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
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
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