Capitol Building Maryland Register

Issue Date: October 13, 2017

Volume 44 • Issue 21 • Pages 975-1026

IN THIS ISSUE

Governor

Regulations

Special Documents

General Notices

Pursuant to State Government Article, §7-206, Annotated Code of Maryland, this issue contains all previously unpublished documents required to be published, and filed on or before September 25, 2017 5 p.m.
 
Pursuant to State Government Article, §7-206, Annotated Code of Maryland, I hereby certify that this issue contains all documents required to be codified as of September 25, 2017.
 
Gail S. Klakring
Acting Administrator, Division of State Documents
Office of the Secretary of State

Seal

Information About the Maryland Register and COMAR

MARYLAND REGISTER

   The Maryland Register is an official State publication published every other week throughout the year. A cumulative index is published quarterly.

   The Maryland Register is the temporary supplement to the Code of Maryland Regulations. Any change to the text of regulations published  in COMAR, whether by adoption, amendment, repeal, or emergency action, must first be published in the Register.

   The following information is also published regularly in the Register:

   • Governor’s Executive Orders

   • Attorney General’s Opinions in full text

   • Open Meetings Compliance Board Opinions in full text

   • State Ethics Commission Opinions in full text

   • Court Rules

   • District Court Administrative Memoranda

   • Courts of Appeal Hearing Calendars

   • Agency Hearing and Meeting Notices

   • Synopses of Bills Introduced and Enacted by the General Assembly

   • Other documents considered to be in the public interest

CITATION TO THE MARYLAND REGISTER

   The Maryland Register is cited by volume, issue, page number, and date. Example:

• 19:8 Md. R. 815—817 (April 17, 1992) refers to Volume 19, Issue 8, pages 815—817 of the Maryland Register issued on April 17, 1992.

CODE OF MARYLAND REGULATIONS (COMAR)

   COMAR is the official compilation of all regulations issued by agencies of the State of Maryland. The Maryland Register is COMAR’s temporary supplement, printing all changes to regulations as soon as they occur. At least once annually, the changes to regulations printed in the Maryland Register are incorporated into COMAR by means of permanent supplements.

CITATION TO COMAR REGULATIONS

   COMAR regulations are cited by title number, subtitle number, chapter number, and regulation number. Example: COMAR 10.08.01.03 refers to Title 10, Subtitle 08, Chapter 01, Regulation 03.

DOCUMENTS INCORPORATED BY REFERENCE

   Incorporation by reference is a legal device by which a document is made part of COMAR simply by referring to it. While the text of an incorporated document does not appear in COMAR, the provisions of the incorporated document are as fully enforceable as any other COMAR regulation. Each regulation that proposes to incorporate a document is identified in the Maryland Register by an Editor’s Note. The Cumulative Table of COMAR Regulations Adopted, Amended or Repealed, found online, also identifies each regulation incorporating a document. Documents incorporated by reference are available for inspection in various depository libraries located throughout the State and at the Division of State Documents. These depositories are listed in the first issue of the Maryland Register published each year. For further information, call 410-974-2486.

HOW TO RESEARCH REGULATIONS

An Administrative History at the end of every COMAR chapter gives information about past changes to regulations. To determine if there have been any subsequent changes, check the ‘‘Cumulative Table of COMAR Regulations Adopted, Amended, or Repealed’’ which is found online at http://www.dsd.state.md.us/PDF/CumulativeTable.pdf. This table lists the regulations in numerical order, by their COMAR number, followed by the citation to the Maryland Register in which the change occurred. The Maryland Register serves as a temporary supplement to COMAR, and the two publications must always be used together. A Research Guide for Maryland Regulations is available. For further information, call 410-260-3876.

SUBSCRIPTION INFORMATION

   For subscription forms for the Maryland Register and COMAR, see the back pages of the Maryland Register. Single issues of the Maryland Register are $15.00 per issue.

CITIZEN PARTICIPATION IN
THE REGULATION-MAKING PROCESS

   Maryland citizens and other interested persons may participate in the process by which administrative regulations are adopted, amended, or repealed, and may also initiate the process by which the validity and applicability of regulations is determined. Listed below are some of the ways in which citizens may participate (references are to State Government Article (SG),

Annotated Code of Maryland):

   • By submitting data or views on proposed regulations either orally or in writing, to the proposing agency (see ‘‘Opportunity for Public Comment’’ at the beginning of all regulations appearing in the Proposed Action on Regulations section of the Maryland Register). (See SG, §10-112)

   • By petitioning an agency to adopt, amend, or repeal regulations. The agency must respond to the petition. (See SG §10-123)

   • By petitioning an agency to issue a declaratory ruling with respect to how any regulation, order, or statute enforced by the agency applies. (SG, Title 10, Subtitle 3)

   • By petitioning the circuit court for a declaratory judgment

on the validity of a regulation when it appears that the regulation interferes with or impairs the legal rights or privileges of the petitioner. (SG, §10-125)

   • By inspecting a certified copy of any document filed with the Division of State Documents for publication in the Maryland Register. (See SG, §7-213)

 

Maryland Register (ISSN 0360-2834). Postmaster: Send address changes and other mail to: Maryland Register, State House, Annapolis, Maryland 21401. Tel. 410-260-3876; Fax 410-280-5647. Published biweekly, with cumulative indexes published quarterly, by the State of Maryland, Division of State Documents, State House, Annapolis, Maryland 21401. The subscription rate for the Maryland Register is $225 per year (first class mail). All subscriptions post-paid to points in the U.S. periodicals postage paid at Annapolis, Maryland and additional mailing offices.

Lawrence J. Hogan, Jr., Governor; John C. Wobensmith, Secretary of State; Gail S. Klakring, Administrator; Mary D. MacDonald, Senior Editor, Maryland Register and COMAR; Elizabeth Ramsey, Editor, COMAR Online, and Subscription Manager; Tami Cathell, Help Desk, COMAR and Maryland Register Online.

Front cover: State House, Annapolis, MD, built 1772—79.

Illustrations by Carolyn Anderson, Dept. of General Services

 

     Note: All products purchased are for individual use only. Resale or other compensated transfer of the information in printed or electronic form is a prohibited commercial purpose (see State Government Article, §7-206.2, Annotated Code of Maryland). By purchasing a product, the buyer agrees that the purchase is for individual use only and will not sell or give the product to another individual or entity.

 


Closing Dates for the Maryland Register

Schedule of Closing Dates and Issue Dates for the
Maryland Register ......................................................................  979

 

COMAR Research Aids

Table of Pending Proposals ...........................................................  980

 

Index of COMAR Titles Affected in This Issue

COMAR Title Number and Name                                                  Page

09        Department of Labor, Licensing, and Regulation ...............  987

10        Maryland Department of Health .........................  983, 986, 988

13A     State Board of Education ..........................................  984, 1010

14        Independent Agencies ........................................................  984

17        Department of Budget and Management ............................  984

31        Maryland Insurance Administration .................................  1012

35        Maryland Department of Veterans Affairs .......................  1014

36        Maryland State Lottery and Gaming Control
               Agency ............................................................................  985

 

PERSONS WITH DISABILITIES

Individuals with disabilities who desire assistance in using the publications and services of the Division of State Documents are encouraged to call (410) 974-2486, or (800) 633-9657, or FAX to (410) 974-2546, or through Maryland Relay.

 

The Governor

EXECUTIVE ORDER 01.01.2017.21 .........................................  982

 

Final Action on Regulations

10  MARYLAND DEPARTMENT OF HEALTH

MEDICAL CARE PROGRAMS

Telehealth Services .  983

MENTAL HYGIENE REGULATIONS

Resident Grievance System ..  983

BOARD OF PHYSICIANS

Hearings Before the Board of Physicians .  983

BOARD OF OCCUPATIONAL THERAPY PRACTICE

General Regulations .  984

Continuing Competency Requirement  984

Sanctioning Guidelines .  984

13A STATE BOARD OF EDUCATION

CERTIFICATION

Teachers .  984

14  INDEPENDENT AGENCIES

CANAL PLACE PRESERVATION AND DEVELOPMENT
   AUTHORITY

Procurement  984

17  DEPARTMENT OF BUDGET AND MANAGEMENT

PERSONNEL SERVICES AND BENEFITS

Leave .  985

36  MARYLAND STATE LOTTERY AND GAMING
   CONTROL AGENCY

GAMING PROVISIONS

General  985

Video Lottery Operation License .  985

Video Lottery Facility Minimum Internal Control
   Standards .  985

VIDEO LOTTERY TERMINALS

Video Lottery Technical Standards .  985

TABLE GAMES

Table Game Equipment  985

Table Games Procedures .  985

 

Withdrawal of Regulations

10 MARYLAND DEPARTMENT OF HEALTH

MENTAL HYGIENE REGULATIONS

Fee Schedule—Mental Health Services—Community-Based
   Programs and Individual Practitioners .  986

 

Proposed Action on Regulations

09  DEPARTMENT OF LABOR, LICENSING, AND
   REGULATION

COMMISSIONER OF FINANCIAL REGULATION

State Collection Agency Licensing Board — Fees .  987

DIVISION OF LABOR AND INDUSTRY

Maryland Occupational Safety and Health Act —
   Incorporation by Reference of Federal Standards .  987

Maryland Occupational Safety and Health Act —
   Incorporation by Reference of Federal Standards .  988

10  MARYLAND DEPARTMENT OF HEALTH

PROCEDURES

Fair Hearing Appeals Under the Maryland State Medical
   Assistance Program ..  988

MEDICAL CARE PROGRAMS

Maryland Medicaid Managed Care Program:
   Definitions .  988

Maryland Medicaid Managed Care Program: Eligibility and
   Enrollment  988

Maryland Medicaid Managed Care Program: MCO
   Application .  988

Maryland Medicaid Managed Care Program: Managed Care
   Organizations .  988

Maryland Medicaid Managed Care Program: Access .  988

Maryland Medicaid Managed Care Program: Benefits .  988

Maryland Medicaid Managed Care Program: Program
   Integrity .  988

Maryland Medicaid Managed Care Program: MCO Dispute
   Resolution Procedures .  988

Maryland Medicaid Managed Care Program: Departmental
   Dispute Resolution Procedures .  988

Nursing Facility Services .  1001

Health Homes .  1002

General Medical Assistance Provider Participation
   Criteria .  1002

Community-based Substance Use Disorder Services .  1003

Community First Choice .  1004

Remote Patient Monitoring .  1006

BOARD OF PHYSICIANS

Mandated Reporting to the Board .  1008

13A STATE BOARD OF EDUCATION

SUPPORTING PROGRAMS

Student Transportation .  1010

31  MARYLAND INSURANCE ADMINISTRATION

HEALTH INSURANCE — GENERAL

Dental Network Adequacy .  1012

35  MARYLAND DEPARTMENT OF VETERANS AFFAIRS

MARYLAND VETERANS ANIMAL SERVICE PROGRAM

General Regulations .  1014

 

Special Documents

DEPARTMENT OF THE ENVIRONMENT

SUSQUEHANNA RIVER BASIN COMMISSION

Actions Taken at September 7, 2017, Meeting .  1016

Projects Approved for Minor Modifications .  1017

Projects Approved for Consumptive Uses of Water  1017

Public Hearing .  1018

PUBLIC HEARING ANNOUNCEMENT — PROPOSED
   RELICENSING OF THE CONOWINGO
   HYDROELECTRIC PROJECT APPLICATION
   FOR WATER QUALITY CERTIFICATION ..  1019

MARYLAND HEALTH CARE COMMISSION

SCHEDULES FOR CERTIFICATE OF NEED
   REVIEW ...  1020

 

General Notices

ADVISORY COUNCIL ON CEMETERY OPERATIONS

Public Meeting .  1024

MARYLAND COLLECTION AGENCY LICENSING BOARD

Public Hearing .  1024

COMPTROLLER OF THE TREASURY

Notice of Interest Rate on Refunds and Moneys Owed to the
   State .  1024

MARYLAND CYBERSECURITY COUNCIL

Public Meeting .  1024

DEPARTMENT OF THE ENVIRONMENT/AIR AND
   RADIATION ADMINISTRATION

Public Hearing .  1024

MARYLAND DEPARTMENT OF HEALTH

Public Hearing .  1024

Public Meeting .  1024

DIVISION OF LABOR AND INDUSTRY/BOARD OF
   BOILER RULES

Public Meeting .  1025

MARYLAND STATE LOTTERY AND GAMING CONTROL
   COMMISSION

Public Meeting .  1025

MARYLAND HEALTH CARE COMMISSION

Public Meeting .  1025

Public Meeting .  1025

Receipt of Application .  1025

Formal Start of Review ..  1025

DEPARTMENT OF NATURAL RESOURCES/FISHING AND
   BOATING SERVICES

Public Notice — Partial Closure of Public Shellfish Fishery
   Area 136 — Effective September 29, 2017 ...........................  1025

STATE ADVISORY COUNCIL ON QUALITY CARE AT
   THE END OF LIFE

Public Meeting .  1026

MARYLAND COLLEGE COLLABORATION FOR
   STUDENT VETERANS COMMISSION

Public Meeting .  1026

BOARD OF WELL DRILLERS

Public Meeting .  1026

Public Meeting .  1026

WORKERS' COMPENSATION COMMISSION

Public Meeting .  1026

 

 

COMAR Online

        The Code of Maryland Regulations is available at www.dsd.state.md.us as a free service of the Office of the Secretary of State, Division of State Documents. The full text of regulations is available and searchable. Note, however, that the printed COMAR continues to be the only official and enforceable version of COMAR.

        The Maryland Register is also available at www.dsd.state.md.us.

        For additional information, visit www.dsd.state.md.us, Division of State Documents, or call us at (410) 974-2486 or 1 (800) 633-9657.

 

Availability of Monthly List of
Maryland Documents

        The Maryland Department of Legislative Services receives copies of all publications issued by State officers and agencies. The Department prepares and distributes, for a fee, a list of these publications under the title ‘‘Maryland Documents’’. This list is published monthly, and contains bibliographic information concerning regular and special reports, bulletins, serials, periodicals, catalogues, and a variety of other State publications. ‘‘Maryland Documents’’ also includes local publications.

        Anyone wishing to receive ‘‘Maryland Documents’’ should write to: Legislative Sales, Maryland Department of Legislative Services, 90 State Circle, Annapolis, MD 21401.

 

CLOSING DATES AND ISSUE DATES through JULY 20, 2018

Issue
Date

Emergency

and Proposed

Regulations

5 p.m.*

Final

Regulations

10:30 a.m.

Notices, etc.

10:30 a.m.

2017

October 27**

October 6

October 18

October 16

November 13***

October 23

November 1

October 30

November 27***

November 6

November 15

November 13

December 8

November 20

November 29

November 27

December 22

December 4

December 13

December 11

2018

January 5**

December 18

December 27

December 22

January 19**

December 29

January 10

January 8

February 2**

January 12

January 24

January 22

February 16

January 29

February 7

February 5

March 2**

February 12

February 21

February 16

March 16

February 26

March 7

March 5

March 30

March 12

March 21

March 19

April 13

March 26

April 4

April 2

April 27

April 9

April 18

April 16

May 11

April 23

May 2

April 30

May 25

May 7

May 16

May 14

June 8**

May 21

May 30

May 25

June 22

June 4

June 13

June 11

July 6

June 18

June 27

June 25

July 20

July 2

July 11

July 9

 

*   Due date for documents containing 8 to 18 pages — 48 hours before date shown; due date for documents exceeding 18 pages — 1 week before date shown

NOTE:  ALL DOCUMENTS MUST BE SUBMITTED IN TIMES NEW ROMAN, 9-POINT, SINGLE-SPACED FORMAT. THE REVISED PAGE COUNT REFLECTS THIS FORMATTING.

** Note closing date changes

***   Note issue date and closing date changes

The regular closing date for Proposals and Emergencies is Monday.

 



Cumulative Table of COMAR Regulations
Adopted, Amended, or Repealed

   This table, previously printed in the Maryland Register lists the regulations, by COMAR title, that have been adopted, amended, or repealed in the Maryland Register since the regulations were originally published or last supplemented in the Code of Maryland Regulations (COMAR). The table is no longer printed here but may be found on the Division of State Documents website at www.dsd.state.md.us.

Table of Pending Proposals

   The table below lists proposed changes to COMAR regulations. The proposed changes are listed by their COMAR number, followed by a citation to that issue of the Maryland Register in which the proposal appeared. Errata pertaining to proposed regulations are listed, followed by “(err)”. Regulations referencing a document incorporated by reference are followed by “(ibr)”. None of the proposals listed in this table have been adopted. A list of adopted proposals appears in the Cumulative Table of COMAR Regulations Adopted, Amended, or Repealed.

 


09 DEPARTMENT OF LABOR, LICENSING, AND REGULATION

 

09.01.04.01—.17 • 44:20 Md. R. 949 (9-29-17)

09.03.06.02—.27 • 44:2 Md. R. 92 (1-20-17)

09.03.12.01,.08 • 44:17 Md. R. 840 (8-18-17)

09.03.13.02 • 44:21 Md. R. 987 (10-13-17)

09.12.31 • 44:21 Md. R. 987 (10-13-17)

                 44:21 Md. R. 988 (10-13-17)

09.13.05.03 • 44:2 Md. R. 114 (1-20-17)

09.16.01.04,.05 • 44:10 Md. R. 489 (5-12-17)

09.19.07.01 • 44:3 Md. R. 192 (2-3-17)

09.23.06.02—.17 • 44:19 Md. R. 900 (9-15-17)

09.32.01.05,.12,.15-1,.16,.24 • 44:3 Md. R. 193 (2-3-17)

09.32.01.18 • 44:3 Md. R. 194 (2-3-17)

09.35.02.02,.03 • 43:21 Md. R. 1170 (10-14-16)

 

10 DEPARTMENT OF HEALTH AND MENTAL HYGIENE

 

     Subtitles 01—08 (1st volume)

 

10.01.01.01—.11 • 44:2 Md. R. 131 (1-20-17)

10.01.04.03,.04,.08 • 44:21 Md. R. 988 (10-13-17)

 

     Subtitle 09 (2nd volume)

 

10.09.10.07-1,.07-2 • 44:21 Md. R. 1001 (10-13-17)

10.09.12.03—.05,.07 • 44:20 Md. R. 952 (9-29-17)

10.09.33.09 • 44:21 Md. R. 1002 (10-13-17)

10.09.36.03 • 44:20 Md. R. 953 (9-29-17)

10.09.36.03-1 • 44:21 Md. R. 1002 (10-13-17)

10.09.44.03 • 44:10 Md. R. 491 (5-12-17)

10.09.62.01 • 44:21 Md. R. 988 (10-13-17)

10.09.63.02,.03,.06 • 44:21 Md. R. 988 (10-13-17)

10.09.64.03,.11 • 44:21 Md. R. 988 (10-13-17)

10.09.65.02,.04,.15,.17,.19,.20,.28 • 44:21 Md. R. 988 (10-13-17)

10.09.66.01,.02 • 44:21 Md. R. 988 (10-13-17)

10.09.67.01,.04,.19 • 44:21 Md. R. 988 (10-13-17)

10.09.68.01—.03 • 44:21 Md. R. 988 (10-13-17)

10.09.71.02,.04,.05 • 44:21 Md. R. 988 (10-13-17)

10.09.72.01,.06 • 44:21 Md. R. 988 (10-13-17)

10.09.79.01—.08 • 44:11 Md. R. 529 (5-26-17)

10.08.80.08 • 44:21 Md. R. 1003 (10-13-17)

10.09.84.02,.05—.07,.10,.15,.18,.19,.23,
     .24
• 44:21 Md. R. 1004 (10-13-17)

10.09.96.01—.13 • 44:21 Md. R. 1006 (10-13-17)

 

     Subtitles 10 — 22 (3rd Volume)

 

10.22.17.06—.08 • 44:20 Md. R. 954 (9-29-17)

10.22.18.04 • 44:20 Md. R. 954 (9-29-17)

 

     Subtitles 23 — 36 (4th Volume)

 

10.27.01.02 • 44:2 Md. R. 131 (1-20-17)

10.29.15.02—.05,.07,.08 • 43:26 Md. R. 1494 (12-23-16)

                                            44:12 Md. R. 595 (6-9-17)

10.32.22.02,.03,.05 • 44:21 Md. R. 1008 (10-13-17)

 

     Subtitles 37—66 (5th Volume)

 

10.62.01.01 • 43:22 Md. R. 1245 (10-28-16)

10.62.08.03,.05—.07 • 43:22 Md. R. 1245 (10-28-16)

10.62.09.03 • 43:22 Md. R. 1245 (10-28-16)

10.62.12.02 • 43:22 Md. R. 1245 (10-28-16)

10.62.15.04—.07 • 43:22 Md. R. 1245 (10-28-16)

10.62.19.02,.04—.06 • 43:22 Md. R. 1245 (10-28-16)

10.62.20.03 • 43:22 Md. R. 1245 (10-28-16)

10.62.22.02 • 43:22 Md. R. 1245 (10-28-16)

10.62.25.03,.05—.07 • 43:22 Md. R. 1245 (10-28-16)

10.62.26.03 • 43:22 Md. R. 1245 (10-28-16)

10.62.28.02 • 43:22 Md. R. 1245 (10-28-16)

10.63.07.01—.14 • 44:17 Md. R. 841 (8-18-17)

 

11 DEPARTMENT OF TRANSPORTATION

 

     Subtitles 01—10

 

11.01.18.01,.02 • 43:22 Md. R. 1251 (10-28-16)

 

     Subtitles 11—22 (MVA)

 

11.14.08.01,.03—.05,.09 • 44:18 Md. R. 868 (9-1-17)

 

12 DEPARTMENT OF PUBLIC SAFETY AND CORRECTIONAL SERVICES

 

12.02.27.01—.40 • 44:19 Md. R. 902 (9-15-17)

