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    Maryland Department of Health
    Regulations

    ​PROPOSAL

    Maryland Register

    Issue Date:  June 7, 2019

    Volume 46 • Issue 12 • Page 554-556

    Title 10 
    MARYLAND DEPARTMENT OF HEALTH

    Subtitle 09 MEDICAL CARE PROGRAMS

    10.09.65 Maryland Medicaid Managed Care Program: Managed Care Organizations

    Authority: Health-General Article, §§2-104, 15-102.3, and 15-103; Insurance Article, §§15-112, 15-605, and 15-1008; Annotated Code of Maryland

    Notice of Proposed Action

    [19-107-P]

         The Secretary of Health proposes to amend Regulation .19 under COMAR 10.09.65 Maryland Medicaid Managed Care Program: Managed Care Organizations.

    Statement of Purpose

    The purpose of this action is to implement the calendar year 2019 HealthChoice Managed Care Organization capitation rates.

    Comparison to Federal Standards

    There is no corresponding federal standard to this proposed action.

    Estimate of Economic Impact

    I. Summary of Economic Impact. The HealthChoice CY 2019 MCO rate adjustment is a decrease of $12,273,269 compared to the FY 2019 appropriation and previously projected spending for the first half of FY 2020. Overall it is a 1.4 percent rate decrease.

     

     

    Revenue (R+/R-)

     

    II. Types of Economic Impact.

    Expenditure (E+/E-)

    Magnitude

     
     

    A. On issuing agency:

    (E-)

    $12,273,269

    B. On other State agencies:

    NONE

    C. On local governments:

    NONE

     

    Benefit (+)
    Cost (-)

    Magnitude

     
     

    D. On regulated industries or trade groups:

    (-)

    $12,273,269

    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. For CY 2019, there is a 1.4 percent decrease, or $12,273,269 decrease, to the Department’s expenses.

    D. For CY 2019, there is a 1.4 percent decrease, or $12,273,269 decrease, to the MCO’s revenue.

    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 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 to mdh.regs@maryland.gov, or fax to 410-767-6483. Comments will be accepted through July 8, 2019. A public hearing has not been scheduled.

    .19 MCO Reimbursement.

    A. (text unchanged)

    B. Capitation Rate-Setting Methodology.

    (1)—(3) (text unchanged)

    (4) Except to the extent of adjustments required by §D of this regulation or by Regulations .19-1—.19-4 of this chapter, the Department shall make payments monthly at the rates specified in the following tables:

    [(a)] — [(d)] (proposed for repeal)

    (a) Rate Table for Families and Children Effective January 1, 2019 — December 31, 2019

    Age/RAC

    Gender

    PMPM Baltimore City

    PMPM Montgomery County

    PMPM Rest of State

    Under age 1 Birth Weight 1500 grams or less

    Both

    $10,633.45

    $9,884.60

    $10,042.70

    Under age 1 Birth Weight over 1500 grams

    Both

    $503.91

    $468.42

    $475.91

    1—5

    Male

    $201.37

    $187.18

    $190.18

    Female

    $171.52

    $159.44

    $161.99

    6—14

    Male

    $115.66

    $107.51

    $109.23

    Female

    $110.78

    $102.98

    $104.63

    15—20

    Male

    $137.88

    $128.17

    $130.22

    Female

    $189.12

    $175.80

    $178.62

    21—44

    Male

    $271.41

    $225.13

    $235.22

    Female

    $384.69

    $319.09

    $333.38

    45—64

    Male

    $519.10

    $430.59

    $449.87

    Female

    $638.23

    $529.41

    $553.12

    ACG-adjusted cells

    ACG 100, 200, 300, 400, 500, 600, 700, 900, 1000, 1100, 1200, 1300, 1600, 1710, 1711, 1712, 1720, 1721, 1722, 1730, 1731, 1732, 1800, 1900, 2000, 2100, 2200, 2300, 2400, 2500, 2800, 2900, 3000, 3100, 3200, 3300, 3400, 3500, 3800, 4210, 5100, 5110, 5200 5230, 5310, 5339

    RAC 1F

    Both

    $243.24

    $201.77

    $210.80

    ACG 800, 1740, 1741, 1742, 1750, 2700, 3600, 1750, 1751, 1752, 2700, 3600, 3700, 3900, 4000, 4100, 4220, 4310, 4410, 4510, 4610, 4710, 4720, 4810, 5340

