STATE OF MARYLAND

DHMH PT lliK

Maryland Department of Health and Mental Hygiene201 W. Preston Street. Baltimore. Maryland 21201Parris N. Glendening. Governor - Georges C. Benjamin, M.D.. Secretary

MARYLAND MEDICAL ASSISTANCE PROGRAMHospital Transmittal No. 173

April 24, 2000

TO: Hospital Administrators

~MFROM: Joseph M. Millstone, Executive DirectorOffice of Health Services

NOTE: Please ensure that appropriate staff members in your organization are infOmled ofthe contents of this transmittal

RE: Emergency and Proposed Amendments to Hospital Services Regulations

EFFECI'IVE DATE:February 2, 2000

ACTION:Emergency RegulationsProposed Regulations

PROGRAM CONTACT PERSON:Katherine Tvaronas (410) 767-1478

The Maryland Medical Assistance Program proposed amendments to Regulations .0 I,.04, .05, .08, and. 10 under COMAR 10.09. 06 Hospital Services. These amendments becameeffective on an emergency basis February 2, 2000.

The purpose of this action is to provide reimbursement to hospital outpatient physicaltherapy, occupational therapy, speech therapy and audiology services providers for children(under age 21) enrolled in Managed Care Organizations in the HealthChoice Program.

These regulations also: (1) remove the requirement for second surgical opinion; (2)clarify regulations regarding physician order entry systems for out of state providers; and (3)correct a reference error.

-800- 735-2258.877-4MD-DHMH . TrY for Disabled - Maryland Relay Service

Web Site: www.dhmh.state.md.usToll Free

PTlliKTHERAPY SERVICES

(~The Program will reimburse the following outpatient revenue codes:PT: 420, 421, 422, 423, 424, 429aT: 430,431,432,433,434,439Speech: 440, 441, 442, 443, 444, 449Aud: 470,471,472,479

Preauthorization is not required for services however, the "Therapy Services Plan of Carefor Children" form shall be completed and shared with the primary care provider at the onset oftherapy. Copies of this form shall be in both the primary care provider's (PCP) medical recordand the providers medical record. A quarterly update on the child's plan of care shared with thePCP is requested. Post payment reviews may be made to assure compliance with this protocol.

Home health and off-campus services provided by a hospital or home health agency mustbe billed on a HCF A 1500 and may not be billed on a UB-92 at Health Services Cost ReviewCommission rates.

Hospital based audiology programs must enroll as an EPSDT Audiology Service providerand observe the regulations in COMAR 10.09.51, but can bill on the UB-92 at Health ServicesCost Review Commission rates on the hospitals Medical Assistance provider number. Hearingaids reQuire }2reauthorization. n

PROPOSED ACTION ON REGU,- .. IONSat G PDi18l 011 Ill. IIDI1h .tho,. 0( N~1IJoy ~~_,..." at 001 DeftlJJUoaa.13.S-N., Long. 77-os'rw:, and nuaning 168- to G A. (tezt ~anpd)

point 14« 8Oulh ./ao,y 0( N~JfIOy C lit Lat. B. Terms Defined.38-zr 1 . .,~. 1?-OS'6.rW, T1IU J G 6-4.IlOl (1) - (29) (tezt undJ~)(6.9 AlP1J) limit oil ~ (J9.1) -Pl4II 0( ~ ~ G written p/(Jn, ...

H. . . ~ by G ~ to GddIW. t/ae ~ PI'ob/.". M" prob.

km. lllhich indud.s.-( oJ DiQ8~;(h) ~nI goaJ.;(c) Flwqucncy of uiail. /or each type 0( ~ ~( Ii) ~ 0( ~ ~ MC'A type ~ aI7'Vica 0,..

-6..

!J

.-,"

SARAH J. ~red,'PH.D.

:~~" "

~,4;oPt

~

~.

