Main_Content

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PROPOSAL

Maryland Register

Issue Date:  December 9, 2016

Volume 43 • Issue 25• Pages 1398—1401

 

Title 10
DEPARTMENT OF HEALTH AND MENTAL HYGIENE

Subtitle 09 MEDICAL CARE PROGRAMS

10.09.70 Maryland Medicaid Managed Care Program: Non-Capitated Covered Services

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

Notice of Proposed Action

[16-326-P]

The Secretary of Health and Mental Hygiene proposes to amend Regulation .02 under COMAR 10.09.70 Maryland Medicaid Managed Care Program: Non-Capitated Covered Services.

Statement of Purpose

The purpose of this action is to update the ICD-10 diagnosis codes included in the behavioral health carve out. The amendment delineates which claims the Administrative Service Organization is responsible for paying and which claims the Managed Care Organizations are responsible for paying. This will bring the regulations up to date with the latest CMS mandated updates.

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 January 9, 2017. A public hearing has not been scheduled.

.02 Behavioral Health Non-Capitated Covered Services.

A.—C. (text unchanged)

D. An MCO is not responsible for reimbursing for the following substance use disorder services if the MCO is billed with a primary diagnosis listed in [§J] §K of this regulation:

E.—F. (text unchanged)

G. An MCO is not responsible for reimbursing the behavioral poisoning diagnoses listed in §N of this regulation in an emergency department setting.

[G.] H. An MCO is not responsible for services billed by specialty mental health providers listed in COMAR 10.09.59 when the bill includes the specialty behavioral health diagnoses listed in [§J or K] §K or L in the primary diagnosis field.

[H.] I. — [J.] K. (text unchanged)

[K.] L. Table of mental health diagnoses:

(1) (text unchanged)

 (2) For dates of service on or after October 1, 2015:

 

F200—F325	(text unchanged)
[F328	Other depressive episodes]
F3281	Premenstrual dysphoric disorder
F3289	Other specified depressive episodes
F329—F341	(text unchanged)
[F348	Other persistent mood (affective) disorders]
F3481	Disruptive mood dysregulation disorder
F3489	Other specified persistent mood disorders
F349—F419	(text unchanged)
[F42	Obsessive-compulsive disorder]
F422	Mixed obsessional thoughts and acts
F423	Hoarding disorder
F424	Excoriation (skin-picking) disorder
F428	Other obsessive compulsive disorder
F429	Obsessive-compulsive disorder, unspecified
F430—F502	(text unchanged)
[F508	Other eating disorders]
F5081	Binge eating disorder
F5089	Other specified eating disorder
F509—F639	(text unchanged)
F640	Transsexualism
F641—Z046	(text unchanged)

 

[L.] M. (text unchanged)

N. Table of poisoning diagnoses, for dates of service on or after July 1, 2016:

 