    RAC 2F

    Both

    $391.81

    $325.00

    $339.55

    ACG 1400, 1500, 1750, 1761, 1762, 1770, 1771, 1772, 2600, 4320, 4520, 4620, 4820

    RAC 3F

    Both

    $506.38

    $420.03

    $438.85

    ACG 4330, 4420, 4830, 4910, 4920, 5010, 5020, 5040

    RAC 4F

    Both

    $704.46

    $584.34

    $610.52

    ACG 4430, 4730, 4930, 5030, 5050

    RAC 5F

    Both

    $997.30

    $827.24

    $864.30

    ACG 4940, 5060

    RAC 6F

    Both

    $1,281.41

    $1,062.91

    $1,110.52

    ACG 5070

    RAC 7F

    Both

    $2,083.82

    $1,728.50

    $1,805.92

    ACG 100, 200, 300, 500, 600, 1100, 1600, 2000, 2400, 3400, 5100, 5110, 5200

    RAC 1G

    Both

    $89.37

    $83.08

    $84.41

    ACG 400, 700, 900, 1000, 1200, 1300, 1710, 1711, 1712, 1800, 1900, 2100, 2200, 2300, 2800, 2900, 3000, 3100, 5310

    RAC 2G

    Both

    $114.64

    $106.57

    $108.27

    ACG 1720, 1721, 1722, 1731, 1732, 1730, 2500, 3200, 3300, 3500, 3800, 4210, 5230, 5339

    RAC 3G

    Both

    $144.33

    $134.16

    $136.31

    ACG 800, 1740, 1741, 1742, 1750, 2700, 3600, 1750, 1751, 1752, 2700, 3600, 3700, 3900, 4000, 4100, 4220, 4310, 4410, 4510, 4610, 4710, 4720, 4810, 5340

    RAC 4G

    Both

    $205.57

    $191.09

    $194.15

    ACG 1400, 1500, 1750, 1761, 1762, 1770, 1771, 1772, 2600, 4320, 4520, 4620, 4820

    RAC 5G

    Both

    $326.72

    $303.71

    $308.56

    ACG 4330, 4420, 4830, 4910, 4920, 5010, 5020, 5040

    RAC 6G

    Both

    $395.20

    $367.37

    $373.24

    ACG 4430, 4730, 4930,4940, 5030, 5050, 5060, 5070

    RAC 7G

    Both

    $1,030.02

    $957.48

    $972.79

    SOBRA Mothers

    $691.48

    $573.58

    $599.27

    Persons with HIV

    ALL

    Both

    $678.39

    $678.39

    $678.39

     

    (b) Rate Table for Disabled Individuals Effective January 1, 2019 — December 31, 2019

    Age/RAC

     

    Gender

    PMPM

    Baltimore City

    PMPM Montgomery County

    PMPM Rest of State

     

    Under Age 1

    Both

    $6,429.19

    $6,429.19

    $6,429.19

     

    1—5

    Male

    $1,326.70

    $1,326.70

    $1,326.70

     

     

    Female

    $900.96

    $900.96

    $900.96

     

    6—14

    Male

    $298.83

    $298.83

    $298.83

     

     

    Female

    $470.97

    $470.97

    $470.97

     

    15—20

    Male

    $238.55

    $238.55

    $238.55

     

     

    Female

    $290.24

    $290.24

    $290.24

     

    21—44

    Male

    $649.59

    $471.43

    $553.89

     

     

    Female

    $848.77

    $615.99

    $723.73

     

    45—64

    Male

    $2,098.31

    $1,522.84

    $1,789.20

     

    45—64

    Female

    $2,229.06

    $1,617.73

    $1,900.68

    ACG-adjusted cells

    ACG 100, 200, 300, 1100, 1300, 1400, 1500, 1600, 1710, 1711, 1712, 1720, 1721, 1722, 1730, 1731, 1732, 1900, 2400, 2600, 2900, 3400, 5100, 5110, 5200, 5310

    RAC 10

    Both

    $296.35

    $215.07

    $252.69

    ACG 400, 500, 700, 900, 1000, 1200, 1740, 1741, 1742, 1750, 1751, 1752 1800, 2000, 2100, 2200, 2300, 2500, 2700, 2800, 3000, 3100, 3200, 3300, 3500, 3900, 4000, 4310, 5330