12.03.01.01—.35 • 44:19 Md. R. 902 (9-15-17)

12.12.30.01—.40 • 44:19 Md. R. 902 (9-15-17)

12.16.02.01—.40 • 44:19 Md. R. 902 (9-15-17)

 

13A STATE BOARD OF EDUCATION

 

13A.04.16.01—.03 • 44:18 Md. R. 871 (9-1-17)

13A.06.07.01,.06—.08,.10 • 44:21 Md. R. 1010 (10-13-17)

 

13B MARYLAND HIGHER EDUCATION COMMISSION

 

13B.02.06.01—.13 • 44:13 Md. R. 634 (6-23-17)

 

14 INDEPENDENT AGENCIES

 

14.06.03.07 • 44:20 Md. R. 964 (9-29-17)

14.22.02.02 • 44:18 Md. R. 872 (9-1-17)

14.28.02.01—.14 • 44:18 Md. R. 879 (9-1-17)

14.28.07.01—.07 • 44:18 Md. R. 879 (9-1-17)

14.36.01.03,.13 • 44:17 Md. R. 844 (8-18-17)

14.36.04.01,.04—.08 • 44:17 Md. R. 844 (8-18-17)

 

15 DEPARTMENT OF AGRICULTURE

 

15.01.12.01—.07 • 44:20 Md. R. 965 (9-29-17)

 

19A STATE ETHICS COMMISSION

 

19A.01.01.02 • 44:16 Md. R. 812 (8-4-17)

19A.01.01.02 • 44:16 Md. R. 816 (8-4-17)

19A.03.04.01—.04 • 44:16 Md. R. 812 (8-4-17)

19A.04.01.02 • 44:16 Md. R. 816 (8-4-17)

19A.04.Appendix A • 44:16 Md. R. 812 (8-4-17)

19A.04.Appendix A • 44:16 Md. R. 816 (8-4-17)

19A.04.Appendix B • 44:16 Md. R. 812 (8-4-17)

19A.04.Appendix B • 44:16 Md. R. 816 (8-4-17)

19A.05.Appendix A • 44:16 Md. R. 812 (8-4-17)

19A.05.Appendix A • 44:16 Md. R. 816 (8-4-17)

19A.05.Appendix B • 44:16 Md. R. 812 (8-4-17)

19A.05.Appendix B • 44:16 Md. R. 816 (8-4-17)

19A.07.01.06 • 44:16 Md. R. 812 (8-4-17)

 

26 DEPARTMENT OF THE ENVIRONMENT

 

     Subtitles 08—12 (Part 2)

 

26.08.02.03-1,.03-3,.04-1,.08 • 44:11 Md. R. 533 (5-26-17)

26.08.07.04 • 43:24 Md. R. 1361 (11-28-16)

26.08.09.01,.04,.06,.07,.08 • 44:11 Md. R. 533 (5-26-17)

26.11.02.01,.10 • 44:14 Md. R. 685 (7-7-17)

26.11.09.01,.04,.06,.11 • 44:12 Md. R. 600 (6-9-17)

26.11.33.01—.14 • 44:12 Md. R. 602 (6-9-17)

26.11.36.01—.04 • 44:14 Md. R. 685 (7-7-17)

 

     Subtitles 19—27 (Part 4)

 

26.19.01.01—.61 • 43:23 Md. R. 1293 (11-14-16) (ibr)

 

31 MARYLAND INSURANCE ADMINISTRATION

 

31.03.02.02,.03 • 44:17 Md. R. 845 (8-18-17)

31.03.05.09,.15 • 44:20 Md. R. 967 (9-29-17)

31.08.14.03 • 44:18 Md. R. 880 (9-1-17)

31.08.15.06 • 44:17 Md. R. 846 (8-18-17)

31.08.18.01—.03 • 44:18 Md. R. 880 (9-1-17)

31.10.44.01—.09 • 44:15 Md. R. 776 (7-21-17)

31.10.45.01—.06 • 44:21 Md. R. 1012 (10-13-17)

31.15.10.04 • 44:18 Md. R. 880 (9-1-17)

 

33 STATE BOARD OF ELECTIONS

 

33.16.02.01 • 44:19 Md. R. 930 (9-15-17)

33.16.04.02 • 44:19 Md. R. 930 (9-15-17)

33.16.05.03,.04 • 44:19 Md. R. 930 (9-15-17)

33.16.06.04 • 44:19 Md. R. 930 (9-15-17)

33.16.07.03 • 44:19 Md. R. 930 (9-15-17)

 

35 DEPARTMENT OF VETERANS’ AFFAIRS

 

35.06.01.01—.07 • 44:21 Md. R. 1014 (10-13-17)

 


The Governor

EXECUTIVE ORDER 01.01.2017.21

Renewal of Executive Order 01.01.2017.02 (Executive Order Regarding the Heroin, Opioid, and Fentanyl Overdose Crisis Declaration of Emergency)

 

WHEREAS, I, Lawrence J. Hogan, Jr., Governor of the State of Maryland, issued Executive Order 01.01.2017.02 due to the heroin, opioid, and fentanyl overdose crisis (the “Crisis”); and

 

WHEREAS, The emergency conditions relating to the Crisis continue to exist.

 

NOW THEREFORE, I, LAWRENCE J. HOGAN, JR., GOVERNOR OF THE STATE OF MARYLAND, BY VIRTUE OF THE AUTHORITY VESTED IN ME BY THE CONSTITUTION AND THE LAWS OF MARYLAND, INCLUDING BUT NOT LIMITED TO TITLE 14 OF THE PUBLIC SAFETY ARTICLE, DECLARE THAT THE STATE OF EMERGENCY CONTINUES TO EXIST PERTAINING TO THE NEED TO CONTROL AND ELIMINATE THE HEROIN, OPIOID, AND FENTANYL OVERDOSE CRISIS AND HEREBY RENEW EXECUTIVE ORDER 01.01.2017.02, EFFECTIVE ON SEPTEMBER 28, 2017, AND SHALL EXPIRE ON OCTOBER 28, 2017, UNLESS SOONER TERMINATED OR EXTENDED IN WRITING BY ME.

 

GIVEN Under My Hand and the Great Seal of the State of Maryland, in the City of Annapolis, this 27th Day of September, 2017.

LAWRENCE J. HOGAN, JR.
Governor

 

ATTEST:

JOHN C. WOBENSMITH
Secretary of State

[17-21-25]

 


Final Action on Regulations

 

Symbol Key

   Roman type indicates text already existing at the time of the proposed action.

   Italic type indicates new text added at the time of proposed action.

   Single underline, italic indicates new text added at the time of final action.

   Single underline, roman indicates existing text added at the time of final action.

   [[Double brackets]] indicate text deleted at the time of final action.

 

 


Title 10
MARYLAND DEPARTMENT OF HEALTH

Subtitle 09 MEDICAL CARE PROGRAMS

10.09.49 Telehealth Services

Authority: Health-General Article, §§2-104(b) and 15-105.2(b), Annotated Code of Maryland; Ch. 280, Acts of 2013

Notice of Final Action

[17-174-F]

On September 27, 2017, the Secretary of Health adopted amendments to Regulations .02, .04—.07, and .09—.11 under COMAR 10.09.49 Telehealth Services. This action, which was proposed for adoption in 44:14 Md. R. 665—667 (July 7, 2017), has been adopted with the nonsubstantive changes shown below.

Effective Date: October 23, 2017.

Attorney General's Certification

In accordance with State Government Article, §10-113, Annotated Code of Maryland, the Attorney General certifies that the following changes do not differ substantively from the proposed text. The nature of the changes and the basis for this conclusion are as follows:

Regulation .05D: In response to comments received, the Department clarified that “telehealth” is the mechanism by which services are delivered, rather than the service itself.

Regulation .10E(4): In response to comments received, the Department changed “behavioral health” to “mental health” to eliminate redundant language in this subsection.

Regulation .11C(1)(b): In response to comments received, the Department changed “behavioral health” to “mental health” to eliminate redundant language in this subsection.

Regulation .11C(1)(c): In response to comments received, the Department corrected a reference to substance use disorder reimbursement procedures.

.05 Covered Services.

Under the Telehealth Program, the Department shall cover:

A.—C. (proposed text unchanged)

D. As determined by the provider’s licensure or credentialing board, [[telehealth]] services performed via telehealth within the scope of a provider’s practice.

.10 Limitations.

A.—D. (proposed text unchanged)

E. The Department may not reimburse a provider for the following:

(1)—(3) (proposed text unchanged)

(4) [[Behavioral]] Mental health and substance use disorder services that did not receive prior authorization from the Department or its ASO.

F.—I. (proposed text unchanged)

.11 Reimbursement.

A.—B. (proposed text unchanged)

C. Distant Site Reimbursement.

(1) The distant site shall be reimbursed:

(a) (proposed text unchanged)

(b) For [[behavioral]] mental health services provided via telehealth, as set forth in COMAR 10.09.59.09; or

(c) For substance use disorder services provided via telehealth, as set forth in COMAR [[10.09.59.09]] 10.09.80.08.

(2)(3) (proposed text unchanged)

DENNIS SCHRADER
Secretary of Health

 

Subtitle 21 MENTAL HYGIENE REGULATIONS

10.21.14 Resident Grievance System

Authority: Health-General Article, §§7.5-201, 7.5-205(d), and 10-701, Annotated Code of Maryland

Notice of Final Action

[17-206-F]

On September 27, 2017, the Secretary of Health adopted amendments to Regulations .01—.04, .06, and .10 under COMAR 10.21.14 Resident Grievance System. This action, which was proposed for adoption in 44:16 Md. R. 810—811 (August 4, 2017), has been adopted as proposed.

Effective Date: October 23, 2017.

DENNIS SCHRADER
Secretary of Health

 

Subtitle 32 BOARD OF PHYSICIANS

10.32.02 Hearings Before the Board of Physicians

Authority: Health Occupations Article, §§14-205 and 14-405, Annotated Code of Maryland

Notice of Final Action

[17-198-F]

On September 27, 2017, the Secretary of Health adopted new Regulation .17 under COMAR 10.32.02 Hearings Before the Board of Physicians. This action, which was proposed for adoption in 44:16 Md. R. 811 (August 4, 2017), has been adopted as proposed.

Effective Date: October 23, 2017.

DENNIS SCHRADER
Secretary of Health

Subtitle 46 BOARD OF OCCUPATIONAL THERAPY PRACTICE

Notice of Final Action

[17-170-F]

On October 2, 2017, the Secretary of Health adopted:

(1) Amendments to Regulations .01 and .02 under COMAR 10.46.01 General Regulations;

(2) Amendments to Regulations .02, .04, and .07 under COMAR 10.46.04 Continuing Competency Requirement; and

(3) Amendments to Regulations .01 and .03, the repeal of existing Regulation .04, amendments to and the recodification of existing Regulation .05 to be Regulation .04, and the recodification of existing Regulation .06 to be Regulation .05 under COMAR 10.46.07 Sanctioning Guidelines.

This action, which was proposed for adoption in 44:14 Md. R. 669—672 (July 7, 2017), has been adopted with the nonsubstantive changes shown below.

Effective Date: October 23, 2017.

Attorney General's Certification

In accordance with State Government Article, §10-113, Annotated Code of Maryland, the Attorney General certifies that the following changes do not differ substantively from the proposed text. The nature of the changes and the basis for this conclusion are as follows:

COMAR 10.46.01 Authority Line: Corrected typographical error.

COMAR 10.46.01.01B(10)(b): This a nonsubstantive change to clarify the meaning proposed. The language added does not impose any additional conditions on the licensees. There is no change in the impact of the regulation as written.

 

10.46.01 General Regulations

Authority: General Provisions Article, [[§4–333(h)]] §4-333(c); Health Occupations Article, §§10–101, 10–205, 10–301, 10–302, 10–304, 10–311—10–313; Annotated Code of Maryland

.01 Definitions.

A. (proposed text unchanged)

B. Terms Defined.

(1)—(9) (proposed text unchanged)

(10) “Evaluation” means the ongoing process of:

(a) (proposed text unchanged)

(b) Interpretation of the [[evaluation]] data by a licensed occupational therapist for purposes including, but not limited to:

(i) The need for treatment; and

(ii) Plans for discharge.

(11)(31) (proposed text unchanged)

DENNIS SCHRADER
Secretary of Health

 

Title 13A
STATE BOARD OF EDUCATION

Subtitle 12 CERTIFICATION

13A.12.02 Teachers

Authority: Education Article, §§2-205, 2-303(g), 6-701—6-705, and 8-3A-03, Annotated Code of Maryland

Notice of Final Action

[17-148-F]

On September 14, 2017, the Professional Standards and Teacher Education Board adopted amendments to Regulation .21 under COMAR 13A.12.02 Teachers. This action, which was proposed for adoption in 44:12 Md. R. 596—597 (June 9, 2017), has been adopted as proposed.

Effective Date: October 23, 2017.

KAREN B. SALMON, Ph.D.
State Superintendent of Schools

 

Title 14
INDEPENDENT AGENCIES

Subtitle 28 CANAL PLACE PRESERVATION AND DEVELOPMENT AUTHORITY

14.28.08 Procurement

Authority: Financial Institutions Article, §13-1008(4), Annotated Code of Maryland

Notice of Final Action

[17-184-F]

On September 26, 2017, the Canal Place Preservation and Development Authority adopted amendments to Regulations .02—.14 under COMAR 14.28.08 Procurement. This action, which was proposed for adoption in 44:15 Md. R. 767—773 (July 21, 2017), has been adopted as proposed.

Effective Date: October 23, 2017.

DEIDRA L. RITCHIE
Executive Director

 

Title 17
DEPARTMENT OF BUDGET AND MANAGEMENT

Subtitle 04 PERSONNEL SERVICES AND BENEFITS

17.04.11 Leave

Authority: State Personnel and Pensions Article, §§4-106 and 9-101, Annotated Code of Maryland

Notice of Final Action

[17-201-F]

On September 22, 2017, the Secretary of Budget and Management adopted amendments to Regulation .03 under COMAR 17.04.11 Leave. This action, which was proposed for adoption in 44:16 Md. R. 812 (August 4, 2017), has been adopted as proposed.

Effective Date: October 23, 2017.

DAVID R. BRINKLEY
Secretary of Budget and Management

 

Title 36
MARYLAND STATE LOTTERY AND GAMING CONTROL AGENCY

Notice of Final Action

[17-219-F]

On October 3, 2017, the Maryland State Lottery and Gaming Control Agency adopted:

(1) Amendments to Regulations .02 and .03 under COMAR 36.03.01 General;

(2) Amendments to Regulation .07 under COMAR 36.03.03 Video Lottery Operation License;

(3) Amendments to Regulations .02, .11, .19, .20, .24, .27, .28, .38, .41, and .42 and new Regulation .51 under COMAR 36.03.10 Video Lottery Facility Minimum Internal Control Standards;

(4) Amendments to Regulations .20 and .31 under COMAR 36.04.01 Video Lottery Technical Standards;

(5) Amendments to Regulation .16 under COMAR 36.05.02 Table Game Equipment;  and

(6) Amendments to Regulation .03 under COMAR 36.05.03 Table Games Procedures.

This action, which was proposed for adoption in 44:17 Md. R. 847—851 (August 18, 2017), has been adopted as proposed.

Effective Date: October 23, 2017.

GORDON MEDENICA
Director

 

 


Withdrawal of Regulations

 

Title 10
MARYLAND DEPARTMENT OF HEALTH

Subtitle 21 MENTAL HYGIENE REGULATIONS

10.21.25 Fee Schedule—Mental Health Services—Community-Based Programs and Individual Practitioners

Authority: Health-General Article, §§2-104, 7.5-205, 10-205, 10-206,
[10-901, 15-103, 15-105] and Title 16, Subtitles 1 and 2, Annotated Code of Maryland

Notice of Withdrawal

[16-239-W]

Pursuant to State Government Article, §10-116(b), Annotated Code of Maryland, notice is given that the proposal to amend Regulations .03-2 and .05—.13 under COMAR 10.21.25 Fee Schedule—Mental Health Services—Community-Based Programs and Individual Practitioners which was published in 43:19 Md. R. 1077—1082 (September 16, 2016), has been withdrawn by operation of law.

GAIL S. KLAKRING
Administrator
Division of State Documents

 


Proposed Action on Regulations

 


 



Title 09
DEPARTMENT OF LABOR, LICENSING, AND REGULATION

Subtitle 03 COMMISSIONER OF FINANCIAL REGULATION

09.03.13 State Collection Agency Licensing Board — Fees

Authority: Business Regulations Article, §§7-302, 7-302.1, and 7-306, Annotated Code of Maryland

Notice of Proposed Action

[17-244-P]

The Maryland Collection Agency Licensing Board proposes to amend Regulation .02 under COMAR 09.03.13 State Collection Agency Licensing Board — Fees.

Statement of Purpose

The purpose of this action is to conform certain collection agency licensing fee to the requirements of H.B. 182, Ch. 253, Acts of 2017 by prorating fees from a 2-year to a 1-year basis.

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 Jedd Bellman, Assistant Commissioner, Office of the Commissioner of Financial Regulation, 500 N. Calvert Street, Baltimore MD 21202, or call 410-230-6390, or email to jedd.bellman@maryland.gov, or fax to 410-333-0475. Comments will be accepted through November 13, 2017.  A public hearing has not been scheduled.

.02. Fees.

A. Initial License Fee. The initial license fee required by Business Regulation Article, §§7-302(a) and 7-302.1, Annotated Code of Maryland, is [$700 for a 2-year] $350 for a 1-year license term.

B. Renewal Fee. The renewal fee required by Business Regulation Article, [§7-302(e)(2)] §7-306(b)(2), Annotated Code of Maryland, is [$700 for a 2-year] $350 for a 1-year renewal term.

TONY SALAZAR
Maryland Collection Agency Licensing Board

 

Subtitle 12 DIVISION OF LABOR AND INDUSTRY

09.12.31 Maryland Occupational Safety and Health Act — Incorporation by Reference of Federal Standards

Authority: Labor and Employment Article, §2-106(b)(4), Annotated Code of Maryland

Notice of Proposed Action

[17-247-P]

The Commissioner of Labor and Industry proposes to adopt, through incorporation by reference under COMAR 09.12.31 Maryland Occupational Safety and Health Act Incorporation by Reference of Federal Standards, amendments to 29 CFR Parts 1910 and 1926, published in 79 FR 20629—20743 (April 11, 2014).

Statement of Purpose

The purpose of this action is to incorporate by reference amendments to 29 CFR Parts 1910 Construction and 1926 General Industry Standards for employee safety related to electric power generation, transmission, and distribution activities.

Comparison to Federal Standards

There is a corresponding federal standard to this proposed action, but the proposed action is not more restrictive or stringent.

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 Mischelle Vanreusel, Regulatory and Grants Coordinator, Division of Labor and Industry, 1100 North Eutaw Street, Room 604, Baltimore, MD  21201, or call 410-767-2225, or email to mischelle.vanreusel@maryland.gov, or fax to 410-767-2986. Comments will be accepted through November 13, 2017. A public hearing has not been scheduled.

A.—V. (text unchanged)

V-1. Electric Power Generation, Transmission, and Distribution; Electrical Protective Equipment.

(1)—(2) (text unchanged).

(3) All amendments and revisions to 29 CFR Parts 1910 and 1926 that appear in the Federal Register on April 11, 2014 (79 FR 20629—20743) are incorporated by reference, as amended.  Effective date:

W.—ZZ-2. (text unchanged).

MATTHEW S. HELMINIAK
Commissioner of Labor and Industry

 

Subtitle 12 DIVISION OF LABOR AND INDUSTRY

09.12.31 Maryland Occupational Safety and Health Act — Incorporation by Reference of Federal Standards

Authority: Labor and Employment Article, §2-106(b)(4), Annotated Code of Maryland

Notice of Proposed Action

[17-249-P]

The Commissioner of Labor and Industry proposes to adopt, through incorporation by reference under COMAR 09.12.31 Maryland Occupational Safety and Health Act — Incorporation by Reference of Federal Standards, amendments to 29 CFR Part 1910, published in 81 FR 82981—83006 (November 18, 2016).

Statement of Purpose

The purpose of this action is to incorporate by reference amendments and revisions to 29 CFR 1910 General Industry Standards for employee safety related to walking/working surfaces.

Comparison to Federal Standards

There is a corresponding federal standard to this proposed action, but the proposed action is not more restrictive or stringent.

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 Mischelle Vanreusel, Regulatory and Grants Coordinator, Division of Labor and Industry, 1100 North Eutaw Street, Room 604, Baltimore, MD 21201, or call 410-767-2225, or email to mischelle.vanreusel@maryland.gov, or fax to 410-767-2986. Comments will be accepted through November 13, 2017. A public hearing has not been scheduled.

A. In General.

(1)—(17) (text unchanged)

(18) All amendments and revisions to 29 CFR Part 1910 that appear in the Federal Register on November 18, 2016 (81 FR 82981—83006) are incorporated by reference, as amended. Effective date:

B.—ZZ-2. (text unchanged)

MATTHEW S. HELMINIAK
Commissioner of Labor and Industry

 

Title 10
MARYLAND DEPARTMENT OF HEALTH

[17-250-P]

The Secretary of Health proposes to:

(1) Amend Regulations .03, .04, and .08 under COMAR 10.01.04 Fair Hearing Appeals Under the Maryland State Medical Assistance Program;

(2) Amend Regulation .01 under COMAR 10.09.62 Maryland Medicaid Managed Care Program: Definitions;

(3) Amend Regulations .02, .03, and .06 under COMAR 10.09.63 Maryland Medicaid Managed Care Program: Eligibility and Enrollment;

(4) Amend Regulations .03 and .11 under COMAR 10.09.64 Maryland Medicaid Managed Care Program: MCO Application;

(5) Amend Regulations .02, .04, .15, .17, .19, and .20 and repeal Regulation .28 under COMAR 10.09.65 Maryland Medicaid Managed Care Program: Managed Care Organizations;

(6) Amend Regulations .01 and .02 under COMAR 10.09.66 Maryland Medicaid Managed Care Program: Access;

(7) Amend Regulations .01, .04, and .19 under COMAR 10.09.67 Maryland Medicaid Managed Care Program: Benefits;

(8) Adopt new Regulations .01—.03 under new chapter, COMAR 10.09.68 Maryland Medicaid Managed Care Program: Program Integrity;

(9) Amend Regulations .02, .04, and .05 under COMAR 10.09.71 Maryland Medicaid Managed Care Program: MCO Dispute Resolution Procedures; and

(10) Amend Regulations .01 and .06 under COMAR 10.09.72 Maryland Medicaid Managed Care Program: Departmental Dispute Resolution Procedures.