T360X2A	Poisoning by penicillins, intentional self-harm
T361X2A	Poisoning by cephalosporins and other beta-lactam antibiotics, intentional self-harm
T362X2A	Poisoning by chloramphenicol group, intentional self-harm
T363X2A	Poisoning by macrolides, intentional self-harm
T364X2A	Poisoning by tetracyclines, intentional self-harm
T365X2A	Poisoning by aminoglycosides, intentional self-harm
T366X2A	Poisoning by rifampicins, intentional self-harm
T367X2A	Poisoning by antifungal antibiotics, systemically used, intentional self-harm
T368X2A	Poisoning by other systemic antibiotics, intentional self-harm
T369X2A	Poisoning by unspecified systemic antibiotic, intentional self-harm
T370X2A	Poisoning by sulfonamides, intentional self-harm
T371X2A	Poisoning by antimycobacterial drugs, intentional self-harm
T372X2A	Poisoning by antimalarials and drugs acting on other blood protozoa, intentional self-harm
T373X2A	Poisoning by other antiprotozoal drugs, intentional self-harm
T374X2A	Poisoning by anthelminthics, intentional self-harm
T375X2A	Poisoning by antiviral drugs, intentional self-harm
T378X2A	Poisoning by other specified systemic anti-infectives and antiparasitics, intentional self-harm
T3792XA	Poisoning by unspecified systemic anti-infective and antiparasitics, intentional self-harm
T380X2A	Poisoning by glucocorticoids and synthetic analogues, intentional self-harm
T381X2A	Poisoning by thyroid hormones and substitutes, intentional self-harm
T382X2A	Poisoning by antithyroid drugs, intentional self-harm
T383X2A	Poisoning by insulin and oral hypoglycemic [antidiabetic] drugs, intentional self-harm
T384X2A	Poisoning by oral contraceptives, intentional self-harm
T385X2A	Poisoning by other estrogens and progestogens, intentional self-harm
T386X2A	Poisoning by antigonadotrophins, antiestrogens, antiandrogens, not elsewhere classified, intentional self-harm
T387X2A	Poisoning by androgens and anabolic congeners, intentional self-harm
T38802A	Poisoning by unspecified hormones and synthetic substitutes, intentional self-harm
T38812A	Poisoning by anterior pituitary [adenohypophyseal] hormones, intentional self-harm
T38892A	Poisoning by other hormones and synthetic substitutes, intentional self-harm
T38902A	Poisoning by unspecified hormone antagonists, intentional self-harm
T38992A	Poisoning by other hormone antagonists, intentional self-harm
T39012A	Poisoning by aspirin, intentional self-harm
T39092A	Poisoning by salicylates, intentional self-harm
T391X2A	Poisoning by 4-Aminophenol derivatives, intentional self-harm
T392X2A	Poisoning by pyrazolone derivatives, intentional self-harm
T39312A	Poisoning by propionic acid derivatives, intentional self-harm
T39392A	Poisoning by other nonsteroidal anti-inflammatory drugs [NSAID], intentional self-harm
T394X2A	Poisoning by antirheumatics, not elsewhere classified, intentional self-harm
T398X2A	Poisoning by other nonopioid analgesics and antipyretics, not elsewhere classified, intentional self-harm
T3992XA	Poisoning by unspecified nonopioid analgesic, antipyretic and antirheumatic, intentional self-harm
T400X2A	Poisoning by opium, intentional self-harm
T401X2A	Poisoning by heroin, intentional self-harm
T402X2A	Poisoning by other opioids, intentional self-harm
T403X2A	Poisoning by methadone, intentional self-harm
T404X2A	Poisoning by other synthetic narcotics, intentional self-harm
T405X2A	Poisoning by cocaine, intentional self-harm
T40602A	Poisoning by unspecified narcotics, intentional self-harm
T40692A	Poisoning by other narcotics, intentional self-harm
T407X2A	Poisoning by cannabis (derivatives), intentional self-harm
T408X2A	Poisoning by lysergide [LSD], intentional self-harm
T40902A	Poisoning by unspecified psychodysleptics [hallucinogens], intentional self-harm
T40992A	Poisoning by other psychodysleptics [hallucinogens], intentional self-harm
T410X2A	Poisoning by inhaled anesthetics, intentional self-harm
T411X2A	Poisoning by intravenous anesthetics, intentional self-harm
T41202A	Poisoning by unspecified general anesthetics, intentional self-harm
T41292A	Poisoning by other general anesthetics, intentional self-harm
T413X2A	Poisoning by local anesthetics, intentional self-harm
T4142XA	Poisoning by unspecified anesthetic, intentional self-harm