"- ~

(e) ~ and(f) Othcr ap~ ~I (30) - (31) (tat uDCba~)

(31.1) -/!rinIGry carw PIOII;'" (PCP)- mcn. a P1actitio.~ -40 i8 lII. Primary ~~ of CGIW foro tII. ~GIld -iu,. IY"POnaibility it ;. to prooid. ~"k. Q)ftb""a".... ~"MII.tioe. GIld ~ted ACCIlt4 CGIW -1'rIi4:a

~ 1M Ml ran,.. of 6t~ IwquiIwd by tII. JI~Atedicaid At~ Corw ~ a ~ ill CO~10.09.67. . .

(32) - (39) (ten ~--!!."-.f)[(40) ~Dd ~ ~n. ID88D8 an -P8Ddeat

~I opinion obtaiDed &um . pb,y8ician be'-w the per.~~ of a 8UIVicaJ prOC8dur. ~y ~meDdedby 8Dother ph.Y8iciaD.J

(41)J (40) - [(47)J (46) (tezt UDf!fi.DIed).0. CoYeI'ed Seovie-.

The ~ aJverw the ~ ="i"' ~ .A. (text ~ch8n8ed) .B. Outpatient -pita! 88rriees: .

(1)-(5) (text ~~'-.d)(6) For rweip;.nt8 ~ IAGII 21 ,.,.. ~ p6y8cal

tiIcrapy. occUpaliOllGl tMlUpy. ~h tII.IUpy. and ~-06:J' -l'fIka if:

( aJ Th. ~ Prucn:dcr ~ a writteJI pion 0(~I&t in ctXlabolUtion with tlIc pcp and lII. recipiat orlII. PGlYnt or 8UaIUiGn of t/w f'a:ipient;

(b) The tlIcrapy .1'fI~ ;. proojUd acmrUing to III.plano(t1yczInzent;and

(c) The P1'Of1ider 0( ~ ~~ .IeIId. GII "pdaRof III. plan of '~I&t to tlIc pcp --", 90 dIJ.".. ..OGUaftatioa&

A. (text UDchanPd)B. The Pn)Sr.Di does DOt QJger=

(1) - (36)' (text ~chaapd)[(37) The admi88ion aDd all rWated ~ ia.-tieat

88I'Vi~ for the fonO1riDg elective S1JrIical ~ whenP8rfonDed on a non..~ iaP8deat b88i8. aDI88 . -.c:oODd sUl3icaJ oPinion has been *.aiDed &om aaother ~-can. or the Pr1JIram or ita desiIDee hu wajgecf the ~meat for a secoad 8UrIical opiDioa;

(8) Cbol8CY8tectomy;(b) H"~my;(c) TraaaUnthral PnJ8tateetomy;(d) LamiDectomy;(e) Di.kectGmy;(D Spinal ftI8ioa;(c) Co~ artery '?JJJe88;(h) Arthropl88ty; and(0 ElectiY8 Cesarean .seca-;J

[(38)J (37) - [(40)J (39) (tat Qncban&8i)

470 PROPOSED ACTION ON REGULATIONS

..L(&tIR - )EzpeDdibt~(Eo+IE - )

(E+)

(R+)NONENONE

BeI.&t(+)c.t(-)

~of1mP8Ct-.

On i8uiDI 8&8DCY=MeDt8lB.YlieDeAdmiDja-

( (FedeI'8l ruDd8 participa-a>

B. other State 8&8Dcie8:c.

~~it1.I.iDdU8trie8 or

(+) 8u.l98,no~ trBde

D.tr8de

E.~

I

pabIjc:adeDtifted by Imt:" aDd NmDber

&WDSeetM8IA. 8Dd~ . PI ~-di~i!l-reimbursahIe . tb8 ~~

will Nceift of' tb8 fee iD P8rdciP8-. .. .tAltal of' .. iy,...1a8.793.