Statement of Purpose

The purpose of this action is to implement regulations to comply with newly adopted federal regulations impacting MCO requirements and oversight (42 CFR Parts 438, 457, and 495). The new requirements include member rights, member materials, appeals and grievances, and program integrity. In order to coincide with current policy, this proposal also corrects the number of long-term care days for which an MCO is responsible.

Comparison to Federal Standards

There is a corresponding federal standard to this proposed action, but the proposed action is not more restrictive or stringent.

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, 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 November 13, 2017. A public hearing has not been scheduled.

 

Subtitle 01 PROCEDURES

10.01.04 Fair Hearing Appeals Under the Maryland State Medical Assistance Program

Authority: Health-General Article, §2-104, Annotated Code of Maryland

.03 Notification of Right to Request a Fair Hearing.

A. The Program [or], delegate agency, or MCO shall notify an individual and his or her authorized representative, if previously designated by the individual or recognized as valid by the Program, in writing:

(1)—(3) (text unchanged)

B.C. (text unchanged)

.04 Request for Fair Hearing.

A.—C. (text unchanged)

D. Timeliness of Appeal. A request for a fair hearing may not be granted unless the request in §A of this regulation is:

(1) Postmarked, delivered in person, or sent by email or facsimile to the Office of Health Services within 120 days of the receipt of the notification specified in Regulation .03A of this chapter, if the appeal concerns services provided or denied by an MCO;

[(1)] (2) Postmarked, delivered in person, or sent by email or facsimile to the Office of Health Services within 90 days of the receipt of the notification specified in Regulation .03A of this chapter, if the appeal concerns services provided or denied [to the recipient] by the fee-for-service program; or

[(2)] (3) Postmarked, delivered in person, or sent by facsimile to the Office of Administrative Hearings; or emailed to Maryland Health Benefit Exchange; telephoned or faxed to the Consolidated Services Center or postmarked, telephoned, faxed, or delivered in person to the delegate agency within 90 days of the receipt of the notification specified in Regulation .03A of this chapter if the appeal concerns the appellant’s eligibility.

E.—F. (text unchanged)

.08 Findings, Timing of Decision, and Effect of Decision.

A—C. (text unchanged)

D. Effect of Decision.

(1)—(3) (text unchanged)

(4) When the decision is favorable to the appellant and is an MCO service, the MCO shall authorize or provide the disputed services no later than 72 hours from the date it receives notice reversing the MCO’s determination.

 

Subtitle 09 MEDICAL CARE PROGRAMS

10.09.62 Maryland Medicaid Managed Care Program: Definitions

Authority: Health-General Article, §15-101, Annotated Code of Maryland

.01 Definitions.

A. (text unchanged)

B. Terms Defined.

(1)—(2) (text unchanged)

(3) “Action” means:

(a) Denial or limited authorization of a requested service, including [the]:

(i) The type or level of service;

(ii) Requirements for medical necessity;

(iii) Appropriateness;

(iv) Setting; or

(v) Effectiveness of a covered benefit.

(b)—(e) (text unchanged)

(4)—(63) (text unchanged)

(64) “Grievance” means an expression of dissatisfaction about any matter other than an action, including but not limited to:

(a) The quality of care or services provided, and aspects of interpersonal relationships such as rudeness of a provider or employee;

(b) Failure to respect the enrollee’s rights regardless of whether remedial action is requested; or

(c) A dispute over an extension of time proposed by the MCO to make an authorized decision.

(65)—(96) (text unchanged)

(96-1) “Limited English proficiency” means the special need status of potential enrollees and enrollees who do not speak English as their primary language and who have a limited ability to read, write, speak, or understand English, and are therefore eligible to receive language assistance for a particular type of service, benefit, or encounter.

(97)—(123) (text unchanged)

(123-1) “Network provider” means a provider that is a member of the MCO’s provider panel.

(124)—(129) (text unchanged)

(129-1) “Overpayment” means:

(a) Any payment made by the Program to a provider in excess of the correct Program payment amount for a service; or

(b) Any payment for services under COMAR 10.09.67 made by the Program or an MCO which at the time of payment, or at a subsequent date, is determined to be inappropriate, inaccurate or in excess of the correct amount of the procedural code billed, for reasons including but not limited to:

(i) Improper claiming;

(ii) Lack of medical necessity;

(iii) Unacceptable practices;

(iv) Fraud, waste, or abuse; or

(v) Provider mistake.

[(130) “Panel provider” means a provider that is a member of the MCO’s provider panel.]

[(131)] (130)[(154)] (153) (text unchanged)

(154) “Readily accessible” means electronic information and services which comply with modern accessibility standards such as:

(a) Section 508 guidelines;

(b) Section 504 of the Rehabilitation Act; or

(c) W3C’s Web Content Accessibility Guidelines (WCAG) 2.0 AA and successor versions.

(155)—(171) (text unchanged)

[(172) “Subcontractor provider” or “subcontractor” means a provider with whom the MCO has a subcontract under which the subcontractor agrees to provide a service or services that the MCO is required to provide under the Medicaid Managed Care Program.]

(172) “Subcontractor” means an individual or entity that has a contract with an MCO that relates directly or indirectly to the performance of the MCO’s obligations under its contract with the Department; provided, however, that a contract does not by itself cause an MCO’s network provider to be a subcontractor.

(173)—(180) (text unchanged)

(181) “Whistleblower” means an individual who exposes any kind of information or activity that alleges any violation of regulation, statute, contract, policy, or unethical behavior that may be indicative of an individual or entity committing fraud, waste, or abuse against the Medicaid program.

[(181)] (182) (text unchanged)

 

10.09.63 Maryland Medicaid Managed Care Program: Eligibility and Enrollment

Authority: Health-General Article, §15-103(b)(16). Annotated Code of Maryland

.02 Enrollment.

A. The Department shall provide to waiver-eligible individuals:

(1) Materials regarding each MCO providing services in the eligible individual’s county of residence including, but not limited to:

[(a) The names and addresses of all participating providers, upon enrollee’s request;]

(a) Information about how to access the provider directory and drug formulary, with instructions for how to request paper copies if needed;

(b) A schedule of the benefits offered, including any benefits offered beyond the basic required package described in COMAR 10.09.67; [and]

(c) Which, if any, benefits are provided directly by the Department;

[(c)] (d) If applicable, a list of services that the MCO does not provide, reimburse for, or provide coverage of, because of moral or religious objections, and information about where and how to obtain these services;

(e) The requirements for each MCO to provide adequate access to covered services, including the network adequacy standards established in COMAR 10.09.66; and

(f) Quality and performance indicators for each MCO, including enrollee satisfaction; and

(2) Materials about the managed care program, including:

(a) The MCO enrollment and disenrollment process; and

(b) The basic features of managed care.

[(2)] (3)—[(3)] (4) (text unchanged)

B.—C. (text unchanged)

D. Upon determination of Maryland Medicaid Managed Care Program eligibility, the Department shall enroll eligible individuals into an MCO by:

(1)—(2) (text unchanged)

(3) Face-to-face meeting, if requested; [or]

(4) Face-to-face meeting in the recipient’s home, if medically necessary; or

(5) Online.

E. Children.

(1) A newborn shall be automatically enrolled from birth in its biological mother’s MCO.

(2) The MCO is responsible for the newborn’s health care from birth until the newborn enrolls into another MCO[, except if the newborn is hospitalized at the time of enrollment into the new MCO, in which case the original MCO is responsible for the hospitalization].

(3) A newborn, automatically assigned to its biological mother’s MCO, is not eligible to change MCOs for family unity as described in COMAR 10.09.63.06 A(1)(b) and (c) during the first 90 days of enrollment.

[(2)] (4) (text unchanged)

F.—L. (text unchanged)

.03 Health Service Needs Information.

A. The Department, MCO, or [its agent] agents of the Department or MCO shall attempt to complete the health service needs information at the time of enrollment.

B. The Department shall transmit any information obtained from health service needs information to the [recipient’s] enrollee’s MCO within 5 business days.

C. (text unchanged)

D. If the Department does not transmit health services needs information for an enrollee to the MCO within 10 days of enrollment, the MCO shall make at least two attempts to conduct an initial screening of the enrollee’s needs, within 90 days of the effective date of enrollment. At least one of these attempts shall be during non-working hours.

[D.] E. The Department shall inform [a recipient] an enrollee identified in connection with the health service needs information as having a behavioral health problem that the individual may self-refer to the behavioral health ASO for services as described in COMAR 10.09.59 and 10.09.80.

.06 Disenrollment.

A (text unchanged)

B. Department-Initiated Disenrollment. The Department shall disenroll from an MCO an enrollee:

(1) Subject to the MCO or long-term care facility obtaining the Department’s determination that the enrollee’s institutionalization has been medically necessary, who has been continuously institutionalized for a period of more than [30] 90 successive days in a long-term care facility;

(2)—(10) (text unchanged

C. —I. (text unchanged)

 

10.09.64 Maryland Medicaid Managed Care Program: MCO Application

Authority: Health-General Article §15-102 and 15-103, Annotated Code of Maryland

.03 Organization, Operations, and Financing.

Except as provided in Regulation .02B of this chapter, an MCO applicant shall include the following information or descriptions in its application:

A.—S. (text unchanged)

T. Copies of the applicant’s written Medicaid marketing plan [with draft copies of all materials,] including[, but not limited to, brochures, fact sheets, and posters that the applicant would like distributed to potential enrollees, and including appropriate foreign language versions required when English is not the native language of a substantial minority of the population to be served]:

(1) A description of how the applicant plans to address the special access provisions in COMAR 10.09.66.01D; and

(2) Sample version of all material and communication the applicant would like to distribute to potential enrollees, including but not limited to:

(a) Brochures;

(b) Fact sheets; and

(c) Posters. 

.11 Management Information System and Data Reporting.

An MCO applicant shall include in its application the following information or descriptions:

A. A description of the applicant’s management information system, including, but not limited to:

(1) Capacities, including:

(a) The ability to generate and transmit electronic claims data consistent with the Medicaid Statistical Information System (MSIS) requirements or successor systems;

(b) The ability to collect and report data on enrollee and provider characteristics and on all services furnished to enrollees through an encounter data system;

(c) The ability to screen the data collected for completeness, logic, and consistency; and

(d) The ability to collect and report data from providers in standardized formats using secure information exchanges and technologies utilized for Medicaid quality improvement and care coordination efforts;

(2)—(4) (text unchanged)

B.—C. (text unchanged)

D. A description of the applicant’s operational procedures for generating financial reports, including, but not limited to:

(1)—(2) (text unchanged)

(3) Quarterly unaudited financial statements; [and]

E. Evidence of the applicant’s ability to collect and report all data necessary to derive indicators for Healthcare Effectiveness Data and Information Set (HEDIS) [report cards]; and

F. A description of the applicant’s procedures for verifying the accuracy and timeliness of reported data, including data from network providers the MCO was compensating on the basis of capitation payments or other payment arrangements that are not fee-for-service.

 

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. (text unchanged)

[B. An MCO’s service area shall contain a minimum of 10,000 waiver-eligible residents.]

[C.] B.[D.] C. (text unchanged)

[E.] D. Assurance Against Insolvency.

(1)—(3) (text unchanged)

(4) If the Commissioner determines and reports to the Secretary that the applicant’s initial surplus is less than $1,250,000 before approval the Department may, at its discretion, designate funds in trust in an amount equal to:

(a) The sum of the amounts due to the owners of the applicant from the Department for Medicaid services provided on a fee-for-service basis, so long as the owners of the applicant have waived in writing their right to receive Medicaid payments until such time as the Department is permitted to remove its funds from the trust account pursuant to §D(6) of this regulation; or

(b) (text unchanged)

(5) If, in accordance with [§E(4)] §D(4) of this regulation, the Department designates funds sufficient to increase the applicant’s initial surplus to $1,250,000, the Department shall designate $250,000 in trust for the applicant.

(6) Funds designated by the Secretary pursuant to [§E(3)—(5)] §D(3)—(5) of this regulation shall remain in trust until such time as the Commissioner has determined that the MCO meets the minimum statutory surplus requirements based on the MCO’s annual report submitted pursuant to Insurance Article, §5-605, Annotated Code of Maryland.

[F.] E. Health Care Delivery. An MCO shall:

(1)—(3) (text unchanged)

(4) Provide enrollees, within 30 days before the intended effective date, written notice when there is a significant change in the nature or location of services provided; and

(5) Provide on the card required in [§G(3)] §E(3) of this regulation, on a separate prescription benefit card, or other technology, prescription billing information that:

(a)—(b) (text unchanged)

[G.] F. An MCO:

(1)—(2) (text unchanged)

(3) Shall prepare and make available all publications in a manner consistent with COMAR 10.09.66.01A, including, but not limited to[, provider]:

(a) Provider directories[, enrollee];

(b) Enrollee handbooks[, health];

(c) Health education materials[,]; and[informational]

(d) Informational brochures[:

(a) In a culturally sensitive manner;

(b) At an appropriate reading comprehension level; and

(c) In the prevalent non-English languages, identified by the State; and

(4) Shall pay Maryland hospital providers on the basis of rates approved by the Maryland Health Services Cost Review Commission (HSCRC)].

[H.] G.[M.] L. (text unchanged)

[N.] M. The requirements of Regulation .17A(2) of this chapter, or [§M(1)] §L(1) of this regulation, may not be construed to:

(1)—(3) (text unchanged)

[O. An MCO shall permit the Department or the U.S. Department of Health and Human Services to inspect or otherwise evaluate the quality, appropriateness, and timeliness of services performed by or on behalf of the MCO or by or on behalf of any subcontractor.

P. An MCO and its subcontractors shall permit the following organizations to inspect, evaluate, or audit books, records, documents, files, accounts, and facilities maintained by or on behalf of the MCO or by or on behalf of any subcontractor:

(1) The Department;

(2) The Medicaid Fraud Control Unit of the Office of the Attorney General;

(3) The Insurance Fraud Division of the Maryland Insurance Administration; or

(4) Other authorized State or federal agencies.

Q. On the request of the following organizations, an MCO shall, within 10 business days of the request, or within a shorter time if provided by other applicable law, regulation, subpoena, or court order, furnish a copy of any books, records, files, accounts, or other documents, and provide access to the facilities maintained by the MCO or its subcontractor:

(1) The Department;

(2) The Medicaid Fraud Control Unit of the Office of the Attorney General;

(3) The Insurance Fraud Division of the Maryland Insurance Administration; or

(4) Other authorized State or federal agency.

R. The chief executive officer of an MCO or his or her designee shall certify, under penalty of perjury, that any books, records, files, accounts, or other documents requested under §§P and Q of this regulation are current, accurate, and complete to the best of that individual’s knowledge.

S. An MCO shall promptly but within 30 calendar days of the suspected fraud report to the Medicaid Fraud Control unit all suspected fraud and abuse, including fraud by employees and subcontractors of the MCO, enrollment agents, and recipients.

T. An MCO shall report to the Department any identified inaccuracies in the encounter data reported by the MCO or its subcontractors within 30 days of the date discovered, regardless of the effect which the inaccuracy has upon MCO reimbursement.]

[U.] N. Disclosure of Provider Incentive Plans.

(1) (text unchanged)

(2) An MCO shall include in the disclosures required by [§U(1)] §N(1) of this regulation information sufficient for the Department to determine whether the incentive plans meet the requirements of 42 CFR §417.479(d)—(g) and, as applicable (i), when there exist compensation arrangements under which payment for designated health services furnished to an individual on the basis of a physician referral would otherwise be denied under §1903(a) of the Social Security Act.

[V.] O. (text unchanged)

[W. Upon the direction of the Department, an MCO shall reduce payments, by 20 percent, to a hospital located in a contiguous state, or in the District of Columbia, for services rendered to its enrollees, if the hospital has failed to supply appropriate discharge data to the Health Services Cost Review Commission.]

[X.] P. (text unchanged)

Q. An MCO shall meet all program integrity requirements as set forth in COMAR 10.09.68.

[Y. The records available for inspection, evaluation, or audit under §§P and Q of this regulation shall also include the books, records, files, accounts or other documents of any related organization that provides supplies or services to the MCO.

Z. An MCO shall meet the requirements of §6032 of the Deficit Reduction Act of 2005, Pub.L. 109—171, which establishes 42 U.S.C. §1396a(a)(68), and relates to Employee Education about False Claims.

AA. Federal financial participation is not available for amounts expended for excluded providers in §M(2) of this regulation, except for emergency services.

BB. For complaints of provider fraud and abuse that warrant a preliminary investigation, the MCO’s report required in §S of this regulation shall include:

(1) The number of complaints;

(2) The name and identification (ID) number of the provider being investigated;

(3) The source of the complaint;

(4) The type of provider;

(5) The nature of the complaint;

(6) The approximate dollar amount involved;

(7) The legal and administrative disposition of the case; and

(8) The method by which the MCO verified that the services being investigated were actually provided to the enrollee.

CC. Effective July 1, 2011, MCOs shall participate in the Maryland Health Care Commission’s Patient Centered Medical Home Program authorized under Health-General Article, §§19-103 and 19-109, Annotated Code of Maryland, and follow the policies and procedures established by the Maryland Health Care Commission.

DD. All MCOs participating in the Program as of January 1, 2013, shall be accredited by the National Committee on Quality Assurance (NCQA) not later than January 1, 2015.]

[EE.] R. (text unchanged)

.04 Special Needs Populations.

A.—B. (text unchanged)

C. General Requirements for Special Needs Populations.

(1)—(4) (text unchanged)

(5) To meet the commitment outlined in §C(4) of this regulation, an MCO shall:

(a)—(e) (text unchanged)

(f) Document the plan of care and treatment modalities provided to enrollees in special populations, assuring that the plan of care:

(i) Is updated at least annually, when the enrollee’s circumstances or needs change significantly, or at the enrollee’s request; and

(ii) (text unchanged)

(g) Be familiar with [community-based resources available] community and social support providers for the special populations.

(6) An MCO shall make documented outreach efforts to contact and educate enrollees who fail to appear for appointments or who have been noncompliant with a regimen of care. These efforts may include, but may not be limited to, notification:

(a) (text unchanged)

(b) By telephone; [and]

(c) By email;

(d) By text messaging; and

[(c)] (e) (text unchanged)

(7)—(9) (text unchanged)

(10) An MCO shall have mechanisms in place to allow enrollees with special health care needs to access a specialist directly as appropriate for the enrollee’s condition and identified needs.

.15 Data Collection and Reporting.

A. (text unchanged)

B. Encounter Data.

(1) (text unchanged)

(2) An MCO may use alternative formats including:

(a) ASC X12N 837 and NCPDP formats; and

(b) ASC X12N 835 format, as appropriate.

(3) An MCO shall submit encounter data that identifies the provider who delivers any items or services to enrollees at a frequency and level of detail to be specified by CMS and the Department.

[(2)] (4) (text unchanged)

[(3)] (5) An MCO shall submit encounter data utilizing [an] a secure on-line data transfer system.

C. (text unchanged)

D. Quarterly Reports. An MCO shall submit to the Department:

(1)—(3) (text unchanged)

(4) [On a quarterly basis and in] In a format specified by the Department, amounts the MCO has cost-avoided and recovered and the number of cases the MCO has handled in each case area during the quarter.

(5) Not later than 45 days after the end of each quarterly rebate period, drug utilization data necessary for the Department to bill manufacturers for rebates in accordance with §1927(b)(1)(A) of the Social Security Act, that:

(a) Include, at a minimum, the following information by National Drug Code of each covered outpatient drug dispensed or covered by the MCO:

(i) Total number of units of each dosage form;

(ii) Total number of units of each dosage strength; and

(iii) Total number of units of each dosage package size; and

(b) Distinguish utilization data for covered outpatient drugs that are subject to discounts under the 340B drug pricing program.

E. Annual Reports. Except as provided in §E(5) of this regulation, an MCO shall submit to the Department annually, within 90 days after the end of the calendar year:

(1)—(3) (text unchanged)

(4) Any revisions to the MCO’s quality assurance, utilization management, and case management plans; [and]

(5) HealthChoice Financial Monitoring Reports (HFMRs), including any supplemental schedules required by the Department:

(a)—(b) (text unchanged)

(c) Submitted according to the following schedule:

(i) (text unchanged)

(ii) Services incurred January 1—December 31 of the prior year, reported through September 30 of the current year—due on November 15 of the current year; and

(6) A detailed description of its drug utilization program activities.

F. HEDIS Reporting. By July 1 of each year, an MCO shall submit to the Department a record of its health care delivery and organizational performance during the preceding year measured utilizing the most recent version of the [Health Plan Employer] Healthcare Effectiveness Data and Information Set (HEDIS) applicable to the reporting period.

G.—K. (text unchanged)

.17 Subcontractual Relationships.

A. Subcontracting Permitted.

(1)—(2) (text unchanged)

[(3) A subcontractor shall be legally qualified to furnish the services provided for in the subcontract in return for the compensation provided in the subcontract.

(4) An MCO may not knowingly enter into a subcontractual relationship with providers who have been convicted of certain crimes or received certain sanctions as specified in §1128 of the Social Security Act.]