T415X2A	Poisoning by therapeutic gases, intentional self-harm
T420X2A	Poisoning by hydantoin derivatives, intentional self-harm
T421X2A	Poisoning by iminostilbenes, intentional self-harm
T422X2A	Poisoning by succinimides and oxazolidinediones, intentional self-harm
T423X2A	Poisoning by barbiturates, intentional self-harm
T424X2A	Poisoning by benzodiazepines, intentional self-harm
T425X2A	Poisoning by mixed antiepileptics, intentional self-harm
T426X2A	Poisoning by other antiepileptic and sedative-hypnotic drugs, intentional self-harm
T4272XA	Poisoning by unspecified antiepileptic and sedative-hypnotic drugs, intentional self-harm
T428X2A	Poisoning by antiparkinsonism drugs and other central muscle-tone depressants, intentional self-harm
T43012A	Poisoning by tricyclic antidepressants, intentional self-harm
T43022A	Poisoning by tetracyclic antidepressants, intentional self-harm
T431X2A	Poisoning by monoamine-oxidase-inhibitor antidepressants, intentional self-harm
T43202A	Poisoning by unspecified antidepressants, intentional self-harm
T43212A	Poisoning by selective serotonin and norepinephrine reuptake inhibitors, intentional self-harm
T43222A	Poisoning by selective serotonin reuptake inhibitors, intentional self-harm
T43292A	Poisoning by other antidepressants, intentional self-harm
T433X2A	Poisoning by phenothiazine antipsychotics and neuroleptics, intentional self-harm
T434X2A	Poisoning by butyrophenone and thiothixene neuroleptics, intentional self-harm
T43502A	Poisoning by unspecified antipsychotics and neuroleptics, intentional self-harm
T43592A	Poisoning by other antipsychotics and neuroleptics, intentional self-harm
T43602A	Poisoning by unspecified psychostimulants, intentional self-harm
T43612A	Poisoning by caffeine, intentional self-harm
T43622A	Poisoning by amphetamines, intentional self-harm
T43632A	Poisoning by methylphenidate, intentional self-harm
T43692A	Poisoning by other psychostimulants, intentional self-harm
T438X2A	Poisoning by other psychotropic drugs, intentional self-harm
T4392XA	Poisoning by unspecified psychotropic drug, intentional self-harm
T440X2A	Poisoning by anticholinesterase agents, intentional self-harm
T441X2A	Poisoning by other parasympathomimetics [cholinergics], intentional self-harm
T442X2A	Poisoning by ganglionic blocking drugs, intentional self-harm
T443X2A	Poisoning by other parasympatholytics [anticholinergics and antimuscarinics] and spasmolytics, intentional self-harm
T444X2A	Poisoning by predominantly alpha-adrenoreceptor agonists, intentional self-harm
T445X2A	Poisoning by predominantly beta-adrenoreceptor agonists, intentional self-harm
T446X2A	Poisoning by alpha-adrenoreceptor antagonists, intentional self-harm
T447X2A	Poisoning by beta-adrenoreceptor antagonists, intentional self-harm
T448X2A	Poisoning by centrally-acting and adrenergic-neuron-blocking agents, intentional self-harm
T44902A	Poisoning by unspecified drugs primarily affecting the autonomic nervous system, intentional self-harm
T44992A	Poisoning by other drug primarily affecting the autonomic nervous system, intentional self-harm
T450X2A	Poisoning by antiallergic and antiemetic drugs, intentional self-harm
T451X2A	Poisoning by antineoplastic and immunosuppressive drugs, intentional self-harm
T452X2A	Poisoning by vitamins, intentional self-harm
T453X2A	Poisoning by enzymes, intentional self-harm
T454X2A	Poisoning by iron and its compounds, intentional self-harm
T45512A	Poisoning by anticoagulants, intentional self-harm
T45522A	Poisoning by antithrombotic drugs, intentional self-harm
T45602A	Poisoning by unspecified fibrinolysis-affecting drugs, intentional self-harm
T45612A	Poisoning by thrombolytic drug, intentional self-harm
T45622A	Poisoning by hemostatic drug, intentional self-harm
T45692A	Poisoning by other fibrinolysis-affecting drugs, intentional self-harm
T457X2A	Poisoning by anticoagulant antagonists, vitamin K and other coagulants, intentional self-harm
T458X2A	Poisoning by other primarily systemic and hematological agents, intentional self-harm
T4592XA	Poisoning by unspecified primarily systemic and hematological agent, intentional self-harm
T460X2A	Poisoning by cardiac-stimulant glycosides and drugs of similar action, intentional self-harm