.I» Pb78ici8D Order BDtry 8, A. (tat. 1~.":8d)

B. '1b obtain ap.-ova1 of a 1i1.Y8iciaD .der entry 818tem.a -.-tal abaU submit a written ltatemeat. 8iIDed by thedIj8f ~~tive officer m- desilllee c:8rtifyiDf that the 1i1y8i-dan .d. entry 818teD1:

(1) - (8) (text 'Ioch."eed)(9) Coabma with an applicable Medicare and Joint

Com-:-i on Aa:zeditation of' H.Jtbcan OrIaDizati0D8requil8ll81ta &O98rDinc electrODic patient ~ aDd au-t.hanti~-1; [aDd] or

(10) (tat. '1I\~.need)C. - G. (text '~"cb~aed)

.10 BlDI"~ aDd R..I_~~~~t PrI~..A. - K. (tat nD~~eed)L. ~8J~ on Medicaze cJaima i8 made subject tA) the~~ .

(1) (tat DftMAfteed)(2) 3..-y'~ 0«. «I~ by MediQre, but by the Pro-

II'8m. it ~~-~1 juatified according tA) [III] IX of' t.bi8~1.-

M. - Q. (tat. UI!.~aed)GEO~ C. BENJAMIN, M.D.

Secretary of Health and MeDtal HYIieDe

~ 21 MENTAL HYGIENE REGULATlC1"'S1 0 .25 Fee Schedule - Mental HealttfSer-

- Community-Based In-Practiti oners

AmI.itT. s.abtitI.

.a~t8IUri8, rat8 thatr8D&ill8~--t,nth CUrl8t a ,UO, wbk:h i8 witbiD tbelimtal H1IieDe 811Pru.-".ati8Io A8 tbe ,..salt or~ . ID8tal baItb 1"""""-" iD-

cllMiJDc both ual pr8Cti~ wiD ~rW9a~ '1'IIe . . ~ ~ uw ~~beJGw.

c... MaD..-at ,1.13 1mita or ~ . - ~ or $&I per 308,842-

CUDjca1 38ri'..-: 1.0 1mita or 8r9b . 8D 89W8p m.~ orS6.38 per..,.;ce ,475,614.BehahilitatiaalSu . 288,968 aDita or ~ . 8D

8gerap or $12.69 per

1btaJ: *u.~,no.NOTE: 1118 above a8Ct b«aU8 tbey iIM:hMI8 a

variety or promciure T.

The propoeed ~OD ha m' DO ~ Y. impeet

C~~ ~OD ~.,.18ed 8CdaD~ IeDt m MichAl..~ey. 'ou Coo!d;n8t1W'. BuDdin" ~521, 201 West Street, Ba1 . MD 21201, « fas

m (410) 333-7 . or can (410) 767 . 'nI.- ~-t8

ameDd er COMAR10.31.21 -('-~~ Pr8Cti,.ti.-'8.

S'!'be parpc-. of thia Ielected reim-

~t rate8 to additional 88I'9iC8_which a provider

1'1Iere thisprv- been~ .

.01A. - E. text n1\..h8nged)[F. July 1, 1997, to June 30, 1998,L tbe,.~ rat8 tor ~t cIiDicaJ .-'OII'aDI8 wiU~.

. . b818fit &am thia 8CtiOD by r8piDc . rw-

--. wiD eDahIe them to maiDtaiD q.-lity ~ mn ~.. appwtQDity to apaDd Iervice ...n.biJity. wiDtbIUUIb iDaa88d availability of Ien'iC8. 'Irider . of

aDd better 8CCeI8ibility.

per

writ-

t at the rat. of S7 4 per

apPi'JPr'.ate CSA mo, ...CSA. proYidea the Adwn;a;~ withpiau that iDclude8 a jR:1i~ date to

at UDder

itioa plan.