[(5)] (3) An MCO shall [use subcontracts that are in writing,] have written agreements with subcontractors that comply with 42 CFR §§438.214 and 455.105, as amended, and include at least the following:

(a)—(c) (text unchanged)

(d) A provision requiring that [subcontractor’s facilities and records be open to inspection by the MCO, the Department, and other government agencies, and that the subcontractor is subject to all audits and inspections to the same extent that audits and inspections may be required of the MCO under law or under its contract with the Department] the subcontractor complies with all State and federal requirements regarding audit, inspection, and evaluation;

(e)—(i) (text unchanged)

(j) If the subcontractor is authorized by the MCO to make referrals, a provision requiring the subcontractor to use the uniform consultation referral form adopted by the Maryland Insurance Administration at COMAR 31.10.12.06; [and]

(k) A provision to the effect that each provision of the subcontract that is required under this section supersede and be controlling over any conflicting terms that appear in the subcontract;

(l) A provision for revocation of the delegation of activities or obligations, or specifying other remedies in instances where the Department or the MCO determines that the subcontractor has not performed satisfactorily;

(m) A provision stating that the MCO has the right to audit the subcontractor pursuant to 42 CFR §438.230(c)(3)(i) for 10 years from the final date of the contract period or from the date of completion of any audit, whichever is later; and

(n) A provision to the effect that all providers and subcontractors are subject to a grievance and appeal system consistent with the requirements of COMAR 10.09.71.

[(6)] (4)—[(7)] (5) (text unchanged)

B. Subcontractual Relations Reporting Requirements.

(1)—(3) (text unchanged)

(4) Network Provider Termination.

(a)—(b) (text unchanged)

(c) If the provider is terminating the contract, the notice required in §B(4)(a) of this regulation shall be provided within [10 days] 15 days after the MCO receives the notice from the terminating provider.

(d)—(f) (text unchanged)

(5) Subcontractor Termination.

(a) When an MCO terminates a subcontract impacting its operations, covered services, or enrollees, the MCO shall provide the Department with written notice regarding the termination that describes:

(i) The dollar amount of the subcontract;

(ii) The effect of the termination on MCO operations;

(iii) The effect of the termination on MCO covered services or enrollees; and

(iv) The MCO’s plan to replace the subcontractor, if applicable.

(b) If the termination of the subcontract impacts MCO operations, the notice required in §B(5)(a) of this regulation shall be provided at least 90 days before the effective date of the termination.

[C. Effect of Subcontract.]

[(1)] C. (text unchanged)

[(2) By entering into a subcontract to provide health care services on behalf of an MCO, the subcontracting provider becomes responsible for providing the specified health care services in compliance with all of the requirements imposed by COMAR 10.09.62—10.09.75, including, but not limited to, requirements concerning access, quality assurance, medical records, and reporting requirements.

(3) When entering into a subcontract to transfer to the subcontracting provider the initial responsibility for providing specified health care services to the MCO’s enrollees, an MCO retains a primary duty to the Department and to its enrollees to ensure that its subcontractor delivers the required services in a manner that is consistent with the requirements of COMAR 10.09.62—10.09.75.]

D.—E. (text unchanged)

.19 MCO Reimbursement.

A. Generally.

(1)—(3) (text unchanged)

[(4) The Department has the authority to recover any overpayments made to MCOs.]

[(5)] (4)[(6)] (5) (text unchanged)

[(7)] (6) [Effective January 1, 2005, the] The Department may consider a retroactive capitation payment to an MCO, if the MCO notifies the Department within 9 months of the first missed capitation payment for an enrollee for whom the MCO has not received all appropriate capitation payments.

[(8)] (7) (text unchanged)

B.—D. (text unchanged)

.20 MCO Payment for Self-Referred, Emergency, Physician, and Hospital [Administrative Days] Services.

A.—D. (text unchanged)

[E. An MCO shall reimburse hospital administrative days at the Medicaid fee-for-service rate.]

E. Payment for Hospital Services.

(1) An MCO shall reimburse Maryland hospital providers on the basis of rates approved by the Maryland Health Services Cost Review Commission (HSCRC).

(2) An MCO shall reimburse hospital administrative days at the Medicaid fee-for-service rate.

(3) Upon the direction of the Department, an MCO shall reduce payments by 20 percent to a hospital located in a contiguous state or in the District of Columbia for services rendered to its enrollees, if the hospital has failed to supply appropriate discharge data to the Health Services Cost Review Commission.

 

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. (text unchanged)

B. Special Access.

[(1) An MCO shall on request make interpretation services available free of charge to each enrollee and potential enrollee who:

(a) Does not speak English; or

(b) Is hearing impaired.

(2) As a part of its initial application, a prospective MCO shall describe, for the Department’s consideration, what special access provisions the applicant has made to fulfill the requirements of this section.]

(1) An MCO shall notify enrollees of the following services and make them available free of charge to the enrollee:

(a) Written materials in the prevalent non-English languages identified by the State;

(b) Written materials in alternative formats;

(c) Oral interpretation services in all non-English languages; and

(d) Auxiliary aids and services, such as:

(i) Teletypewriter/Telecommunication Device for the Deaf (TTY/TDD); and

(ii) American Sign Language.

(2) An MCO shall include taglines with its written materials that:

(a) Explain the availability of written translation or oral interpretation to understand the information provided; and

(b) Provide the toll-free and TTY/TDD telephone number of the MCO’s customer service unit.

(3) An MCO shall format taglines included with written materials in the following manner:

(a) In a font size no smaller than 18 point; and

(b) In the prevalent non-English languages identified by the State.

C. Written Materials. An MCO shall provide all its written materials in the following manner:

(1) Using language and a format that is easily understood;

(2) In a font size no smaller than 12 point;

(3) Available in alternative formats and through the provision of auxiliary aids and services; and

(4) Available in an appropriate manner that takes into consideration the special needs of enrollees or potential enrollees with disabilities or limited English proficiency.

D. An MCO may provide enrollee information electronically so long as all of the following requirements are met:

(1) The format is readily accessible;

(2) The information is placed in a location on the MCO’s website that is prominent and readily accessible;

(3) The information is provided in an electronic form which can be electronically retained and printed;

(4) The information is consistent with the content and language requirements of this section;

(5) The enrollee is informed that the information is available in paper form without charge upon request; and

(6) Should the enrollee request it, the MCO provides the information in paper form within 5 business days.

.02 Access Standards: Enrollee Handbook and Provider Directory.

A. An MCO shall inform and educate its enrollees about [the]:

(1) Basic information about the MCO;

(2) [Availability] The availability of health care services and how to access them;

(3) The definitions of managed care terminology in accordance with 42 CFR §438.10(c)(4)(i); and

[(3)] (4) (text unchanged)

B. An MCO shall, at the time of enrollment, and anytime upon request, furnish each enrollee with a copy of the MCO’s enrollee handbook that includes all language in the template provided by the Department and the following current information:

(1) (text unchanged)

(2) Information on how to access urgent care and emergency care services [and the fact that prior authorization is not required for these services.], including:

(a) What constitutes an emergency medical condition and emergency services;

(b) The following facts:

(i) Prior authorization is not required for these services; and

(ii) The enrollee has a right to use any hospital or other setting for emergency care;

(3) (text unchanged)

(4) How and where to access any benefits provided by the State, including any cost sharing, and how transportation is provided;

(5) The amount, duration, and scope of benefits available in sufficient detail to ensure that enrollees understand the benefits to which they are entitled;

[(4)] (6) (text unchanged)

[(5)] (7) Information on the availability of self-referral services as well as any restrictions on the enrollee’s freedom of choice among network providers;

(8) Information about how enrollees may obtain benefits from out-of-network providers;

[(6)] (9) Any policies and procedures necessary to facilitate accessing needed services in compliance with the Maryland Medicaid Managed Care Program, including any requirements for service authorizations or referrals for specialty care and for other benefits not furnished by the enrollee’s primary care provider;

[(7)] (10) (text unchanged)

(11) A statement that the MCO cannot require an enrollee to obtain a referral before choosing a family planning provider;

(12) The process of selecting and changing the enrollee’s primary care provider;

[(8)] (13) (text unchanged)

(14) Information on how to access auxiliary aids and services, including additional information in alternative formats or languages;

[(9)] (15) The toll-free telephone number for member services, medical management, and any other unit providing services directly to enrollees, including:

(a) A description of [the MCO’s consumer services hotline, including toll-free telephone number,] each unit and number;

(b) [explaining how it] An explanation of how the phone numbers can be used to obtain information and assistance; and

(c) An explanation of the MCO’s internal grievance procedure.

[(10)] (16)[(15)] (21) (text unchanged)

(22) Information on how to report suspected fraud or abuse;

[(16)] (23)[(17)] (24) (text unchanged)

C. Provider Directory.

(1) An MCO shall provide enrollees with information regarding their provider networks including:

(a)—(c) (text unchanged)

(d) A listing of the individual practitioners who are the MCO’s primary and specialty care providers in the enrollee’s county, grouped by medical specialty, giving:

(i)—(iii) (text unchanged)

(iv) Telephone number or numbers;

(v) Website URL, as appropriate;

(vi) Any group affiliation, as appropriate;

(vii) Cultural and linguistic capabilities, including languages offered by the provider or a skilled medical interpreter at the provider’s offices, American Sign Language interpretation, and whether the provider has completed cultural competence training;

(viii) An indication of whether the provider’s office or facility has accommodations for physical disabilities, including offices, exam room or rooms and equipment;

[(iv)] (ix)[(vi)] (xi) (text unchanged)

(2) (text unchanged)

D. (text unchanged)

E. The Department may consider the information listed in §§B and C of this regulation to be provided if the MCO:

(1) Mails a printed copy of the information to the enrollee’s mailing address;

(2) Provides the information by email after obtaining the enrollee’s agreement to receive the information by email;

(3) Posts the information on the MCO’s website and advises the enrollee in paper or electronic form that the information is available on the internet and includes the applicable internet address, provided that enrollees with disabilities who cannot access this information online are provided auxiliary aids and services upon request at no cost; or

(4) Provides the information by any other method that can reasonably be expected to result in the enrollee receiving that information.

[E.] F. An MCO shall [make a good faith effort to keep the Department’s online provider directory accurate by submitting regular updates when its provider’s network status changes] update its online provider directory no later than 30 days after the MCO receives updated provider information.

G. An MCO shall update its paper directory on a monthly basis.

H. An MCO shall make provider directories available on its website in a machine-readable file and format as specified by the Secretary for the U.S. Department of Health and Human Services.

 

10.09.67 Maryland Medicaid Managed Care Program: Benefits

Authority: Health-General Article, Title 15, Subtitle 1, Annotated Code of Maryland

.01 Required Benefits Package — In General.

A. (text unchanged)

B. An MCO shall ensure that the services provided are sufficient in amount, duration, or scope to reasonably achieve the purpose for which the services are furnished.

[B.] C.[C.] D. (text unchanged)

E. An MCO may place appropriate limits on a service on the basis of criteria applied under the State plan, such as medical necessity.

[E.] F. Cost Sharing and Prohibitions.

(1) (text unchanged)

(2) An MCO may not:

(a)—(b) (text unchanged)

(c) Arbitrarily deny or reduce the amount, duration, or scope of a required service solely because of diagnosis, type of illness, or condition of the enrollee.

[F.] G. (text unchanged)

[G.] H. [The] An MCO shall provide for a second opinion from a qualified health care professional within the network, or, if necessary, arrange for the enrollee to obtain one outside the MCO network.

.04 Benefits — Pharmacy Services.

A. An MCO shall provide outpatient drugs as defined in §1927(k)(2) of the Social Security Act.

[A.] B. (text unchanged)

[B.] C. Except as provided in [§C] §B of this regulation, an MCO is required to provide only those drugs and related pharmaceutical products that are prescribed or ordered by:

(1)—(3) (text unchanged)

[C.] D. (text unchanged)

[D.] E. Drug Formulary.

(1) An MCO shall establish and maintain a drug formulary that is at least equivalent to the standard therapies of the Maryland Medical Assistance Program[.], and include at a minimum:

(a) Covered generic and name brand medications; and

(b) The tier each medication is on.

(2)—(3) (text unchanged)

(4) [Effective July 1, 2009, an] An MCO shall include in its formulary the following drugs:

(a)—(e) (text unchanged)

(5)—(6) (text unchanged)

[E.] F. Any option for accessing pharmacy services by mail order may be implemented only at the request of the enrollee except for when the drug is a specialty drug as defined in [§F.] §G of this regulation.

[F.] G.[G.] H. (text unchanged)

[H.] I. An MCO shall:

(1) Establish and maintain a drug [use management] utilization review program; [and]

(2) Adhere to the minimum performance standards established by the Department for these programs, whenever used, including but not limited to standards for the following drug use management components:

(a)—(c) (text unchanged)

(d) Prior authorization that complies with the requirements of §1927(d)(5) of the Social Security Act;

(e)—(f) (text unchanged)

(g) Pharmacy and Therapeutic Committee[.];

(3) Establish procedures to distinguish drug utilization data for covered outpatient drugs that are subject to discounts under the 340B drug pricing program; and

(4) Provide to the Department a detailed description of its drug utilization review program activities on an annual basis.

[I.] J. The Department shall:

(1) Review each MCO’s drug [use management] utilization review program annually; and

(2) Notify an MCO annually if any of the standards established in [§H(2)] §I(2) of this regulation have not been met.

[J.] K. For any performance standard identified in [§I(2)] §J(2) of this regulation, MCOs shall acknowledge any deficiencies within 30 days and correct any deficiencies within 90 days or be subject to sanctions listed in COMAR 10.09.73.01A and B.

.19 Benefits — Family Planning Services.

A. An MCO shall provide to its enrollees comprehensive family planning services, including but not limited to medically necessary office visits and laboratory tests, all FDA-approved contraceptive devices, methods, and supplies, and voluntary sterilizations.

B. An MCO may place appropriate limits on family planning services for the purpose of utilization control, provided that the services are provided in a manner that protects and enables the enrollee’s freedom to choose the method of family planning to be used consistent with 42 CFR §441.20.

C. An MCO may not apply a copayment or coinsurance requirement for contraceptive drugs or devices.

D. An MCO shall provide coverage for a single dispensing of a supply of prescription contraceptives for a 6-month period.

E. The requirement in §D of this regulation does not apply to the first 2-month supply of prescription contraceptives dispensed to a member under:

(1) The initial prescription for the contraceptives; or

(2) Any subsequent prescription for a contraceptive that is different than the last contraceptive dispensed.

 

10.09.68 Maryland Medicaid Managed Care Program: Program Integrity

Authority: Health-General Article, Title 15, Subtitle 1, Annotated Code of Maryland

.01 Requirements to Detect and Prevent Fraud, Waste, and Abuse.

A. An MCO or its responsible subcontractor shall implement and maintain arrangements or procedures that are designed to detect and prevent fraud, waste, and abuse, which includes a compliance program that has, at a minimum, the following elements:

(1) Written policies, procedures, and standards of conduct that include the MCO’s commitment to comply with all applicable:

(a) Requirements and standards under the contract; and

(b) Federal and State requirements including:

(i) Written policies for all employees and those of any contractor or agent that provide detailed information about the False Claims Act and other Federal and State laws described in section 1902(a)(68)of the Social Security Act; and

(ii) Information about rights of employees to be protected as whistleblowers.

(2) The designation of a compliance officer, who reports directly to the chief executive officer and the board of directors and is responsible for developing and implementing policies, procedures, and practices designed to ensure compliance with the requirements of the contract, and at minimum the following staff members:

(a) An investigator who is responsible for fraud, waste, and abuse investigations;

(b) An auditor who is responsible for identifying potential fraud, waste, and abuse through analysis of claims and related information; and

(c) An analyst capable of reviewing data and codes who is responsible for reviewing and researching evidence of potential fraud, waste, and abuse.

(3) Staffing and resources located in Maryland to identify and investigate potential fraud, waste, and abuse, which shall be based on criteria determined by the Department that may include but are not limited to:

(a) Number of enrollees;

(b) Number of claims received on an annual basis;

(c) Volume of suspected fraudulent and abusive claims currently being detected;

(d) Other factors relating to the vulnerability of the MCO to fraud and abuse; and

(e) An assessment of optimal caseload which can be handled by an investigator on an annual basis.

(4) The establishment of a regulatory compliance committee, which reports to the board of directors and to the MCO’s senior management level and is charged with overseeing the organization’s compliance program and its compliance with the requirements under the contract;

(5) A system for training and educating the compliance officer, the organization’s senior management, and the organization’s employees regarding the federal and State standards and requirements under the contract;

(6) Effective lines of communication between the compliance officer and the organization’s employees;

(7) Enforcement of standards through well-publicized disciplinary guidelines;

(8) Establishment and implementation of procedures and a system with dedicated staff for:

(a) Routine internal monitoring and auditing of compliance risks;

(b) Prompt response to compliance issues as they are raised;

(c) Investigation of potential compliance problems as identified in the course of self-evaluation and audits;

(d) Correction of problems, identified under §A(7)(c) of this regulation, promptly and thoroughly, or coordination of suspected criminal acts with law enforcement agencies, to reduce the potential for recurrence; and

(e) Ongoing compliance with the requirements under the contract.

B. An MCO shall ensure that a subcontractor is legally qualified to furnish the services provided for in the subcontract.

C. An MCO may not contract with the State unless conflict of interest safeguards at least equal to federal safeguards under section 27 of 41 U.S.C. §423, as amended, are in place.

D. An MCO may not knowingly have a relationship of the type described in §E of this regulation with the following:

(1) An individual or entity that is debarred, suspended, or otherwise excluded from:

(a) Participating in procurement activities under the Federal Acquisition Regulation; or

(b) Participating in non-procurement activities under Executive Order Numbers 12549 or. 12549; or

(2) An individual or entity who is an affiliate, as defined in 48 CFR §2.101, of a person described in §D(1) of this section.

E. The relationships described in §D of this Regulation, are as follows:

(1) A director, officer, or partner of the MCO;

(2) A subcontractor of the MCO;

(3) A person with beneficial ownership of 5 percent or more of the MCO’s equity; or

(4) A network provider or person with an employment, consulting or other arrangement with the MCO for the provision of items and services that is significant and material to the MCO’s obligations under its contract with the Department.

F. An MCO may not have a relationship with an individual or entity that is excluded from participation in any Federal health care program under section 1128 or 1128A of the Social Security Act.

G. An MCO shall monitor the Department’s correspondence and any database publicizing Department-initiated terminations of providers from the Program.

H. An MCO shall terminate the contract of, or refrain from contracting with, providers terminated or excluded from participation in the Program. 

I. An MCO shall suspend payments to a network provider for which the Department has determined that there is a credible allegation of fraud in accordance with 42 CFR §455.23.

J. An MCO shall establish a system to verify, by sampling or other methods, whether services that have been represented to have been delivered by network providers were received by enrollees and shall apply such verification processes at least annually.

K. An MCO shall require and have a mechanism for a network provider to report to the MCO when it has received an overpayment and to:

(1) Return the overpayment to the MCO within 60 calendar days after the date on which the overpayment was identified; and

(2) Notify the MCO in writing of the reason for the overpayment.

L. Overpayments to Providers and Subcontractors.

(1) Overpayments recovered by an MCO, including those recovered due to waste, fraud and abuse, may be retained by the MCO, so long as it is reported to the Department.

(2) If the Department, Federal government, or its agents identified the potential fraud, waste, or abuse that leads to recovery of funds paid to an MCO provider, and the MCO did not previously identify and report the provider for potential overpayments, the State shall have the right to recover from the MCO the entire amount of the overpayment.

(3) The State shall have the sole right of recovery of an overpayment when the MCO has identified the overpayment and the MCO has not initiated recovery within 90 days after the completion of the MCO’s investigation.

(4) The MCO shall have the right to appeal, pursuant to COMAR 10.09.72, the Department’s recovery of an overpayment.

M. The Department has the authority to recover any overpayments made to MCOs.

.02 Access to Information.

A. An MCO, its subcontractors, and its subcontractor’s subcontractors shall permit the following organizations or their designees to inspect, evaluate, or audit books, records, contracts, computer or other electronic systems, premises, and facilities that pertain to the MCO’s Medicaid enrollees, and any aspect of services and activities performed, or determination of amounts payable under, the MCO’s contract with the Department:

(1) The Department and its agents;

(2) The Medicaid Fraud Control Unit of the Office of the Attorney General;

(3) The Insurance Fraud Division of the Maryland Insurance Administration;

(4) The Centers for Medicare and Medicaid Services;

(5) The Inspector General of the Department of Health and Human Services;

(6) The Comptroller General; and

(7) Other authorized State or federal agencies.

B. The right to inspect, audit, and evaluate shall exist for 10 years from the final date of the contract period or from the completion of any audit, whichever is later, except, if the Department, Centers for Medicare and Medicaid Services, or the Department of Health and Human Services Inspector General determines that there is a reasonable possibility of fraud, or similar risk, those agencies may inspect, audit, and evaluate at any time.

C. Notwithstanding §B of this regulation, the Department has the right to inspect the accuracy, truthfulness, and completeness of the encounter data submitted by, or on behalf of, the MCO. 

.03 Reporting.

A. An MCO shall submit to the Department the following:

(1) Encounter data in the form and manner described in COMAR 10.09.65.15B, 42 CFR §438.242(c), and 42 CFR §438.818.

(2) Data required by the Department in order to certify the actuarial soundness of capitation rates to an MCO, under 42 CFR §438.3, including base data described in 42 CFR §438.5(c) that is generated by the MCO.

(3) Data required by the Department to determine compliance of the MCO with the medical loss ratio requirement described in 42 CFR §438.8.

(4) Data required by the Department and the Maryland Insurance Administration to determine that the MCO has made adequate provision against the risk of insolvency as required under 42 CFR §438.116.