    RAC 11

    Both

    $364.82

    $264.76

    $311.07

    ACG 600, 1760, 1761, 1762, 3600, 3700, 4100, 4320, 4410, 4710, 4810, 4820

    RAC 12

    Both

    $699.42

    $507.60

    $596.38

    ACG 3800, 4210, 4220, 4330, 4420, 4720, 4910, 5320

    RAC 13

    Both

    $783.85

    $568.51

    $667.95

    ACG 800, 4430, 4510, 4610, 5040, 5340

    RAC 14

    Both

    $1,096.47

    $795.76

    $934.94

    ACG 1770, 1771, 1772, 4520, 4620, 4830, 4920, 5050

    RAC 15

    Both

    $1,381.88

    $1,002.89

    $1,178.30

    ACG 4730, 4930, 5010

    RAC 16

    Both

    $1,423.21

    $1,032.88

    $1,213.54

    ACG 4940, 5020, 5060

    RAC 17

    Both

    $2,170.47

    $1,575.21

    $1,850.72

    ACG 5030, 5070

    RAC 18

    Both

    $3,872.14

    $2,810.08

    $3,301.70

    Persons with AIDS

    All

    Both

    $1,982.61

    $1,269.36

    $1,269.36

    Persons with HIV

    All

    Both

    $1,997.41

    $1,997.41

    $1,997.41

     

    (c) Rate Table for Supplemental Payments for Delivery/Newborn and Hepatitis C Therapy Effective January 1, 2019 — December 31, 2019

    Age

    Gender

    Baltimore City

    Montgomery County

    Rest of State

    Supplemental Payment Cells

     

     

     

     

     

    Delivery/Newborn-all births except live birth weight 1,500 grams or less and gestational age of 21 weeks or more

    All

    Both

    $16,395.64

    $12,953.96

    $14,130.96

    Delivery/Newborn — live birth weight 1,500 grams or less and a gestational age of 21 weeks or more

    All

    Both

    $86,211.08

    $86,211.08

    $86,211.08

    Delivery/Newborn by same enrollee — subsequent live birth weight 1,500 grams or less with a gestational age less than 21 weeks or does not meet the requirements in §B(4)(i) of this regulation

    All

    Both

    $16,395.64

    $12,953.96

    $14,130.96

    Hepatitis C Therapy

    All

    Both

    $20,598.22

    $20,598.22

    $20,598.22

     

    (d) Rate Table for Childless Adult Population Effective January 1, 2019 — December 31, 2019

     

    Age/RAC

    Gender

    PMPM Baltimore City

    Montgomery County

    PMPM Rest of State

     

    19—44

    Male

    $347.86

    $277.04

    $316.60

     

    19—44

    Female

    $412.94

    $328.87

    $375.82

     

    45—64

    Male

    $940.05

    $748.66

    $855.56

     

    45—64

    Female

    $865.06

    $688.94

    $787.30

    ACG-adjusted cells

     

     

     

     

     

    ACG 100, 200, 300, 400, 500, 600, 700, 900, 1000, 1100, 1200, 1300, 1600, 1710, 1711, 1712, 1720, 1721, 1722, 1730, 1731, 1732, 1800, 1900, 2000, 2100, 2200, 2300, 2400, 2500, 2800, 2900, 3000, 3100, 3200, 3300, 3400, 3500, 3800, 4210, 5100, 5110, 5200 5230, 5310, 5339

    RAC 1H

    Both

    $308.54

    $245.72

    $280.81

    ACG 800, 1740, 1741, 1742, 1750, 2700, 3600, 1750, 1751, 1752, 2700, 3600, 3700, 3900, 4000, 4100, 4220, 4310, 4410, 4510, 4610, 4710, 4720, 4810, 5340

    RAC 2H

    Both

    $464.28

    $369.75

    $422.55

    ACG 1400, 1500, 1750, 1761, 1762, 1770, 1771, 1772, 2600, 4320, 4520, 4620, 4820

    RAC 3H

    Both

    $483.85

    $385.02

    $439.99

    ACG 4330, 4420, 4830, 4910, 4920, 5010, 5020, 5040

    RAC 4H

    Both

    $838.59

    $667.86

    $763.22

    ACG 4430, 4730, 4930, 5030, 5050

    RAC 5H

    Both

    $1,049.48

    $835.81

    $955.15

    ACG 4940, 5060

    RAC 6H

    Both

    $1,356.64

    $1,080.43

    $1,234.70

    ACG 5070

    RAC 7H

    Both

    $2,178.60

    $1,735.05

    $1,982.78

    HIV

    19—64

    Both

    $577.22

    $577.22

    $577.22

    (e)—(i) (text unchanged)

    (5) (text unchanged)

    C.—D. (text unchanged)

    ROBERT R. NEALL
    Secretary of Health

     ​