO enrollment in each county.
(2) An eligible MCO shall receive a portion of the funds allocated to the rural county based on the ratio of the eligible MCO’s enrollment to the total enrollment for all eligible MCOs in the county combined with the fund distribution methodology described in §E of this regulation.
(3) Effective January 1, [2015] 2017, any outstanding funds not awarded in §C(2) of this regulation shall be distributed to all [Statewide] MCOs in accordance with each MCO’s Statewide enrollment, [or if there are no Statewide MCOs, to all MCOs in accordance with each MCO’s total enrollment] regardless of participation in a rural area or whether an MCO is accepting new members.
D.—E. (text unchanged)
10.09.67 Maryland Medicaid Managed Care Program: Benefits
Authority: Health-General Article, Title 15, Subtitle 1, Annotated Code of Maryland
.01 Required Benefits Package — In General.
A. Except for non-covered services set forth in Regulation .27 of this chapter and the non-capitated services described in COMAR 10.09.70, an MCO shall provide its enrollees with a benefits package that includes the covered services specified in this chapter when these services are deemed to be medically necessary including services covered under the Maryland Medicaid State Plan in the amount, duration, and scope set forth in the State Plan and in accordance with 42 CFR §440.230.
B.—F. (text unchanged)
.07 Benefits — Inpatient Hospital Services.
A. (text unchanged)
B. Admission to Long-Term Care Facility.
(1) An MCO shall provide to its enrollees medically necessary long-term care facility services for:
(a) The first [30] 90 continuous days following the enrollee's admission; and
(b) Any days following the first [30] 90 continuous days of an admission until the date the MCO has obtained the Department's determination that the admission is medically necessary as specified in §B(2) of this regulation.
(2) For any long-term care facility admission that is expected to result in a length of stay exceeding [30] 90 days, an MCO or long-term care facility shall request a determination by the Department that the admission is medically necessary.
(3) The Department’s determination as described in §B(2) of this regulation is only applicable if the enrollee is still in the long-term care facility on the [31st] 91st day.
(4) Acute care services provided within the first [30] 90 days following an enrollee's admission to a long-term care facility do not constitute a break in calculating the [30] 90 continuous day requirement if the enrollee is discharged from the hospital back to the long-term care facility.
C.— I. (text unchanged)
.12 Benefits — Long-Term Care Facility Services.
A. An MCO shall provide to its enrollees medically necessary services in a chronic hospital, a chronic rehabilitation hospital, or a nursing facility for:
(1) The first [30] 90 continuous days following the enrollee's admission; and
(2) Any days following the first [30] 90 continuous days of an admission until the date the MCO has obtained the Department’s determination that the admission is medically necessary as specified in §C of this regulation.
B. Acute care services provided within the first [30] 90 days following an enrollee's admission to a long-term care facility do not constitute a break in calculating the [30] 90 continuous day requirement if the enrollee is discharged from the hospital back to the long-term care facility.
C. For any long-term care facility admission that is expected to result in a length of stay exceeding [30] 90 days, an MCO or long-term care facility shall request a determination by the Department that the admission is medically necessary.
D. The Department’s determination as described in §C of this regulation is only applicable if the enrollee is still in the long-term care facility on the [31st] 91st day.
E.—G. (text unchanged)
VAN T. MITCHELL
Secretary of Health and Mental Hygiene