(5) Documentation described in 42 CFR §438.207(b) on which the Department bases its certification that the MCO has complied with the State’s requirements for availability and accessibility of services, including the adequacy of the provider network, as set forth in 42 CFR §438.206.

(6) In accordance with §F of this regulation, information on ownership and control described in 42 CFR §455.104 from an MCO and its subcontractors, as governed by 42 CFR §438.230.

(7) An annual report of overpayment recoveries as required in 42 CFR §438.608(d)(3).

(8) Any other data, documentation, or information relating to the performance of the entity’s obligations under its contract with the Department, or required by the Department or the Secretary of the Department of Health and Human Services.

B. An MCO shall report to the Department any identified inaccuracies in the encounter data reported by the MCO or its subcontractors within 30 days of the date discovered regardless of the effect which the inaccuracy has upon MCO reimbursement.

C. An MCO shall promptly report to the Department’s Office of Inspector General (OIG) any potential fraud, waste, abuse, or information it has received from whistleblowers relating to the integrity of the MCO, its network providers, or its subcontractors.

D. An MCO shall report any potential fraud directly to the Medicaid Fraud Control Unit and the Department’s OIG, including fraud by providers, employees and subcontractors of the MCO, enrollment agents, and enrollees.

E. After reporting any potential fraud, waste, or abuse to the Department’s OIG and to the Medicaid Fraud Control Unit, the MCO may not take the following actions without prior written approval from the State:

(1) Contact the subject of the investigation about any matter related to the investigation;

(2) Enter into or attempt to negotiate any settlement or agreement regarding the incident; or

(3) Accept any monetary or other type of consideration offered by the subject of the investigation in connection with the incident.

F. For complaints of provider fraud and abuse that warrant a preliminary investigation, the MCO’s reports required in §§C and D of this regulation shall include:

(1) The number of complaints;

(2) The name and identification number of the provider being investigated;

(3) The source of the complaint;

(4) The type of provider;

(5) The nature of the complaint;

(6) The approximate dollar amount involved;

(7) The legal and administrative disposition of the case; and

(8) The method by which the MCO verified that the services being investigated were actually provided to the enrollee.

G. An MCO shall provide to the Department written disclosure of any affiliation prohibited under 42 CFR §438.610 and take action as directed by the Department.

H. An MCO shall provide to the Department written disclosures of information on ownership and control required under 42 CFR §455.104, including:

(1) The following information for any individual or corporation with an ownership or control interest in the MCO:

(a) For individuals:

(i) Name;

(ii) Address;

(iii) Date of birth; and

(iv) Social Security number; and

(b) For corporate entities:

(i) Name;

(ii) Applicable primary business address;

(iii) Every business location and applicable P.O. Box address; and

(iv) Other tax identification number or any subcontractor in which the MCO has a 5 percent or more interest;

(2) Whether the individual or corporation with an ownership or control interest in the MCO:

(a) Is related to another person with ownership or control interest in the disclosing entity as a spouse, parent, child, or sibling; or

(b) Whether the individual or corporation with an ownership or control interest in any subcontractor in which the MCO has a 5 percent or more interest is related to another person with ownership or control interest in the MCO as a spouse, parent, child, or sibling;

(3) The name of any other MCO in which an owner of the MCO has an ownership or control interest;

(4) The name, address, date of birth, and Social Security number of any managing employee or agent of the MCO;

(5) Disclosures of ownership and control information from MCOs are due at the following times:

(a) Upon application;

(b) Upon the managed care entity executing the contract with the State;

(c) Upon renewal or extension of the contract; and

(d) Within 35 days after any change in ownership of the managed care entity.

I. An MCO shall report to the Department all overpayments identified and recovered, specifying the overpayments due to fraud.

J. An MCO shall report third-party liability collection activities as described in COMAR 10.09.65.18.

K. An MCO shall report to the Department the amounts the MCO has cost-avoided and the number of third-party liability cases the MCO has handled. 

L. An MCO shall notify the Department promptly when it has knowledge of an enrollee’s change of residence or death.

M. An MCO shall notify the Department promptly when the MCO receives information about a change in a network provider’s circumstances that may affect the network provider’s eligibility to participate in the Program, including the termination of the provider agreement with the MCO. 

N. An MCO shall submit all required data, documentation and information in the format specified by the Department.

O. An MCO’s chief executive officer, chief financial officer, or directly-reporting authorized employee shall certify to the best of that individual’s information, knowledge, and belief, that any records, data, or other documents requested under regulations are accurate, complete and truthful.

P. As directed by the Department’s OIG, the MCO shall submit written reports documenting its Program Integrity efforts, including but not limited to:

(1) The dollar amount of losses and recoveries attributable to overpayment, abuse, and fraud; and

(2) The number of referrals to the Department’s OIG during the prior State fiscal year.

 

10.09.71 Maryland Medicaid Managed Care Program: MCO Dispute Resolution Procedures

Authority: Health-General Article, §[15-103(b)(i)(4)] 15-103(b)(9)(i)4, Annotated Code of Maryland

.02 Internal Complaint Process for Enrollees.

A. An MCO shall have written complaint procedures by which an enrollee who is dissatisfied with the MCO or its network providers, or decisions made by the MCO or a provider, may seek recourse verbally or in writing within the MCO at any time.

B. An MCO shall:

(1) (text unchanged)

[(2) Include as part of the written complaint procedures a form for the enrollee’s use when filing an appeal or grievance, and a process, which shall include providing interpreter services and toll-free numbers with TTY/TDD, by which an MCO staff member can assist in its completion;]

(2) Give enrollees any reasonable assistance in completing forms and taking other procedural steps related to a grievance or appeal in a manner consistent with COMAR 10.09.66.01A;

(3) Prepare the document describing the MCO’s internal complaint process:

(a)—(b) (text unchanged)

(c) In the prevalent non-English languages, identified by the State; [and]

(4) Deliver a copy of the MCO’s complaint procedures to each enrollee:

(a) With the MCO’s initial [mailing to] contact with a new enrollee; and

(b) At any time upon an enrollee’s request;

(5) Maintain an accurate and accessible record of grievances and appeals for monitoring by the State and CMS, which includes, at a minimum:

(a) A general description of the reason for the appeal or grievance;

(b) The date received;

(c) The date of each review or, if applicable, review meeting;

(d) Resolution at each level of the appeal or grievance, if applicable;

(e) Date of resolution at each level, if applicable; and

(f) Name of the enrollee for whom the appeal or grievance was filed; and

(6) Provide in its written procedures that an enrollee may file appeals and grievances orally or in writing.

C. An MCO shall include in the internal complaint process the procedures for registering and responding to appeals and grievances in a timely fashion, which:

(1)—(8) (text unchanged)

[(9) Include an appeal process which provides at its final level an opportunity for the enrollee to be heard by the MCO’s chief executive officer, or the chief executive officer’s designee;]

[(10)] (9) (text unchanged)

[(11)] (10) Include a documented procedure for written notification of the MCO’s determination:

(a) (text unchanged)

(b) To those individuals and entities required to be notified of the grievance pursuant to [§C(10)] §C(9) of this regulation; and

(c) (text unchanged)

[(12)] (11) Ensure that decision makers on appeals and grievances [were not involved in previous levels of review or decision-making and are health care professionals with clinical expertise in treating the enrollee’s condition if any of the following apply]:

(a) Were not involved in previous levels of decision-making;

(b) Are not subordinates of people involved in previous levels of decision-making;

(c) Are health care professionals with clinical expertise in treating the enrollee’s condition or disease, if any of the following apply:

[(a)] (i)—[(b)] (ii) (text unchanged)

[(c)] (iii) The grievance involves clinical issues; and

(d) Take into account all comments, documents, records, and other information submitted by the enrollee or their representative, without regard to whether such information was submitted or considered in the initial action.

.04 Actions and Decisions.

A. For certain services to enrollees that require preauthorization [by the MCO, the MCO shall make a determination in a timely manner so as not to adversely affect the health of the enrollee and within 2 business days of receipt of necessary clinical information, but not later than 7 calendar days from the date of the initial request.] the following conditions apply:

(1) For standard authorization decisions, the MCO shall make a determination within 2 business days of receipt of necessary clinical information, but not later than 14 calendar days from the date of the initial request so as not to adversely affect the health of the enrollee;

(2) For expedited authorization decisions, the MCO shall make a determination and provide notice no later than 72 hours after receipt of the request for service if the provider indicates or the MCO determines that the standard timeframe stated in §A(1) of this regulation could jeopardize:

(a) The enrollee’s life;

(b) The enrollee’s health; or

(c) The enrollee’s ability to attain, maintain, or regain maximum function; and

(3) For all covered outpatient drug authorization decisions, the MCO shall provide notice by telephone or other telecommunication device within 24 hours of a preauthorization request in accordance with section 1927(d)(5)(A) of the Social Security Act.

B. (text unchanged)

C. An MCO shall ensure that compensation to individuals or entities that conduct utilization management activities is not structured to provide incentives for the individual or entity to deny, limit, or discontinue medically necessary services to any enrollee.

[C.] D. Notices of a decision to deny an authorization shall be provided to the enrollee and the [regulation] requesting provider within the following time frames:

(1) [24] For standard authorization decisions, within 72 hours from the date of the determination [for emergency, medically related requests]; [and]

(2) [72] For expedited authorization decisions, within 24 hours from the date of determination [for nonemergency, medically related requests];

(3) Standard and expedited authorization decisions may be extended up to 14 calendar days, if the following conditions are met:

(a) The enrollee or the provider requests an extension; or

(b) The MCO justifies to the Department, upon request, a need for additional information and how the extension is in the enrollee’s interest;

(4) If the MCO successfully justifies extending the standard service authorization decision timeframe, the MCO shall:

(a) Give the enrollee written notice of the reason for the decision to extend the timeframe;

(b) Inform the enrollee of the right to file a grievance if he or she disagrees with the extension decision; and

(c) Issue and carry out the MCO’s determination as expeditiously as the enrollee’s health condition requires but not later than the date the extension expires.

[D.] E. An MCO shall give an enrollee written notice of any action[, except for denials of payment which do not require notice to the enrollee,] within the following time frames:

(1)—(3) (text unchanged)

(4) As soon as practicable for nursing facility transfers or discharges when:

(a) The safety or health of individuals in the facility would be endangered;

(b) The enrollee’s health improves sufficiently to allow a more immediate transfer or discharge; or

(c) An immediate transfer or discharge is required by the enrollee’s urgent medical needs; [or] and

[(d) An enrollee has not resided in the nursing facility for 30 days.]

(5) For denial of payment, at the time of any action affecting the claim.

[E.] F. A notice of adverse action shall:

(1) Be in writing; [and]

(2) Meet the following requirements:

(a)—(d) (text unchanged)

(e) Inform enrollees that information is available in alternative formats and how to access those formats[.]; and

(3) Contain the following information:

(a) The action the MCO has made or intends to make;

(b) The reasons for the action, including the right for the enrollee to be provided upon request and free of charge, reasonable access to and copies of all documents, records, and other information relevant to the MCO’s action, including:

(i) Medical necessity criteria; and

(ii) Any processes, strategies, or evidentiary standards used in setting coverage limits;

(c) The enrollee’s right to request an appeal of the MCO’s action, including information on:

(i) Exhausting the MCO’s one level of appeal; and

(ii) The right to request a State fair hearing;

(d) The procedures for exercising the rights described;

(e) The circumstances under which an appeal process can be expedited and how to request it;

(f) The enrollee’s right to have benefits continue pending resolution of the appeal;

(g) How to request that benefits be continued; and

(h) The circumstances under which the enrollee may be required to pay the costs of the services.

[F.] G. (text unchanged)

.05 Appeal Process for Enrollees.

A. An MCO’s appeal process shall:

(1) Require that an enrollee, or a provider acting on the enrollee’s behalf, file an appeal within [90] 60 days from the date on the MCO’s notice of action;

(2) (text unchanged)

(3) Permit an enrollee to request an appeal either orally or in writing;

(4) Provide that oral requests for appeal are considered the initiation of the appeal to establish the earliest possible filing date, and are confirmed in writing, unless the enrollee, their representative, or the provider requests an expedited appeal;

[(3)] (5) (text unchanged)

[(4)] (6) Allow the enrollee and the enrollee’s representative the opportunity [before and during the appeal process] to examine the enrollee’s case file, [including medical records and any other documents and records;] free of charge, at least 5 business days after the enrollee files the appeal which includes:

(a) Medical records;

(b) Other documents and records; and

(c) Any new or additional evidence considered, relied upon, or generated by the MCO in connection with the action.

[(5)] (7) Allow a provider or authorized representative acting on behalf of an enrollee to file an appeal with the enrollee’s written consent;

[(6)] (8) (text unchanged)

[(7) Provide at its final level an opportunity for the enrollee to be heard by the MCO’s chief executive officer, or the chief executive officer’s designee; and]

[(8)] (9) Establish and maintain an expedited review process, when the MCO determines or the provider indicates that taking the time for a standard resolution could seriously jeopardize the enrollee’s life, physical or mental health, or ability to attain, maintain, or regain maximum function[.]; and

(10) Ensure that punitive action is not taken against a provider who requests an expedited resolution or supports an enrollee’s appeal.

B. Resolution.

(1)—(2) (text unchanged)

(3) For any extension not requested by the enrollee, the MCO shall [give]:

(a) Give the enrollee written notice; and

(b) Make reasonable efforts to give the enrollee verbal notice of the reason for the delay.

[(4) Expedited appeals shall be resolved within 3 business days after the MCO receives the appeal.

(5) If the MCO denies a request for expedited resolution of an appeal, the MCO shall:

(a) Transfer the appeal to the standard time frame of not longer than 30 days from the day the MCO receives the appeal with a possible 14-day extension as described in §B(2) of this regulation; and

(b) Make reasonable efforts to give the enrollee prompt verbal notice of the denial of expedited resolution and provide a written notice within 2 calendar days.]

[(6)] (4) Continuation of Benefits. The MCO shall continue the enrollee’s benefits pending the outcome of the appeal if all of the following occur:

[(a) The enrollee requests extension of benefits]

(a) The enrollee timely files for continuation of benefits;

(b) (text unchanged)

(c) The appeal involves the termination, suspension, or reduction of a previously authorized [course of treatment] service;

(d)—(e) (text unchanged)

[(7)] (5) (text unchanged)

(6) If the MCO or State fair hearing officer reverses a decision to deny, limit or delay services, the MCO shall authorize or provide the disputed services within 72 hours of the date the MCO receives the reversal.

C. Expedited Appeals.

(1) An expedited resolution may be approved when the MCO determines or the provider indicates that taking the time for a standard resolution could seriously jeopardize:

(a) The enrollee’s life;

(b) The enrollee’s physical or mental health; or

(c) The enrollee’s ability to attain, maintain, or regain maximum function.

(2) Expedited appeals shall be resolved within 72 hours after the MCO receives the appeal.

(3) If the MCO denies a request for expedited resolution of an appeal, the MCO shall:

(a) Transfer the appeal to the standard time frame of not longer than 30 days from the day the MCO receives the appeal with a possible 14-day extension as described in §B(2) of this regulation; and

(b) Make reasonable efforts to give the enrollee prompt verbal notice of the denial of expedited resolution and provide a written notice within 2 calendar days.

[C.] D. Notification.

(1) The MCO shall provide written notice of resolution which includes:

[(1)] (a) The results and date of the appeal resolution; [and]

(b) The reasons for the action;

[(2)] (c) For decisions not wholly in the enrollee’s favor:

[(a)] (i)[(d)] (iv) (text unchanged)

[(e)] (v) (text unchanged)

(2) For notice of an expedited resolution, in addition to requirements listed in §D(1) of this regulation, the MCO shall also make reasonable efforts to provide oral notice of the decision.

E. If an MCO fails to adhere to the notice and timing requirements, as described in §§A—D of this regulation, the enrollee is deemed to have exhausted the MCO’s appeals process and may initiate a State fair hearing.

 

10.09.72 Maryland Medicaid Managed Care Program: Departmental Dispute Resolution Procedures

Authority: Health-General Article, §15-103(b)(9)(i)4, Annotated Code of Maryland

.01 Department’s Complaint Process.

A.—B. (text unchanged)

C. For appeals or grievances received from the Department, an MCO shall provide the Department with ongoing updates in a timeframe specified by the Department, based on the urgency of the appeal or grievance.

.06 MCO Appeal.

A. (text unchanged)

B. The following Department decisions are appealable by the MCO or MCO applicant:

(1)—(6) (text unchanged)

(7) The amount of a penalty or incentive as described in COMAR 10.09.65.03; [and]

(8) The denial of a hepatitis C payment as described in 10.09.65.19; and

(9) Overpayments recovered by the Department.

C.—H. (text unchanged)

DENNIS SCHRADER
Secretary of Health

 

Subtitle 09 MEDICAL CARE PROGRAMS

10.09.10 Nursing Facility Services

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

Notice of Proposed Action

[17-257-P]

The Secretary of Health proposes to amend Regulations .07-1 and .07-2 under COMAR 10.09.10 Nursing Facility Services.

Statement of Purpose

The purpose of this action is to:

(1) Extend the interim working capital fund; and

(2) Establish the budget adjustment factor in order to provide a rate increase of 2 percent in accordance with the Fiscal Year 2018 budget.

Comparison to Federal Standards

There is no corresponding federal standard to this proposed action.

Estimate of Economic Impact

I. Summary of Economic Impact. In accordance with the Program’s budget for Fiscal Year 2018, rates for nursing facility services will increase by 2 percent. In addition, working capital advances will result in loss of potential interest income to the State.

 

 

Revenue (R+/R-)

 

II. Types of Economic Impact.

Expenditure

(E+/E-)

Magnitude

 


 

 

A. On issuing agency:

(1)

(E+)

$12,895,751

(2)

(R-)

$211,360

B. On other State agencies:

NONE

C. On local governments:

NONE

 

 

Benefit (+)
Cost (-)

Magnitude

 


D. On regulated industries or trade groups:

(+)

$13,107,111

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(1). The average reimbursement rate for nursing facility services in Fiscal Year 2017 was $250.84. After a 2 percent increase in Fiscal Year 2018 under the provisions of the proposed amendments, the average rate will be $255.86. Based on a projected 5,656,320 Medicaid days in Fiscal Year 2017, and 5,595,744 days in Fiscal Year 2018, total Medicaid expenditures for nursing facility services will increase by $12,895,751.
($255.86 x 5,595,744) – ($250.84 x 5,656,320) = $12,895,751

A(2). The interim working capital fund will provide approximately $16,000,000 to providers during Fiscal Year 2018, resulting in loss of potential interest income of $211,360, based on a rate of return of 1.321 percent.

D. Provider reimbursement for nursing facilities will increase by $12,895,751 during Fiscal Year 2018 as described in Section III.A. Providers will also benefit from the State’s loss of potential interest income in the amount of $211,360 due to providing working capital advances.

Economic Impact on Small Businesses

The proposed action has a meaningful economic impact on small business. An analysis of this economic impact follows.

Eight nursing homes, which qualify as small businesses, are expected to account for 46,026 Medicaid days during Fiscal Year 2018. At an average increase in rates of $5.02 per day, the impact on small businesses is estimated as an increase in revenue of $231,051. The amount of benefit to small businesses due to the interim working capital fund is indeterminate.

Impact on Individuals with Disabilities

The proposed action has an impact on individuals with disabilities as follows:

The proposed action affects payments for services used by individuals with disabilities, but is not expected to have an impact on availability or access to services.

Opportunity for Public Comment

Comments may be sent to Michele Phinney, 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 November 13, 2017. A public hearing has not been scheduled.

.07-1 Interim Working Capital Fund.

A.—H. (text unchanged)

I. The Interim Working Capital Fund expires on May 1, [2017] 2018. Providers shall repay all outstanding funds to the Department by May 1, [2017] 2018. The Department may grant repayment extensions of not longer than 60 days under extraordinary circumstances.

.07-2 Prospective Rates Effective January 1, 2015.

A.—M. (text unchanged)

N. Final facility rates for the period July 1, 2017, through June 30, 2018, shall be each nursing facility’s quarterly rate, exclusive of the amount identified in Regulation .11-8A(2) of this chapter, reduced by the budget adjustment factor of 9.652 percent, plus the Nursing Facility Quality Assessment add-on identified in Regulation .10-1E of this chapter and the ventilator care add-on amount identified in Regulation .11-8A(2) of this chapter when applicable.

DENNIS SCHRADER
Secretary of Health

 

Subtitle 09 MEDICAL CARE PROGRAMS

10.09.33 Health Homes

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

Notice of Proposed Action

[17-256-P]

The Secretary of Health proposes to amend Regulation .09 under COMAR 10.09.33 Health Homes.

Statement of Purpose

The purpose of this action is to update the listed rates for Maryland Chronic Health Homes by 2 percent effective July 1, 2017. The fiscal 2018 State budget, approved S.B. 170, Budget Bill (Fiscal Year 2018), Ch. 150, Acts of 2017, includes a 2 percent rate increase for community behavioral health providers.

Comparison to Federal Standards

There is no corresponding federal standard to this proposed action.

Estimate of Economic Impact

I. Summary of Economic Impact. This proposed action will result in the increase of the rates for Maryland Chronic Health Homes services. The State general funds impact is expected to be $94,403 for State fiscal year 2018. The federal funds impact is expected to be $94,403. The total funds impact is expected to be $188,806.

 

 

Revenue (R+/R-)

 

II. Types of Economic Impact.

Expenditure

(E+/E-)

Magnitude

 


A. On issuing agency:

(E+)

$188,806

B. On other State agencies:

NONE

C. On local governments:

NONE

 

 

Benefit (+)
Cost (-)

Magnitude

 


D. On regulated industries or trade groups:

(+)

$188,806

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. and D. Estimated fiscal impacts are based on calendar year 2016 utilization and enrollment growth rates. Actual utilization could be lower if enrollment plateaus. Historically, we’ve also seen some fluctuation in the percentage of individuals who receive the 2+ services/month to qualify the provider for the PMPM.