T461X2A	Poisoning by calcium-channel blockers, intentional self-harm
T462X2A	Poisoning by other antidysrhythmic drugs, intentional self-harm
T463X2A	Poisoning by coronary vasodilators, intentional self-harm
T464X2A	Poisoning by angiotensin-converting-enzyme inhibitors, intentional self-harm
T465X2A	Poisoning by other antihypertensive drugs, intentional self-harm
T466X2A	Poisoning by antihyperlipidemic and antiarteriosclerotic drugs, intentional self-harm
T467X2A	Poisoning by peripheral vasodilators, intentional self-harm
T468X2A	Poisoning by antivaricose drugs, including sclerosing agents, intentional self-harm
T46902A	Poisoning by unspecified agents primarily affecting the cardiovascular system, intentional self-harm
T46992A	Poisoning by other agents primarily affecting the cardiovascular system, intentional self-harm
T470X2A	Poisoning by histamine H2-receptor blockers, intentional self-harm
T471X2A	Poisoning by other antacids and anti-gastric-secretion drugs, intentional self-harm
T472X2A	Poisoning by stimulant laxatives, intentional self-harm
T473X2A	Poisoning by saline and osmotic laxatives, intentional self-harm
T474X2A	Poisoning by other laxatives, intentional self-harm
T475X2A	Poisoning by digestants, intentional self-harm
T476X2A	Poisoning by antidiarrheal drugs, intentional self-harm
T477X2A	Poisoning by emetics, intentional self-harm
T478X2A	Poisoning by other agents primarily affecting gastrointestinal system, intentional self-harm
T4792XA	Poisoning by unspecified agents primarily affecting the gastrointestinal system, intentional self-harm
T480X2A	Poisoning by oxytocic drugs, intentional self-harm
T481X2A	Poisoning by skeletal muscle relaxants [neuromuscular blocking agents], intentional self-harm
T48202A	Poisoning by unspecified drugs acting on muscles, intentional self-harm
T48292A	Poisoning by other drugs acting on muscles, intentional self-harm
T483X2A	Poisoning by antitussives, intentional self-harm
T484X2A	Poisoning by expectorants, intentional self-harm
T485X2A	Poisoning by other anti-common-cold drugs, intentional self-harm
T486X2A	Poisoning by antiasthmatics, intentional self-harm
T48902A	Poisoning by unspecified agents primarily acting on the respiratory system, intentional self-harm
T48992A	Poisoning by other agents primarily acting on the respiratory system, intentional self-harm
T490X2A	Poisoning by local antifungal, anti-infective and anti-inflammatory drugs, intentional self-harm
T491X2A	Poisoning by antipruritics, intentional self-harm
T492X2A	Poisoning by local astringents and local detergents, intentional self-harm
T493X2A	Poisoning by emollients, demulcents and protectants, intentional self-harm
T494X2A	Poisoning by keratolytics, keratoplastics, and other hair treatment drugs and preparations, intentional self-harm
T495X2A	Poisoning by ophthalmological drugs and preparations, intentional self-harm
T496X2A	Poisoning by otorhinolaryngological drugs and preparations, intentional self-harm
T497X2A	Poisoning by dental drugs, topically applied, intentional self-harm
T498X2A	Poisoning by other topical agents, intentional self-harm
T4992XA	Poisoning by unspecified topical agent, intentional self-harm
T500X2A	Poisoning by mineralocorticoids and their antagonists, intentional self-harm
T501X2A	Poisoning by loop [high-ceiling] diuretics, intentional self-harm
T502X2A	Poisoning by carbonic-anhydrase inhibitors, benzothiadiazides and other diuretics, intentional self-harm
T503X2A	Poisoning by electrolytic, caloric and water-balance agents, intentional self-harm
T504X2A	Poisoning by drugs affecting uric acid metabolism, intentional self-harm
T505X2A	Poisoning by appetite depressants, intentional self-harm
T506X2A	Poisoning by antidotes and chelating agents, intentional self-harm
T507X2A	Poisoning by analeptics and opioid receptor antagonists, intentional self-harm
T508X2A	Poisoning by diagnostic agents, intentional self-harm
T50902A	Poisoning by unspecified drugs, medicaments and biological substances, intentional self-harm
T50992A	Poisoning by other drugs, medicaments and biological substances, intentional self-harm

VAN T. MITCHELL
Secretary of Health and Mental Hygiene

 

 

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