Issue Date: September 2, 2016
Volume 43 • Issue 18 • Pages 1025—1027
DEPARTMENT OF HEALTH AND MENTAL HYGIENE
Subtitle 09 MEDICAL CARE PROGRAMS
Notice of Proposed Action
The Secretary of Health and Mental Hygiene proposes to amend:
(1) Regulations .02, .03, and .23 under COMAR 10.09.65 Maryland Medicaid Managed Care Program: Managed Care Organizations;
(2) Regulation .01 under COMAR 10.09.66 Maryland Medicaid Managed Care Program: Access; and
(3) Regulation .15 under COMAR 10.09.67 Maryland Medicaid Managed Care Program: Benefits.
Statement of Purpose
The purpose of this action is to:
(1) Include sexual orientation and gender as basis for nondiscrimination;
(2) Add section 1157 of the Affordable Care Act to the list of provisions that MCOs must comply with;
(3) Remove the requirement that a full SPR review must be conducted annually;
(4) Replace the current asthma HEDIS measure with asthma medication ratio effective January 1, 2017;
(5) Include texts and emails as prohibited cold-call marketing activities; and
(6) Clarify that medically necessary podiatry services are covered for all members.
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 firstname.lastname@example.org, or fax to 410-767-6483. Comments will be accepted through October 3, 2016. A public hearing has not been scheduled.
10.09.65 Maryland Medicaid Managed Care Program: Managed Care Organizations
Authority: Health-General Article, §§2-104 and 15-103, Annotated Code of Maryland
.02 Conditions for Participation.
A.—F. (text unchanged)
G. An MCO:
(1) (text unchanged)
(2) May not discriminate against an enrollee on any basis, including, but not limited to, age, sex, race, creed, color, marital status, sexual orientation, gender identity, national origin, physical or mental handicap, health status, or need for health care services;
(3)—(4) (text unchanged)
H.—I. (text unchanged)
J. MCO Local Access Area Participation.
(1)—(3) (text unchanged)
(4) Unless the Department approves a shorter time frame, an MCO that exits the Program during the calendar year shall submit their exit transition plan to the Department 120 days prior to the effective date of the exit.
[(4)] (5)—[(7)] (8) (text unchanged)
K.—W. (text unchanged)
X. An MCO shall meet all other requirements of applicable State and federal law including but not limited to:
(1)—(5) (text unchanged)
(6) Any laws that pertain to enrollee rights; [and]
(7) 45 CFR Part 74, as amended, including particular attention to requirements at 45 CFR §§74.42, 74.43, 74.44, 74.48, and 74. 53(a) and (b), and Appendix A; and
(8) Section 1557 of the Affordable Care Act.
Y.—EE. (text unchanged)
.03 Quality Assessment and Improvement.
A. (text unchanged)
B. An MCO shall participate in all quality assessment activities required by the Department in order to determine if the MCO is providing medically necessary enrollee health care. These activities include, but are not limited to:
(1) [An annual] A Systems Performance Review (SPR) performed by an external quality review organization hired by the Department to assess an MCO’s structure and operations in order to determine its ability to provide health care to its enrollees as follows:
(a)—(d) (text unchanged)
(2) (text unchanged)
(3) The annual collection and evaluation of a set of performance measures with targets as determined by the Department as follows:
(a) The composition of the core performance measures are listed in [§B(3)(d)] §B(3)(d) and (e) of this regulation;
(b)—(d) (text unchanged)
(e) Effective January 1, 2017, the core performance measures are:
(i) Adolescent well care visits;
(ii) Adult Body Mass Index (BMI) assessment;
(iii) Ambulatory care for Supplemental Security Income (SSI) adults;
(iv) Ambulatory care for Supplemental Security Income (SSI) children;
(v) Breast cancer screening;
(vi) Childhood immunizations—Combo 3;
(vii) Comprehensive diabetes care—HbA1c testing;
(viii) Controlling high blood pressure;
(ix) Immunization for adolescents;
(x) Lead screening for children 12—23 months old;
(xi) Asthma medication ratio;
(xii) Postpartum care; and
(xiii) Well child visits, 3—6 years old;
[(e)] (f)—[(g)] (h) (text unchanged)
(4)—(6) (text unchanged)
C. (text unchanged)
A.—B. (text unchanged)
C. An MCO may not engage in any cold call marketing, including activities using or involving any of the following mechanisms:
(1)—(3) (text unchanged)
[(4)] (6)—[(5)] (7) (text unchanged)
D. (text unchanged)
10.09.66 Maryland Medicaid Managed Care Program: Access
Authority: Health-General Article, §§15-102.1(b)(10) and 15-103(b), Annotated Code of Maryland
.01 Access Standards: Addressing Enrollees’ Individualized Needs.
A. An MCO shall provide access to health care services and information in a manner that addresses the individualized needs of its enrollees, regardless of gender, sexual orientation, or gender identity, including, but not limited to, the delivery of services and information to enrollees:
(1)—(4) (text unchanged)
B. (text unchanged)
10.09.67 Maryland Medicaid Managed Care Program: Benefits
Authority: Health-General Article, Title 15, Subtitle 1, Annotated Code of Maryland
.15 Benefits — Podiatry Services.
A. An MCO shall provide for its enrollees medically necessary podiatry services [as follows:].
[A. Medically necessary services for enrollees younger than 21 years old;]
B. In addition to the services described in §A of this regulation, an MCO shall provide:
[B.] (1)—[C.] (2) (text unchanged)
VAN T. MITCHELL
Secretary of Health and Mental Hygiene