Economic Impact on Small Businesses

The proposed action has a meaningful economic impact on small business. An analysis of this economic impact follows.

Small businesses that could be impacted by this proposal include opioid treatment programs (OTPs), psychiatric rehabilitative programs (PRPs), and mobile treatment programs (MTs) who are enrolled as a Health Home with Maryland Medicaid. Health Home providers will receive Medicaid reimbursement rates that are increased by 2 percent for all Health Home services.

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, 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 November 13, 2017. A public hearing has not been scheduled.

.09 Payment Procedures.

A.—B. (text unchanged)

C. Payment shall be made:

(1) (text unchanged)

(2) Effective [July 1, 2016] July 1, 2017, at a monthly rate per participant of [$100.85] $102.86, on the condition that the requirements of this chapter are met.

DENNIS SCHRADER
Secretary of Health

 

Subtitle 09 MEDICAL CARE PROGRAMS

10.09.36 General Medical Assistance Provider Participation Criteria

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

Notice of Proposed Action

[17-248-P]

The Secretary of Health proposes to adopt new Regulation .03-1 under COMAR 10.09.36 General Medical Assistance Provider Participation Criteria.

Statement of Purpose

The purpose of this action is to implement the Centers for Medicare and Medicaid Services’ Community Settings Rule. The language enhances community integration requirements and qualities of settings where individuals receive Medicaid home and community-based services. The purpose of the rule is to increase opportunity for personal choices, integration in community life, dignity, privacy, and respect. The proposed regulation also includes a timeline for provider compliance.

Comparison to Federal Standards

There is a corresponding federal standard to this proposed action, but the proposed action is not more restrictive or stringent.

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 an impact on individuals with disabilities as follows:

The new requirements increase the rights of individuals with disabilities and promote dignity, autonomy, respect, and personal choice in settings in which individuals receive Medicaid-covered home and community-based services.

Opportunity for Public Comment

Comments may be sent to Michele Phinney, 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 November 13, 2017. A public hearing has not been scheduled.

.03-1 Conditions for Participation―Home and Community-Based Settings.

A. Providers of services under COMAR 10.09.84 shall comply with the provisions of §§D―F of this regulation and 42 CFR 441.301(c)(4).

B. Effective January 1, 2018, to be enrolled as a provider of services authorized under §§1915(c) or 1915(i) of the Social Security Act, the provider shall comply with the provisions of §§D―F of this regulation and 42 CFR 441.301(c)(4).

C. Providers of services authorized under §§1915(c) or 1915(i) of the Social Security Act that are enrolled Maryland Medicaid providers before January 1, 2018, shall comply with the provisions of §§D―F of this regulation on or before March 17, 2022.

D. The setting in which services are provided shall:

(1) Be integrated in and support full access to the greater community for individuals receiving Medicaid home and community-based services to the same degree of access as individuals not receiving Medicaid home and community-based services;

(2) Be selected by the individual from among setting options, including nondisability specific settings;

(3) Be identified and documented in the person-centered service plan and is based on the individual’s needs and preferences;

(4) Ensure an individual’s rights of:

(a) Privacy;

(b) Dignity and respect; and

(c) Freedom from coercion and restraint;

(5) Optimize, but not regiment, individual initiative, autonomy, and independence in making life choices, including but not limited to:

(a) Daily activities;

(b) Physical environment; and

(c) With whom to interact; and

(6) Facilitate individual choice regarding services and supports, and who provides them.

E. In addition to the provisions of §D of this regulation, provider-owned or controlled settings shall meet the following conditions:

(1) The unit or dwelling is a specific physical place that can be owned, rented, or occupied under a legally enforceable agreement by the individual receiving services and the individual has, at a minimum, the same responsibilities and protections from eviction that tenants have under the landlord tenant law of the State, county, city, or other designated entity;

(2) Each individual has privacy in their sleeping or living unit, as evidenced by the following:

(a) Units have entrance doors lockable by the individual, with only appropriate staff having keys to doors;

(b) Individuals sharing units have a choice of roommates; and

(c) Individuals have the freedom to furnish and decorate their sleeping or living units within the lease or other agreement;

(3) Individuals have the freedom and support to control their own schedules and activities;

(4) Individuals have access to food at any time;

(5) Individuals are able to have visitors of their choosing at any time; and

(6) The setting is physically accessible to the individual.

F. Any modification of the conditions under §§D and E of this regulation shall be supported by a specific assessed need and justified in the person-centered services plan in accordance with 42 CFR 441.301(c)(2)(xiii).

DENNIS SCHRADER
Secretary of Health

 

Subtitle 09 MEDICAL CARE PROGRAMS

10.09.80 Community-based Substance Use Disorder Services

Authority: Health-General Article, §§2-104(b), 8-204(c)(1), 15-103(a)(1), and 15-105(b), Annotated Code of Maryland

Notice of Proposed Action

[17-255-P]

The Secretary of Health proposes to amend Regulation .08 under COMAR 10.09.80 Community-based Substance Use Disorder Services.

Statement of Purpose

The purpose of this action is to update the listed rates for community-based substance use disorder (SUD) services by 2 percent effective July 1, 2017. The fiscal 2018 State budget, approved under S.B. 170, Ch. 150, Acts of 2017, includes a 2 percent rate increase for community behavioral health providers.

Comparison to Federal Standards

There is no corresponding federal standard to this proposed action.

Estimate of Economic Impact

I. Summary of Economic Impact. This proposed action will result in the increase of the rates for community-based SUD services. The State general funds impact is expected to be $814,890 for State fiscal year 2018. The federal funds impact is expected to be $2,375,148. The total funds impact is expected to be $3,190,038.

 

 

Revenue (R+/R-)

 

II. Types of Economic Impact.

Expenditure

(E+/E-)

Magnitude

 


A. On issuing agency:

(E+)

$3,190,038

B. On other State agencies:

NONE

C. On local governments:

NONE

 

 

Benefit (+)
Cost (-)

Magnitude

 


D. On regulated industries or trade groups:

(+)

$3,190,038

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. and D. Estimated fiscal impacts are based on calendar year 2016 utilization. The estimate of impact on the issuing agency is the sum of the general funds impact of $814,890 and the federal funds impact of $2,375,148, totaling $3,190,038.

Economic Impact on Small Businesses

The proposed action has a meaningful economic impact on small business. An analysis of this economic impact follows.

Small businesses that could be impacted by this proposal include community-based substance use disorder (SUD) treatment providers who are enrolled with Maryland Medicaid and provide services to Medicaid enrolled participants. Community-based SUD providers will receive Medicaid reimbursement rates that are increased by 2 percent for all services billed through H codes listed on the public substance use disorder fee schedule and listed in COMAR 10.09.80.08.

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, 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 November 13, 2017. A public hearing has not been scheduled.

.08 Payment Procedures.

A.—C. (text unchanged)

D. Effective July 1, [2016] 2017, rates for the services outlined in this regulation shall be as follows:

(1) For services outlined in this regulation, as delivered through an OHCQ certified or licensed substance use disorder treatment provider:

(a) Comprehensive substance use disorder assessment — [$144.82] $147.74;

(b) Level 1 group substance use disorder counseling — [$39.78] $40.58 per session;

(c) Level 1 individual substance use disorder counseling — [$20.40] $20.81 per 15-minute increment with a maximum of six 15-minute increments per day;

(d) Level 2.1 Intensive Outpatient treatment[$127.50] $130.05 per diem;

(e) Level 2.5 Partial Hospitalization half day session — [$132.60] $135.25 per diem;

(f) Level 2.5 Partial Hospitalization full day session — [$214.20] $218.48 per diem;

(g) Ambulatory Withdrawal Management — [$71.40] $72.83 per diem;

(h)—(i) (text unchanged)

(2) For services outlined in this regulation as delivered through an opioid treatment programs:

(a) Comprehensive substance use disorder assessment — [$144.84] $147.74;

(b) Level 1 group substance use disorder counseling — [$39.78] $40.58 per session;

(c) Level 1 individual substance use disorder counseling — [$20.40] $20.81 per 15-minute increment with a maximum of six 15-minute increments per day;

(d) Opioid Maintenance Therapy — [$63.00] $64.26 per participant per week;

(e) Medication Assisted Treatment Induction — [$204] $208.08 per participant per week;

(f) Buprenorphine Maintenance Therapy — [$56.00] $57.12 per participant per week; and

(g) (text unchanged)

E.—F. (text unchanged)

DENNIS SCHRADER
Secretary of Health

 

Subtitle 09 MEDICAL CARE PROGRAMS

10.09.84 Community First Choice

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

Notice of Proposed Action

[17-212-P]

The Secretary of Health proposes to amend Regulations .02, .05—.07, .10, .15, .18, .19, .23, and .24 under COMAR 10.09.84 Community First Choice.

Statement of Purpose

The purpose of this action is to:

(1) Clarify definitions;

(2) Add participation requirements for all Community First Choice providers to be free from conflicts of interest and for personal assistance providers to conduct criminal history record checks on all direct service providers;

(3) Clarify covered services related to transition services for supports planning, home delivered meals, technology that substitutes for human assistance, and environmental adaptations; and

(4) Change the methodology for payment to a daily rate for participants who require more than 12 hours of service per day.

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 an impact on individuals with disabilities as follows:

This program exclusively serves individuals with disabilities. However, the impact will be minimal as the changes clarify existing policies and add a daily rate. The daily rate provides additional flexibility for participants within the existing service system.

Opportunity for Public Comment

Comments may be sent to Michele Phinney, 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 November 13, 2017. A public hearing has not been scheduled.

.02 Definitions.

A. (text unchanged)

B. Terms Defined.

(1)―(8) (text unchanged)

(9) Community Setting.

(a) (text unchanged)

(b) “Community setting” does not mean:

(i)—(iii) (text unchanged)

(iv) Intermediate care facilities for individuals with intellectual disabilities; or

[(v) Community-based residential facilities for individuals with intellectual or developmental disabilities licensed under COMAR 10.22.02; or]

[(vi)] (v) (text unchanged)

(10)—(12) (text unchanged)

(13) Home.

[(13)] (a) (text unchanged)

(b) “Home” does not mean:

(i) An assisted living program as defined in COMAR 10.07.14;

(ii) A residential rehabilitation program licensed as a therapeutic group home under COMAR 10.21.07;

(iii) An alternative living unit, group home, or individual family care home as defined in COMAR 10.22.01;

(iv) Community-based residential facilities for individuals with intellectual or developmental disabilities licensed under COMAR 10.22.02; or

(v) Any other provider-owned or controlled residence.

(14)―(30) (text unchanged)

(31) “Representative” means:

(a) The person authorized by the individual[, on the form provided by the Department,] to serve as a representative in connection with the provision of Community First Choice services and supports;[ or]

(b) The individual who signs the plan of service on the participant’s behalf;

(c) Any individual who makes decisions on behalf of the participant related to the participant’s plan of service;

(d) A legal guardian of the individual for the participant; or

(e) The parent or foster parent of a dependent minor child.

(32)―(34) (text unchanged)

.05 Conditions for Provider Participation — General Requirements.

A. To participate as a provider of a service covered under this chapter, a provider:

(1)—(8) (text unchanged)

(9) Shall verify Medicaid eligibility at the beginning of each month that services will be rendered; [and]

(10) May not be a Medicaid provider or principal of a Medicaid provider that has overpayments that remain due to the Department; and

(11) Shall be free from conflicts of interest.

B.—C. (text unchanged)

.06 Specific Conditions for Provider Participation — Personal Assistance.

A. Personal assistance service providers shall:

(1) Be licensed as a Residential Service Agency under COMAR 10.07.05 to provide Level Two or Level Three home care services;

(2)(8) (text unchanged)

(9) Submit a Medicaid provider application to the Department if the new owner chooses to participate in the Program; [and]

(10) At least monthly, collect and maintain the participant’s signature, or that of the participant’s representative when applicable, verifying services rendered; and

(11) Conduct a criminal history records check on all direct service workers including nurses, in accordance with the procedure for a State criminal history records check established under Health-General Article, Title 19, Subtitle 19, Annotated Code of Maryland.

B.―C. (text unchanged)

.07 Specific Conditions for Provider Participation — Supports Planning.

To participate in the Program as a supports planning provider under Regulation .15 of this chapter, a provider shall:

[A. Be free from conflicts of interest;]

[B.] A.[C.] B. (text unchanged)

.10 Specific Conditions for Provider Participation — Items or Services that Substitute for Human Assistance.

A.―C. (text unchanged)

D. To participate as a provider of accessibility adaptations a provider shall:

(1) Have a current license with the Maryland Home Improvement Commission; and

(2) Be approved by the Department.

.15 Covered Services — Supports Planning.

A. (text unchanged)

B. Supports planning services include [time spent by a qualified provider conducting any of] the following activities:

(1)―(6) (text unchanged)

(7) [Verifying the participant’s eligibility at the beginning of each month that personal assistance services will be rendered] Administering funds for transition services.

.18 Covered Services — Items or Services that Substitute for Human Assistance.

A.―C. (text unchanged)

[D. Excluded from coverage under this regulation are adaptations or improvements to the home which:

(1) Are of general maintenance, such as carpeting, roof repair, and central air conditioning;

(2) Are not of direct medical or remedial benefit to the participant;

(3) Add to the home’s total square footage; or

(4) Modify the exterior of the home, other than the provision of ramps.]

[E.] D. The program covers home-delivered meals provided during meal periods that personal assistance services are not provided. Home-delivered meals shall be:

(1) Delivered to the participant’s home;

(2) Intended for consumption at home;

(3) Nutritionally adequate for the participant’s age based on the Recommended Dietary Allowance (RDA) or Dietary Reference Intake (DRI), as established by the Food and Nutrition Board of the National Research Council and demonstrated by having the menus certified in writing by the participant’s physician, dietitian, or nutritionist; and

(4) At least one-third of the RDA, DRI, or therapeutic diet requirements ordered by the participant’s physician, dietitian, or nutritionist, including any ordered nutritional supplements.

E. Technology that substitutes for human assistance includes:

(1) Environmental controls for the home or automobile;

(2) Personal computers, software, or accessories;

(3) Augmentative communication devices;

(4) Maintenance or repair of technology devices;

(5) Self-help aids that assist with activities of daily living or instrumental activities of daily living; and

(6) Assessments and training in the use of assistive technology.

.19 Covered Services — Environmental Assessments and Adaptations.

A. The Program covers an on-site environmental assessment and adaptations of a home or residence where the participant lives or will live as a participant.

B. An environmental assessment or adaptation may not be provided before the effective date of the participant’s [eligibility for] enrollment in services.

C. The [service] environmental assessment may be recommended by a multidisciplinary team in the plan of service for a participant when an environmental assessment is considered necessary to:

(1)―(2) (text unchanged)

D.―E. (text unchanged)

.23 Limitations.

A.―B. (text unchanged)

C. The Program does not cover the following services:

(1)―(4) (text unchanged)

(5) Transition services more than 60 days post transition; [or]

(6) Personal assistance services provided outside the State for more than [14] 30 days per calendar year[.];

(7) Environmental adaptations to the home which:

(a) Are of general maintenance, such as carpeting, roof repair, and central air conditioning;

(b) Are not of direct medical or remedial benefit to the participant;

(c) Add to the home’s total square footage; or

(d) Modify the exterior of the home, other than the provision of ramps, lifts, sidewalks necessary to utilize a ramp or lift, and railings; or

(8) Experimental technology or equipment.

D. (text unchanged)

E. Payment for environmental adaptations and technology that substitutes for human assistance is limited to a combined reimbursement of up to $15,000 over a 3-year period per participant.

F. For technology items or services above $1,000, multiple quotes from providers are required.

.24 Payment Procedures.

A.—D. (text unchanged)

E. Effective May 1, 2017, for personal assistance services up to 12 hours per day, payment will be made in 15-minute units of service. For individuals who are determined to need more than 12 hours of personal assistance per day, a daily rate for the service will be paid.

[E.] F. (text unchanged)

DENNIS SCHRADER
Secretary of Health

 

Subtitle 09 MEDICAL CARE PROGRAMS

10.09.96 Remote Patient Monitoring

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

Notice of Proposed Action

[17-254-P]

The Secretary of Health proposes to adopt new Regulations .01—.13 under a new chapter, COMAR 10.09.96 Remote Patient Monitoring.

Statement of Purpose

The purpose of this action is to create a new chapter governing medically necessary services rendered via remote patient monitoring to assist Maryland Medicaid participants in managing and controlling their chronic conditions.

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, 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 November 13, 2017. A public hearing has not been scheduled.

.01 Purpose and Scope.

A. This chapter applies to remote patient monitoring services reimbursed by the Maryland Medical Assistance Program effective January 1, 2018.

B. The purpose of providing medically necessary services via remote patient monitoring is to assist participants in managing and controlling their chronic conditions in order to reduce readmissions and emergency department visits and to improve quality of care

C. The target populations are high-risk, chronically ill Maryland Medical Assistance Program participants suffering from diabetes, congestive heart failure, or chronic obstructive pulmonary disease.

.02 Definitions.

A. In this chapter, the following terms have the meanings indicated.

B. Terms Defined.

(1) “Certified nurse practitioner” means an individual who meets the licensure and conditions of participation set forth in COMAR 10.09.01.

(2) “Department” means the Maryland Department of Health, which is the single State agency designated to administer the remote patient monitoring program.

(3) “Episode” means the span of treatment during which remote patient monitoring services are rendered to eligible participants.

(4) “Home” means the place of residence occupied by the participant, other than a hospital, nursing facility, or other medical or psychiatric institution.

(5) “Home health agency” means a public or private agency or organization that meets the licensure requirements and conditions of participation of COMAR 10.09.04.

(6) “Maryland Medical Assistance Program” means the program of comprehensive medical, behavioral, and other health-related care for indigent and medically indigent individuals, jointly financed by the federal and state governments and administered by states under Title XIX of the Social Security Act, 42 U.S.C. §1396 et seq., as amended.

(7) “Medically necessary” means that the service or benefit is:

(a) Directly related to diagnostic, preventive, curative, palliative, rehabilitative, or ameliorative treatment of an illness, injury, disability, or health condition;

(b) Consistent with currently accepted standards of good medical practice;

(c) The most cost-efficient service that can be provided without sacrificing effectiveness or access to care; and

(d) Not primarily for the convenience of the consumer, family, or provider.

(8) “Participant” means an individual who is certified as eligible for, and is receiving, Medical Assistance benefits. 

(9) “Physician” means an individual who meets the licensure requirements and conditions of participation of COMAR 10.09.02.

(10) “Physician assistant” means an individual who meets the licensure requirements and conditions of participation set forth in COMAR 10.09.55. 

(11) “Program” means the Maryland Medical Assistance Program.

(12) “Provider” means an individual or an organization who:

(a) Meets the requirements of Regulations .03 and .04 of this chapter; and

(b) Through an appropriate agreement with the Department, has been identified as a Program provider by the issuance of a unique provider number.

(13) “Remote patient monitoring” means digital technologies to collect medical and other forms of health data from individuals in one location and electronically transmit that information securely to health care providers in a different location for assessment, recommendations, and interventions.

.03 License Requirements.

A. The provider shall:

(1) Meet all license requirements as set forth in COMAR 10.09.36.02; and

(2) Be licensed in the state in which the participant resides.

B. A home health agency shall be:

(1) Licensed pursuant to Health-General Article, §§19-401—19-408, Annotated Code of Maryland;

(2) Part of a hospital or related institution licensed pursuant to Health-General Article, §§19-301—19-359, Annotated Code of Maryland; or

(3) Legally authorized to provide home health services in the jurisdiction in which the service is provided.

C. A doctor of medicine or osteopathy shall be licensed and legally authorized to practice medicine and surgery in the state in which the service is provided.

D. A certified nurse practitioner shall:

(1) Hold a current license to practice registered nursing in Maryland, and be certified as a nurse practitioner by the Nursing Board; or

(2) Meet the nurse practitioner regulatory requirements of the state in which the services are provided.

E. A physician assistant applying for provider status shall:

(1) Be licensed to practice as a physician assistant in Maryland or in the state or jurisdiction in which the service is provided;

(2) Be in compliance with requirements set forth in COMAR 10.32.03;

(3) If practicing in Maryland, have a delegation agreement with a supervising physician that outlines the physician assistant’s duties within the medical practice or facility which has been filed with and approved by the Board of Physicians; and

(4) If practicing in Maryland, have a delegation agreement with a supervising physician that documents the specialized training, education, and experience of the physician assistant for performing advanced duties.

.04 Provider Conditions for Participation.

A. To provide remote patient monitoring, the provider shall:

(1) Be enrolled with an active status as a Maryland Medical Assistance Program provider on the date the service is rendered;

(2) Be a:

(a) Physician;

(b) Physician assistant; 

(c) Certified nurse practitioner; or

(d) Home health agency when remote patient monitoring services are prescribed by a physician; and

(3) Meet the requirements for participation in the Medical Assistance Program as set forth in COMAR 10.09.36.03.

B. Medical Record Documentation. A remote patient monitoring provider shall:

(1) Maintain documentation using either electronic or paper medical records;

(2) Retain remote patient monitoring records according to the provisions of Health-General Article, §4-403, Annotated Code of Maryland;

(3) Submit the preauthorization on a form developed by the Department; and

(4) Include the participant’s consent to participate in remote patient monitoring.

C. Remote patient monitoring is not a substitute for delivery of care. Provider shall see patients in person periodically for follow-up care.

.05 Participant Eligibility for Services.