MARYLAND REGISTER. VOL. 27, I88JE 4 FRIDAY, FEBRUARY 25, ~

451

For iDformatiOD ~ ~ AeCiaG z RecuJadoaa, ~ iaaide &oat ~.- - - ---

s,.bol~Roman type ilMiicates text eziatiq before emerpacy atatua ... panted. Italic type iDdjcat,u DeW text. (SiDcJe bracbtaJiDdjcat8 deleted tazL

- = , 1.s!~UDder State GoverDmeDtArtide. tlO-WCb), J.~'" Code ofJiarrIaDd. aD 8pDC1 ma1 peatioD die JaiDt StaDdiq Commit8 aD~~tive, Esecutiye. aDd ~~.tift (AELB), ukiDc that the \.ua1 procedUr88 - ~-!JC ,...~I.~ be ... MkI8becaU8 -rseDC7 caactitioaa aiat. U tb8 ~~u. ~ tII8 ~ tb8 1WIUl8tiaD8 an IiYeD .u 7 8t8tuL EaI8rpDC1atabla ~ that the reculatioaa ~ 8&ctift imal8dl.taiy, - at . Iat8r ti1D8 IpeciAad b7 tb8 Commiu.. After die Commit*-bu 1l'aDt8d ~p""7 statu8, the recuiatiaaa an ~-~ iD tII8 MEt..ulable -- altbe M8'1I8Dd B81i8ter. The 8ppru.81 oC

q ltatua ma1 be lubject tD ODe or ~ CIIIMIi~ IDdnoflftl . ti1D8 limit. DuriDc the tim8 tb8 8merI8DC7 ItabI8 is In e6ct,die 8IWDC7 may edopt the recuiatioaa thIVUIb the 18181 pna~tI .-,.-. Utbe..DC7 ~ not m adopt tb8 r.,I,l.dI-.. the~.~-; stabI8 ~ wbea the time Umit - the ~.~-; r-.uI&a.. IDd8. Wb8D ~ ; atab8 upi.-, die tat ~ die

NlUiatioaa rwerta to ita oriIiaa1iaD1Uap. ---

Titl e 08DEPARTMENT

menta to Regulationa .01, .04, .0&, .08, and .10 underCOMAB. 10_~.. B88Pi&al ~

~ cy statu. bepD: February 2, 2000.~ c" 8tata8 espirec July 31, 2000.

TJDEWATER

08.02.05GEORG~ C. BENJ'AMIN. M.D.

~'Y of HaIth and Mental HJIieDe14-215,

1~

~Ie 21 MENTA~~ENE REGULA~NS10 .2S Fee Schedule - Mentat H~ s.erv-

I - Community-Based and tn-Practitioners

, a.Jtb-G..-l AItid8.'ntle 18, SaDdtIa8 1 -;;

'AA:tIOD

A.:tioa

EzecuUve,andto 8m8Dd-

02.01 Flab.~

ote: The text or chia docum t.-ill DOt bebeca~ it appears .. a Nodce Ac-

I> 466 - 468 or chi8 luue, re ..

. -

"t

~I..

Title 10D EPARTM ENT 0 F

HEALTH AND MENTAL HYGIENESubtitle 09 MEDICAL CARE PROGRAMS

10.09.06 Hospital ServicesAuu-ity: Bealtb-G-._1 Article. H2.1041bJ. 15-103. lad 15-~

ADnGtatadCodeofw.ry1ud

The . ,Executive, andLelialative RB9iew emerpncy 8tatu8 tu amead-menta to Reguiatio , .02, and .M - .13 underCOMa 10.21.21 Schedule - Meatal HealthSem.. - Co.. .BaMd Procrama aad IJIdl-.Wu8I

:BID..-aCf' .. March 1, 2000.:""' ;IeJ' JaDe 30, 2000-

. Da& be

~rencedu

fAMIN, M.D.

talH7lieDeNotice of E-..&~7 ActiOD[oo.O86-El

The Joint Committee on AAm;ni-trative. Executige, aDdT- ~.I.tive Review baa granted emeflenCY status to ameDd-

'2MARYLAND REQJSTER. VOL. 27, I88UE 4 FRIDAY. FEBRUARY 25, ~