A. A participant is eligible to receive remote patient monitoring services if:

(1) The participant is enrolled in the Maryland Medical Assistance Program on the date the service is rendered;

(2) The participant consents to remote patient monitoring services and has the capability to utilize the monitoring tools and take actions to improve self-management of the chronic disease;

(3) The participant has the internet connections necessary to host the equipment in the home;

(4) The participant is at high risk for avoidable hospital utilization due to poorly controlled:

(a) Chronic obstructive pulmonary disease;

(b) Congestive heart failure;

(c) Diabetes type 1; or

(d) Diabetes type 2; and

(5) The provision of remote patient monitoring may reduce the risk of preventable hospital utilization and promote improvement in control of the chronic condition.

B. Participants with the conditions described in §A(4) of this regulation are eligible for an episode of remote patient monitoring if the participant had:

(1) Two hospital admissions within the prior 12 months with the same qualifying medical condition as the primary diagnosis;

(2) Two emergency department visits within the prior 12 months with the same qualifying medical condition as the primary diagnosis; or

(3) One hospital admission and one separate emergency department visit within the prior 12 months with the same qualifying condition as the primary diagnosis.

.06 Covered Services.

A. Remote patient monitoring services include:

(1) Installation;

(2) Education for the participant in the use of the equipment; and

(3) Daily monitoring of vital signs and other medical statistics.

B. The remote patient monitoring provider shall establish an intervention process to address abnormal data measurements in an effort to prevent avoidable hospital utilization.

C. Physician, nurse practitioner, and physician assistant providers who establish remote patient monitoring programs shall be responsible for:

(1) Establishing criteria for reporting abnormal measurements;

(2) Informing the participant of abnormal results; and

(3) Monitoring results and improvements in patient’s ability to self-manage chronic conditions. 

D. Medical interventions by a physician, nurse practitioner, or physician assistant based on abnormal results shall be reimbursed according to COMAR 10.09.02.07.

E. A home health agency shall:

(1) Have an order by a physician who has examined the patient and with whom the patient has an established, documented and ongoing relationship;

(2) Report abnormal measurements to the participant and to the ordering provider; and

(3) Send the ordering provider a weekly summary of monitoring results, including improvement in patient’s ability to self-manage chronic conditions.

.07 Limitations.

A. Remote patient monitoring services are only covered for participants who meet the eligibility criteria specified in Regulation .05 of this chapter.

B. The Program does not cover:

(1) Remote patient monitoring equipment;

(2) Upgrades to remote patient monitoring equipment;

(3) The internet connections necessary to transmit the results of remote patient monitoring services to the provider’s offices; or

(4) More than:

(a) 2 months of remote patient monitoring services per episode; and

(b) Two episodes per year per participant.

C. Home health agencies may only be reimbursed for remote patient monitoring when the service is ordered by a physician.  

.08 Preauthorization Requirements.

The Department may preauthorize services when the provider submits to the Department adequate documentation demonstrating the:

A. Participant’s condition meets the criteria listed in Regulation .05 of this chapter; and

B. Participant has not already been preauthorized for two episodes during the past rolling calendar year.

.09 Payment Methodology.

A. After providing the services outlined in Regulation .06 of this chapter, the remote patient monitoring provider shall submit the request for payment using the format designated by the Department.

B. Home health agencies shall:

(1) Bill on a UB04; and 

(2) Be paid a monthly rate.

C. Physicians, nurse practitioners, and physician assistants who provide remote patient monitoring shall:

(1) Bill using a CMS 1500 or an 837P; and

(2) Be paid a monthly rate.

D. Professionals following up on abnormal results from remote patient monitoring shall be paid the lesser of:

(1) Provider’s customary charge unless the service is free to individuals not covered by Medicaid; or

(2) The Department’s professional fee schedule as found in COMAR 10.09.02.07.

.10 Recovery and Reimbursement.

Recovery and reimbursement shall be in accordance with COMAR 10.09.36.07.

.11 Cause for Suspension or Removal and Imposition of Sanctions.

Cause for suspension or removal and imposition of sanctions shall be in accordance with COMAR 10.09.36.08.

 

 

.12 Appeal Procedures.

Providers filing appeals from administrative decisions made in connection with these regulations shall do so in accordance with COMAR 10.09.36.09.

.13 Interpretive Regulation.

Except when the language of a specific regulation indicates an intent by the Department to provide reimbursement for covered services to Program recipients without regard to the availability of federal financial participation, State regulations shall be interpreted in conformity with applicable federal statutes and regulations.

DENNIS SCHRADER
Secretary of Health

 

Subtitle 32 BOARD OF PHYSICIANS

10.32.22 Mandated Reporting to the Board

Authority: Health Occupations Article, §§14-205(a)(2), 14-413, 14-414,
14-5A-18, 14-5B-15, 14-5C-18, 14-5E-18, 14-5F-19, and 15-103, Annotated Code of Maryland

Notice of Proposed Action

[17-213-P]

The Secretary of Health proposes to amend Regulations .02, .03, and .05 under COMAR 10.32.22 Mandated Reporting to the Board. This action was considered at a public meeting on April 26, 2017, notice of which was given by publication on the Board’s Website at https://www.mbp.state.md.us/forms/Apr17Fullagenda.pdf from April 12, 2017 through April 26, 2017 pursuant to General Provisions Article, §3-302(c), Annotated Code of Maryland.

Statement of Purpose

The purpose of this action is to:

(1) Remove references to and provisions regarding postgraduate training programs or individuals in such programs;

(2) Remove provisions regarding certain reports due to be filed with the Board twice a year;

(3) Update the name of the Department of Health and Mental Hygiene to Maryland Department of Health; and

(4) Make other minor editorial corrections.

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, 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 dhmh.regs@maryland.gov, or fax to 410-767-6483. Comments will be accepted through November 13, 2017. A public hearing has not been scheduled.

.02 Definitions.

A. (text unchanged)

B. Terms Defined.

(1) (text unchanged)

[(2) “Academic probation” means a program of heightened monitoring of an individual in a postgraduate training program imposed because of academic or performance deficiencies.]

[(3)] (2)—[(7)] (6) (text unchanged)

[(8)] (7) “Change” means any of the following actions by a reporting entity:

(a) Terminating or failing to renew a health care provider’s staff privileges or employment or contract with the reporting entity[, or terminating or refusing or failing to renew or to extend the term of the academic contract of an individual in a postgraduate training program];

(b)—(h) (text unchanged)

[(9)] (8)[(13)] (12) (text unchanged)

[(14)] (13) “Health care provider” means a physician[,] or an allied health provider[, or an individual in a postgraduate training program].

[(15)] (14) (text unchanged)

[(16) Hospital.]

[(a)] (15) “Hospital” has the meaning stated in Health-General Article, §19-301, Annotated Code of Maryland.

[(b) “Hospital” includes, with respect to an institution that meets the requirements of Health-General Article, §19-301, Annotated Code of Maryland, any entity which:

(i) Operates or administers a postgraduate training program; or

(ii) Has the authority to hire or discipline or to grant, deny, limit, or modify the contract or privileges of an individual in a postgraduate training program.]

[(17) “Individual in a postgraduate training program” means an intern, an assistant resident, a resident, or a clinical fellow in a postgraduate training program as defined in this regulation.]

[(18)] (16)[(24)] (22) (text unchanged)

[(25) “Postgraduate training program” means a program of academic training that meets the requirements of COMAR 10.32.01 and 10.32.07.]

[(26)] (23)[(30)] (27) (text unchanged)

.03 Mandated Reports.

A. Subject to the limitations set out in §§B, C and [E] D of this regulation, the reporting entity shall report to the Board in writing any change made with respect to a health care provider:

(1)—(3) (text unchanged)

B. (text unchanged)

C. Specific Changes Not Reportable. The following changes do not require reporting by a reporting entity:

(1) (text unchanged)

(2) Voluntary resignations that:

(a)—(b) (text unchanged)

(c) May be caused by, for example:

(i) (text unchanged)

(ii) The health care provider’s desire to relocate from Maryland; or

(iii) The health care provider’s desire to retire; [or]

[(iv) A decision by an individual in a postgraduate training program to leave the program to pursue another specialty before the expiration of the term of the training program originally contemplated;]

(3)—(7) (text unchanged)

[(8) With respect to an individual in a postgraduate training program:

(a) The expiration of the postgraduate training program contract at the end of its term as originally contemplated and while the individual is in good standing with the program; or

(b) Academic probation, unless imposed for any of the reasons set out in §B(3), (4), (8), or (9) of this regulation.]

[(9)] (8) With respect to allied health providers and subject to the requirements of [§E(1)] §D(1) and (2) of this regulation, entrance into an alcohol or a drug treatment program:

(a) — (c) (text unchanged)

(d) Provided by a health care practitioner who is competent and capable of dealing with alcoholism and drug abuse[.]; or

[(10)] (9) With respect to physicians and subject to the requirements of [§E(3)] §D(3) and (4) of this regulation, entrance into an alcohol or a drug treatment program:

(a) — (c) (text unchanged)

[D. With respect to physicians, each reporting entity shall file a report with the Board that contains the name of each licensed physician who, during the 6 months preceding the report, was employed by, had privileges with, or applied for privileges with that entity.]

[E.] D. Exceptions to [§C(9) and (10)] §C(8) and (9) of This Regulation.

(1) Section [C(9)] C(8) of this regulation applies only where:

(a)—(c) (text unchanged)

(2) Section [C(9)] C(8) of this regulation does not apply to:

(a)—(b) (text unchanged)

(c) Any change made by the reporting entity based on events set out in Regulation .03B which occurred subsequent to the provider’s entrance into the alcohol or drug treatment program[;].

(3) Section [C(10)] C(9) of this regulation applies only where:

(a)—(c) (text unchanged)

(4) Section [C(10)] C(9) of this regulation does not apply to:

(a)—(c) (text unchanged)

.05 Time Frames for the Submission of Reports.

A. Physicians [or Individuals in a Postgraduate Training Program].

(1) A reporting entity shall file reports required under this chapter with the Board[:] within 10 days of any change made with regard to a physician.

[(a) Within 10 days of any change made with regard to a physician or an individual in a postgraduate training program; and

(b) Twice a year:

(i) In a cumulative report of all changes made with regard to physicians and individuals in postgraduate training programs; and

(ii) Separately, in the report required under Regulation .03D of this chapter.]

(2) (text unchanged)

[(3) The required reports prescribed in §A(1)(b) of this regulation shall be filed as follows:

(a) By February 1 of each year for the 6-month reporting period of July 1 through December 31 of each year; and

(b) By August 1 of each year for the 6-month reporting period of January 1 through June 30 of each year.]

B.C. (text unchanged)

DENNIS SCHRADER
Secretary of Health

 

Title 13A
STATE BOARD OF EDUCATION

Subtitle 06 SUPPORTING PROGRAMS

13A.06.07 Student Transportation

Authority: Education Article, §§2-205, 5-205, and 8-410, Annotated Code of Maryland

Notice of Proposed Action

[17-246-P]

The Maryland State Board of Education proposes to amend Regulations .01, .06.08, and .10 under COMAR 13A.06.07 Student Transportation. This action was considered by the State Board of Education at their meeting on August 22, 2017.

Statement of Purpose

The purpose of this action is to (1) change the school vehicle driver qualifications; (2) include assault in the second degree to the disqualifying conditions; and (3) add clarification that certain disqualifying conditions and termination provisions apply to school vehicle driver trainees as well as to drivers.

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 Gabriel D. Rose, Director of Pupil Transportation, Emergency Management, Maryland State Department of Education, 200 West Baltimore Street, Baltimore, Maryland 21201, or call 410-767-0209 (TTY 410-333-6442), or email to gabriel.rose1@maryland.gov, or fax to 410-333-2232. Comments will be accepted through November 13, 2017. A public hearing has not been scheduled.

Open Meeting

Final action on the proposal will be considered by the State Board of Education during a public meeting to be held on December 5, 2017, 9 a.m., at 200 West Baltimore Street, Baltimore, Maryland 21201.

.01 Definitions.

A. In this chapter, the following terms have the meanings indicated.

B. Terms Defined.

(1)—(10) (text unchanged)

(11) “Insubordination” means violating a lawful order or failing to obey a lawful order given by a superior.

[(11)] (12) [(12)] (13)(text unchanged)

(14) “Misfeasance” means performing a proper act in a wrongful or injurious manner or the improper performance of an act which might have been lawfully done.

[(13)] (15) [(18)] (20) (text unchanged)

(21)”Property Damage” means injury to real or personal property, the amount of which is established by evidence of replacement values and cost of repairs.

[(19)] (22) [(21)] (24) (text unchanged)

[(22)] (25) “School vehicle attendant” means an individual who:

(a) (text unchanged)

(b) Is employed by a local school system or an entity contracting with a local school system as a school vehicle attendant; and

(c) (text unchanged)

[(23)] (26) “School vehicle driver” means an individual who:

(a) Has applied for employment with a local school system or an entity contracting with a school system as a school vehicle driver;

(b) —(d) (text unchanged)

[(24)] (27) (text unchanged)

[(25)] (28) [(32)] (35) (text unchanged

(36) “Unsafe actions” means misfeasance, incompetence, insubordination, or any act or omission that adversely affects transportation or safety.

[(33)] (37) (text unchanged)

.06 School Vehicle Driver Trainee and School Vehicle Driver Qualifications.

A. (text unchanged)

B. School Vehicle Driver Qualifications. A school vehicle driver shall:

(1) Do [one of] the following:

(a) Meet the requirements in §A of this regulation; [or] and

(b) (text unchanged)

(2)—(3) (text unchanged)

C. (text unchanged)

.07 School Vehicle Driver and Trainee Disqualifying Conditions and Termination.

A. A school vehicle driver or trainee who does not meet the qualifications of the evaluation under Regulation [.06] .06C of this chapter may be disqualified from driving a school vehicle at the discretion of the supervisor of transportation, unless the supervisor of transportation determines that retraining, instruction, or both, are satisfactorily completed.

B. Disqualification for Driving Record.

(1) Except as set forth in §B(2) of this regulation, a school vehicle driver or trainee shall be disqualified from driving a school vehicle if the driving record shows three current points.

(2) (text unchanged)

(3) If a school vehicle driver or trainee has more than three current points, the driver may not operate a school vehicle.

C. Disqualification for Criminal Conduct.

(1) A local school system [may not permit an individual to operate] shall disqualify an individual school vehicle driver or trainee from operating a school vehicle if the individual:

(a) Has been convicted of a crime or if criminal charges are pending against the individual for a crime involving:

(i)—(iv) (text unchanged)

(v) A crime of violence as set forth in Criminal Law Article, §14-101, Annotated Code of Maryland;

(vi) Assault in the second degree as set forth in Criminal Law Article, §3-203, Annotated Code of Maryland;

[(vi)] (vii)—[(viii)] (ix) (text unchanged)

(b) (text unchanged)

(2) [An individual] A school vehicle driver or trainee who [pleads] pled guilty or nolo contendere with respect to, is placed on probation before judgment with respect to, or is convicted of an offense listed in [§C(1)(a)(i)—(vii)] §C(1)(a)(i)— (viii) of this regulation is permanently disqualified from operating a school vehicle in Maryland, except as provided in §C(1)(a)(iv) of this regulation.

(3) [An individual] A school vehicle driver or trainee who pleads guilty or nolo contendere with respect to, is placed on probation before judgment with respect to, or is convicted of an offense listed in [§C(1)(a)(viii)] §C(1)(a)(ix) of this regulation is disqualified from operating a school vehicle for a minimum of 10 years from the date of the action.

(4) [An individual] A school vehicle driver or trainee who engages in conduct prohibited under Regulation .10B(2) of this chapter is disqualified from operating a school vehicle in Maryland, except as provided under Regulation .10D of this chapter.

D. Disqualification for Unsafe Actions. Misfeasance, incompetence, insubordination, or any act [of] or omission that adversely affects transportation or safety may be grounds for disqualification and termination of a school vehicle driver or trainee by the supervisor of transportation.

E. Disqualification for Accidents.

(1) The school vehicle driver or trainee shall report to the supervisor of transportation a school vehicle accident involving personal injury or property damage as soon as practicable after the accident.

(2)—(4) (text unchanged)

(5) A [driver] school vehicle driver or trainee who has had two preventable accidents involving personal injury or appreciable damage in a 24-month period may not operate a school vehicle in any local school system for a period of 5 years from the date of the last accident, unless the supervisor of transportation places a letter in the driver’s personnel file documenting sufficient reasons to retain the individual as a qualified school vehicle driver.

(6) A [driver] school vehicle driver or trainee who has more than two preventable accidents involving personal injury or appreciable damage in any 24-month period is permanently disqualified from operating a school vehicle in Maryland.

F. Disqualified Driver Database.

(1) The Department’s Office of Pupil Transportation shall maintain a confidential computer database of [drivers] school vehicle drivers or trainees who have been disqualified by a local school system under §§B—E of this regulation or for any other reason.

(2) The supervisor of transportation shall notify the Department’s Office of Pupil Transportation of a [driver’s] school vehicle driver’s or trainee’s disqualification within 30 days of the [driver’s] school vehicle driver’s or trainee’s receipt of notification of the disqualification.

(3) (text unchanged)

(4) Upon receipt of the current list of active school vehicle drivers, the Department’s Office of Pupil Transportation shall match that list with the Department’s confidential computer database established under this regulation and immediately notify the supervisor of transportation if an active [driver] school vehicle driver or trainee is listed on the Department’s computer database.

.08 School Vehicle Attendant Qualifications and Disqualifications.

A. (text unchanged)

B. Disqualifications for Criminal Conduct.

(1) An individual may not serve as a school vehicle attendant if the individual has been convicted of a criminal charge or if a criminal charge is pending for a crime involving:

(a)—(c) (text unchanged)

(d) A crime of violence as set forth in Criminal Law Article, §14-101, Annotated Code of Maryland; [or]

(e) Assault in the second degree as set forth in Criminal Law Article, §3-203, Annotated Code of Maryland; or

[(e)] (f) (text unchanged)

(2)—(3) (text unchanged)

C. Disqualification for Unsafe Actions. Misfeasance, incompetence, insubordination, or any act or omission that adversely affects transportation or safety may be grounds for disqualification and termination of the school vehicle attendant by the supervisor of transportation.

D. Disqualified Attendant Database.

(1) The Department’s Office of Pupil Transportation shall maintain a confidential computer database of attendants or trainees who have been disqualified by a local school system under §§B and C of this regulation or for any other reason.

(2) The supervisor of transportation shall notify the Department’s Office of Pupil Transportation of an attendant’s or trainee’s disqualification within 30 days of the attendant’s or trainee’s receipt of notification of the disqualification.

(3)—(4) (text unchanged)

.10 Alcohol and Controlled Substances Use and Testing.

A. Testing Program Required.

(1)—(3) (text unchanged)

(4) An alcohol or controlled substances test shall be administered as soon as practicable if a supervisor of transportation, who has received training in identifying the signs and symptoms of controlled substances and alcohol abuse or use, has determined there is reasonable suspicion that a school vehicle driver or trainee is using alcohol or a controlled substance.

(5) (text unchanged)

B. Disqualification of [Drivers] School Vehicle Drivers and Trainees.

(1) A school vehicle driver or trainee who engages in conduct prohibited by §B(2) of this regulation is permanently disqualified from operating a school vehicle in Maryland except under §D of this regulation.

(2) Prohibited conduct is:

(a)—(g) (text unchanged)

(h) While on duty, using controlled substances legally prescribed by a licensed physician, unless the use is according to the instructions of the prescribing physician who has advised the [driver] school vehicle driver or trainee that the substance does not adversely affect the [driver’s] school vehicle driver’s or trainee’s ability to safely operate a school vehicle; or

(i) (text unchanged)

(3) [An employee or an applicant for employment] A school vehicle driver or trainee is determined as having refused to take a controlled substances test under §B(2)(f) of this regulation if the [employee or an applicant for employment] school vehicle driver or trainee:

(a) After being directed to report for testing, fails to appear for any test, except a pre-employment test as set forth in §B(6) of this regulation, within a reasonable time, as determined by the employer or supervisor, and consistent with regulations;

(b) If an owner-operator or self-employed school vehicle driver, fails to appear for a test when notified to do so by an employer or supervisor;

(c)—(j) (text unchanged)

(4) [An applicant] A school vehicle driver or trainee reporting for a pre-employment controlled substances test is not considered to have refused a test under this chapter if:

(a) The [applicant] school vehicle driver or trainee leaves the testing site before the testing process actually commences; or

(b) The [applicant] school vehicle driver or trainee does not leave a urine specimen because the individual left the testing site before the testing actually commences.

(5) [An employee or an applicant for employment] A school vehicle driver or trainee is determined as having refused to take an alcohol test if the [employee] school vehicle driver or trainee:

(a) Fails to appear for a test, except a pre-employment test as set forth in §B(6) of this regulation, within a reasonable time as determined by the employer or supervisor and consistent with regulations, after being directed to report for a test;

(b) In the case of [an employee] a school vehicle driver or trainee who is an owner-operator or self-employed [individual] school vehicle driver or trainee, fails to appear for a test when notified to do so by an employer or supervisor;

(c)—(g) (text unchanged)

(6) [An applicant] A school vehicle driver or trainee reporting for a pre-employment test who does not provide a saliva or breath specimen under §B(2)(g) of this regulation because the applicant left the testing site before the testing commences, is not considered to have refused to test.

C. Reporting Disqualified Drivers.

(1)—(2) (text unchanged)

(3) The Office of Pupil Transportation of the Department shall maintain a confidential computer database of the disqualified school vehicle driver’s or trainee’s information reported by the local school systems under §C(1) of this regulation.

(4) (text unchanged)

(5) Upon receipt of the current list of active school vehicle drivers, the Department’s Office of Pupil Transportation shall match that list with the Department’s confidential computer database established under this regulation and immediately notify the supervisor of transportation if an active [driver] school vehicle driver or trainee is listed on the Department’s computer database.

D.—F. (text unchanged)

KAREN B. SALMON, Ph.D.
State Superintendent of Schools

 

Title 31
MARYLAND INSURANCE ADMINISTRATION

Subtitle 10 HEALTH INSURANCE — GENERAL

31.10.45 Dental Network Adequacy

Authority: Insurance Article, §§2-109(a)(1) and 15-112(e), Annotated Code of Maryland

Notice of Proposed Action

[17-258-P]

The Insurance Commissioner proposes to adopt new Regulations .01—.06 under a new chapter, COMAR 31.10.45 Dental Network Adequacy.

Statement of Purpose

The purpose of this action is to adopt new regulations pursuant to amendments to Insurance Article, §15-112, Annotated Code of Maryland, that were made during the 2016 legislative session.

Comparison to Federal Standards

There is no corresponding federal standard to this proposed action.

 

 

Estimate of Economic Impact

I. Summary of Economic Impact. The cost to insurance carriers may increase to meet these new requirements. While the amount of the cost is unknown, the increase is expected to be minimal.

 

 

Revenue (R+/R-)

 

II. Types of Economic Impact.

Expenditure

(E+/E-)

Magnitude

 


A. On issuing agency:

NONE

B. On other State agencies:

NONE

C. On local governments:

NONE

 

 

Benefit (+)
Cost (-)

Magnitude

 


D. On regulated industries or trade groups:

(1) Administrative Expense

(-)

Minimal

(2) Cost of Operations

(-)

Minimal

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.)

D(1). Assuming that insurance carriers are now required to submit additional forms to the Maryland Insurance Administration for review, their administrative expense may increase.

D(2). Assuming that insurance carriers may have to expend some time and resources to work with additional providers to contract with them, their cost of operations may increase slightly.

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 Lisa Larson, Regulations Manager, Maryland Insurance Administration, 200 St. Paul Place, Suite 2700 Baltimore, MD 21202, or call 410-468-2007, or email to networkadequacy.mia@maryland.gov, or fax to 410-468-2020. Comments will be accepted through November 13, 2017. A public hearing has not been scheduled.

.01 Scope.

This chapter applies to carriers that issue or renew dental plans in Maryland and use a provider panel for a dental plan offered in Maryland.

.02 Definitions.

A. In this chapter, the following terms have the meanings indicated.

B. Terms Defined.

(1) “Carrier” means:

(a) An insurer authorized to sell dental insurance;

 

 

(b) A nonprofit health service plan that provides coverage for dental services; or

(c) A dental plan organization as defined in Insurance Article, §14-401, Annotated Code of Maryland.

(2) “Dental plan” means a contractual arrangement for dental services.

(3) “Dental network adequacy waiver request” means a written request from a carrier to the Commissioner in which the carrier seeks the Commissioner’s approval to be relieved of certain dental network adequacy standards in this chapter for 1 year.

(4) “Dental service” has the meaning stated in Insurance Article, §14-401, Annotated Code of Maryland.

(5) “Dentist” has the meaning stated in Health Occupations Article §4-101, Annotated Code of Maryland.

(6) “Enrollee” means a person entitled to dental benefits from a carrier.

(7) Essential Community Provider.

(a) “Essential community provider” means a provider that serves predominantly low-income or dentally underserved individuals.

(b) “Essential community provider” includes local health departments.

(8) Network.

(a) “Network” means a carrier’s participating providers with which a carrier contracts to provide dental services to the carrier’s enrollees under the carrier’s dental plan.

(b) “Network” includes, if a carrier uses a provider panel developed by a subcontracting entity, providers that contract with the subcontracting entity to provide dental services to the carrier’s enrollees under the carrier’s dental plan.

(9) “Participating provider” means a provider on a carrier’s provider panel.

(10) “Provider” means:

(a) A dentist;

(b) A group of dentists; or

(c) A facility where dentists provide dental services.

(11) Provider Panel.

(a) “Provider panel” means the providers who participate in a carrier’s network.

(b) “Provider panel” does not include an arrangement in which any provider may participate solely by contracting with the carrier to provide dental services at a discounted fee-for-service rate.

(12) “Rural area” means a list of zip codes provided on the Maryland Insurance Administration’s website, with a human population of less than 1,000 per square mile according to the Maryland Department of Planning.

(13) “Specialty provider” means a dentist who focuses on a specific area of dental care for a group of patients and is identified as a specialist by the Maryland State Board of Dental Examiners.

(14) “Suburban area” means a list of zip codes provided on the Maryland Insurance Administration’s website, with a human population equal to or more than 1,000 per square mile, but less than 3,000 per square mile according to the Maryland Department of Planning.

(15) Telehealth.

(a) “Telehealth” means, as it relates to the delivery of dental services, the use of interactive audio, video, or other telecommunications or electronic technology by a provider to deliver a dental service within the scope of practice of the provider at a location other than the location of the patient.

(b) “Telehealth” does not include:

(i) An audio-only telephone conversation between a provider and a patient;

(ii) An electronic mail message between a provider and a patient; or

(iii) A facsimile transmission between a provider and a patient.

(16) “Urban area” means a list of zip codes provided on the Maryland Insurance Administration’s website, with a human population equal to or greater than 3,000 per square mile according to the Maryland Department of Planning.

(17) “Urgent care” means the treatment for a condition of an enrollee that satisfies either of the following:

(a) A dental condition that, in the absence of dental services within 72 hours, could reasonably be expected by an individual, acting on behalf of a carrier and applying the judgment of a prudent layperson who possesses an average knowledge of health and medicine, would result in:

(i) Placing the enrollee’s life or dental health in serious jeopardy;

(ii) The inability of the enrollee to regain maximum dental function;

(iii) Serious impairment to the enrollee’s dental function; or

(iv) Serious dysfunction of any bodily organ or part of the enrollee; or

(b) A dental condition of an enrollee that, in the absence of dental services or treatment within 72 hours, would, in the opinion of a provider with knowledge of the enrollee’s condition, subject the enrollee to severe pain that cannot be adequately managed without the care or treatment.

(18) “Waiting time” means the time from the initial request for dental services by an enrollee or by the enrollee’s treating provider to the earliest date offered for the appointment for services.

.03 Travel Distance Standards.

A. Sufficiency Standards.

(1) Using the zip code list on the Maryland Insurance Administration’s website, each provider panel of a carrier shall have within the geographic area served by the carrier’s network or networks, sufficient dentists, including specialty providers, and facilities to meet the maximum travel distance standards listed in the chart under §A(2) of this regulation for each type of geographic area measured from the enrollee’s place of residence.

(2) Chart of Travel Distance Standards.

 

Urban Area Maximum Distance

(miles)

Suburban Area Maximum Distance (miles)

Rural Area Maximum Distance

(miles)

Provider type:

 

 

 

General dentist

15

30

60

Endodontic

30

45

75

Orthodontics and dentofacial orthopedics

30

45

75

Oral and maxillofacial pathology

30

45

75

Oral and maxillofacial radiology

30

45

75

Oral and maxillofacial surgery

30

45

75

Pediatric dentistry

30

45

75

Periodontic

30

45

75

Prosthodontics

30

45

75

 

B. Each provider panel of a carrier shall include at least 20 percent of the available essential community providers in each of the urban, rural, and suburban areas.

.04 Appointment Waiting Time Standards.

A. Sufficiency Standards.

(1) Subject to §B of this regulation, each carrier’s provider panel shall meet the waiting time standards listed in §C of this regulation for at least 95 percent of the enrollees covered under dental plans that use that provider panel.

(2) When it is clinically appropriate and an enrollee elects to utilize a telehealth appointment, a carrier may consider that utilization as a part of its meeting the standards listed in §C of this regulation.

B. Preventive care services and periodic follow-up care may be scheduled in advance consistent with professionally recognized dental standards of practice as determined by the treating provider acting within the scope of the provider’s license.

C. Chart of Waiting Time Standards.

 

First Available Appointment Waiting Time Standards

Urgent care

3 calendar days

General dentistry services

30 calendar days

Nonurgent specialty care

30 calendar days

.05 Waiver Request Standards.

A. A carrier may apply for a dental network adequacy waiver, for up to 1 year, of a dental network adequacy requirement listed in this chapter.

B. The Commissioner may find good cause to grant the dental network adequacy waiver request only if the carrier demonstrates that the providers necessary for an adequate network:

(1) Are not available to contract with the carrier;

(2) Are not available in sufficient numbers;

(3) Have refused to contract with the carrier; or

(4) Are unable to reach agreement with the carrier.

C. A carrier seeking a dental network adequacy waiver shall submit a written request to the Commissioner that includes the following information:

(1) A description of any waiver previously granted by the Commissioner;

(2) A list of providers within the relevant service area that the carrier attempted to contract with, identified by name and specialty, if any, or facility type;

(3) A description of how and when the carrier last contacted the providers;

(4) A description of any reason each provider gave for refusing to contract with the carrier;

(5) Steps the carrier will take to attempt to improve its network to avoid future dental network adequacy waiver requests;

(6) If applicable, a statement that there are no providers available within the relevant service area for a covered service or services for which the carrier requests the waiver; and

(7) An attestation to the accuracy of the information contained in the dental network adequacy waiver request.

D. A carrier submitting a dental network adequacy waiver request may submit a written request to the Commissioner that specific information included in the plan or request not be disclosed under the Public Information Act and shall:

(1) Identify the particular information that the carrier requests not be disclosed; and

(2) Cite the statutory authority that permits denial of access to the information.

E. The Commissioner may review a request made under §D of this regulation upon receipt of a request for access pursuant to the Public Information Act.

F. The Commissioner may notify the carrier that made a request under §D of this regulation before granting access to information that was the subject of the request.

.06 Dental Network Adequacy Executive Summary Form.

A. For each provider panel used by a carrier for a dental plan, the carrier shall provide the network sufficiency results for the dental plan service area as follows:

(1) Travel Distance Standards.

(a) For each provider type listed in Regulation .03 of this chapter, list the percentage of enrollees for which the carrier met the travel distance standards, in the following format:

 

 

Urban Area

Suburban Area

Rural Area

General dentist

 

 

 

Specialty provider

 

 

 

 

(b) List the total number of essential community providers in the carrier’s network.

(c) List the total percentage of essential community providers available in the dental benefit plan’s service area that are participating providers.

(2) Appointment Waiting Time Standards.

(a) For each appointment type listed in Regulation .04 of this chapter, list the percentage of enrollees in which the carrier met the appointment waiting time standards, in the following format:

 

Appointment Waiting Time Standard Results

Urgent care — within 3 calendar days

 

Routine dental services — within 30 calendar days

 

Nonurgent specialty care — within 30 calendar days

 

 

(b) List the total percentage of telehealth appointments counted as part of the appointment waiting time standard results.

B. Each carrier shall provide a description of how it will monitor, on an ongoing basis, the ability of participating providers to provide covered services to the carrier’s enrollees.

C. The dental network adequacy access plan executive summary form filed by a carrier pursuant to §A of this regulation is not confidential information.

ALFRED W. REDMER, JR.
Insurance Commissioner

 

Title 35
MARYLAND DEPARTMENT OF VETERANS AFFAIRS

Subtitle 06 MARYLAND VETERANS ANIMAL SERVICE PROGRAM

35.06.01 General Regulations

Authority: State Government Article 9-957, Annotated Code of Maryland

Notice of Proposed Action

[17-245-P]

The Secretary of the Maryland Department of Veterans Affairs proposes to adopt new Regulations .01—.07 under a new chapter, COMAR 35.06.01 General Regulations, under a new subtitle, Subtitle 06 Maryland Veterans Animal Service Program.

Statement of Purpose

The purpose of this action is to establish procedures for the Department to carry out the responsibilities and goals of the Maryland Veterans Service Animal Program, pursuant to State Government Article, §9-957, Annotated Code of Maryland.

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 an impact on individuals with disabilities as follows:

The Maryland Veterans Service Animal Program exists to help facilitate the pairing of a service or support dog with an eligible veteran with disabilities. “Service dog” has the meaning of a dog meeting the definition of a service dog under the Americans with Disabilities Act, as amended, and means any dog that is individually trained to do work or perform tasks for the benefit of an individual with a disability, including a physical, sensory, psychiatric, intellectual, or other mental disability. “Support dog” includes a dog that serves as an emotional support animal, comfort animal, or therapy animal that a medical professional has determined provides benefit for an individual with a disability.

Opportunity for Public Comment

Comments may be sent to Dana Hendrickson, Director of Outreach and Advocacy, Maryland Department of Veterans Affairs, 16 Francis Street, 4th Floor, Annapolis, MD 21401, or call 410-260-3842, or email to dana.hendrickson@maryland.gov, or fax to 410-216-7928. Comments will be accepted through November 13, 2017. A public hearing has not been scheduled.

.01 Purpose.

The purpose of this chapter is to establish procedures for the Department to carry out the responsibilities and goals of the Maryland Veterans Service Animal Program pursuant to State Government Article, §9-957(h), Annotated Code of Maryland.

.02 Definitions.

A. In this subtitle, the following terms have the meaning indicated.

B. Terms Defined.

(1) “Eligible nonprofit training entity” means a nonprofit training entity that qualifies under State Government Article, §9-957(d)(2), Annotated Code of Maryland.

(2) “Eligible veteran” has the meaning stated in State Government Article, §9-957(a)(2), Annotated Code of Maryland.

(3) “Fund” has the meaning stated in State Government Article, §9-957(a)(3), Annotated Code of Maryland.

(4) “Nonprofit training entity” has the meaning stated in State Government Article, §9-957(a)(4), Annotated Code of Maryland.

(5) “Program” means the Maryland Veterans Service Animal Program.

(6) “Program participant” has the meaning stated in State Government Article, §9-957(a)(6), Annotated Code of Maryland.

(7) Service Dog

(a) “Service dog” has the meaning stated in the Americans with Disabilities Act, 42 U.S.C. §12101 et seq., as amended.

(b) “Service dog” includes any dog that is individually trained to do work or perform tasks for the benefit of an individual with a disability, including a physical, sensory, psychiatric, intellectual, or other mental disability.

(c) “Service dog” does not include any other species of animal, whether wild or domestic, trained or untrained.

(8) “Successful program participant” has the meaning stated in State Government Article, §9-957(a)(7), Annotated Code of Maryland.

(9) “Support dog” means a dog that serves as an emotional support animal, comfort animal, or therapy animal that a medical professional has determined provides benefit for an individual with a disability.

.03 General Applicability.

These regulations apply to every expenditure by the Department of money from the Fund.

.04 Program Outreach.

A. The Department will promote the program to eligible veterans using website announcements, social media sites, electronic newsletters, print media and brochures, and community outreach events.

B. The Department will encourage successful program participants to assist with program outreach and referral of eligible veterans.

.05 Referral of Eligible Veterans to Selected Nonprofit Training Entities.

A. Eligible nonprofit training entities must complete a Program application and submit any additional information or documentation requested by the Department.

B. Nonprofit training entities must be registered and in good standing with the Office of the Secretary of State to be considered.

C. The Department will publish a list of the selected nonprofit training entities on its website.

D. The Department will refer veterans to the list of entities and maintain a record of referrals made.

E. The nonprofit training entity will screen a referred veteran for eligibility to become a program participant.

.06 Donations to the Fund.

A. The Department will accept online donations through its website.

B. The Department will allow donors to request anonymity before publishing an annual list of donors.

.07 Disbursements from the Fund to Selected Nonprofit Training Entities.

A. Within 10 business days of a program participant’s successful completion of a selected nonprofit training entity’s training protocol, and receipt of a service or support dog from the nonprofit training entity, the entity shall notify the Department in writing, on a form to be provided by the Department, of such successful completion and receipt of a service or support dog.

B. Upon verification of the participant’s successful program completion, and contingent on available funds, the Department may disburse to the entity up to $1,000 to partially offset the entity’s costs for providing a service or support dog and services to a successful program participant.

C. The Department will consider whether the entity is providing a service dog or a support dog when determining the availability and amount of funds to be disbursed. Priority will be given to programs providing service dogs.

GEORGE W. OWINGS III
Secretary of Veterans Affairs

 

 


Special Documents

 


DEPARTMENT OF THE ENVIRONMENT

SUSQUEHANNA RIVER BASIN COMMISSION

Actions Taken at September 7, 2017, Meeting

 

AGENCY:  Susquehanna River Basin Commission.

 

ACTION:  Notice.

 

SUMMARY:  As part of its regular business meeting held on September 7, 2017, in Elmira, New York, the Commission took the following actions:  1) approved or tabled the applications of certain water resources projects; and 2) took additional actions, as set forth in the Supplementary Information below.

 

DATES:  September 7, 2017.

 

ADDRESSES: Susquehanna River Basin Commission, 4423 N. Front Street, Harrisburg, PA  17110-1788.

 

FOR FURTHER INFORMATION CONTACT:  Jason E. Oyler, General Counsel, telephone:  717-238-0423, ext. 1312; fax:  717-238-2436; joyler@srbc.net. Regular mail inquiries may be sent to the above address.  See also Commission website at www.srbc.net.

 

SUPPLEMENTARY INFORMATION:  In addition to the actions taken on projects identified in the summary above and the listings below, the following items were also presented or acted upon at the business meeting:  1) approval of a grant and a grant amendment; 2) tabled action to amend Commission By-laws; 3) adoption of guidelines for preparing an alternatives analysis to provide clarity to project sponsors regarding a formal evaluation of alternate options for a proposed water source, use or diversion; 4) release of proposed rulemaking to amend the Commission’s regulations to codify and strengthen its Access to Records Policy; 5) approval of waiver requests of Carrolltown Borough Municipal Authority and the Village of Hamilton to extend the expiration dates of their groundwater withdrawal approvals; 6) approval of Middletown Borough’s request for waiver, modifying the requirements of the regulation appropriate to Middletown’s request and directed staff to apply this modification to similar situations while a corresponding rulemaking is developed; 7) denied a request for waiver from Peak Resorts, Inc./Greek Peak Mountain Resort; 8) approval to extend the terms of emergency certificates for Sunset Golf Course, Sunoco Pipeline L.P., and Furman Foods, Inc.; and 9) a report on delegated settlements with the following project sponsors, pursuant to SRBC Resolution 2014-15:  Labrador Mountain, in the amount of $2,000; Standing Stone Golf Club, Inc., in the amount of $2,000; and Suez Water Owego-Nichols, Inc., in the amount of $7,500.

 

Project Applications Approved:

The Commission approved the following project applications:

Project Sponsor and Facility:  Cabot Oil & Gas Corporation (Meshoppen Creek), Springville Township, Susquehanna County, Pa.  Renewal with modification of surface water withdrawal of up to 0.750 mgd (peak day) (Docket No. 20130904).

Project Sponsor and Facility:  Chesapeake Appalachia, L.L.C. (Chemung River), Athens Township, Bradford County, Pa.  Renewal of surface water withdrawal of up to 0.999 mgd (peak day) (Docket No. 20130905).

Project Sponsor and Facility:  Chesapeake Appalachia, L.L.C. (Sugar Creek), Burlington Township, Bradford County, Pa.  Renewal of surface water withdrawal of up to 0.499 mgd (peak day) (Docket No. 20130906).

Project Sponsor and Facility:  Chesapeake Appalachia, L.L.C. (Susquehanna River), Terry Township, Bradford County, Pa.  Renewal of surface water withdrawal of up to 1.440 mgd (peak day) (Docket No. 20130907).

Project Sponsor and Facility:  Chief Oil & Gas LLC (Towanda Creek), Leroy Township, Bradford County, Pa.  Surface water withdrawal of up to 1.500 mgd (peak day). 

Project Sponsor and Facility:  Downs Racing, L.P. d/b/a Mohegan Sun Pocono, Plains Township, Luzerne County, Pa.  Consumptive use of up to 0.350 mgd (peak day). 

Project Sponsor and Facility:  Elizabethtown Area Water Authority, Mount Joy Township, Lancaster County, Pa.  Renewal of groundwater withdrawal of up to 0.432 mgd (30-day average) from Well 6 (Docket No. 19861103).

Project Sponsor and Facility:  Elizabethtown Area Water Authority, Mount Joy Township, Lancaster County, Pa.  Groundwater withdrawal of up to 0.432 mgd (30-day average) from Well 7. 

Project Sponsor and Facility:  Elizabethtown Area Water Authority, Elizabethtown Borough and Mount Joy Township, Lancaster County, Pa.  Modification to correct total system limit to remove inclusion of water discharged to the Conewago watershed to offset passby and transfer of water from Conewago Creek to Back Run (Docket No. 20160903).

Project Sponsor and Facility:  Moxie Freedom LLC, Salem Township, Luzerne County, Pa.  Modification to increase consumptive use by an additional 0.408 mgd (peak day), for a total consumptive use of up to 0.500 mgd (peak day) (Docket No. 20150907).

Project Sponsor and Facility:  Susquehanna Gas Field Services, LLC (Meshoppen Creek), Meshoppen Borough, Wyoming County, Pa.  Renewal of surface water withdrawal of up to 0.145 mgd (peak day) (Docket No. 20130913).

Project Sponsor and Facility:  Susquehanna Nuclear, LLC, Salem Township, Luzerne County, Pa.  Modification to increase consumptive use by an additional 5.000 mgd (peak day), for a total consumptive use of up to 53.000 mgd (peak day) (Docket No. 19950301).

Project Sponsor and Facility:  Susquehanna Nuclear, LLC (Susquehanna River), Salem Township, Luzerne County, Pa.  Modification to increase surface water withdrawal by an additional 10.000 mgd (peak day), for a total surface water withdrawal increase of up to 76.000 mgd (peak day) (Docket No. 19950301).

Project Sponsor and Facility:  SWEPI LP (Elk Run), Sullivan Township, Tioga County, Pa.  Surface water withdrawal of up to 0.646 mgd (peak day). 

Project Sponsor and Facility:  SWN Production Company, LLC (Wyalusing Creek), Wyalusing Township, Bradford County, Pa.  Renewal of surface water withdrawal of up to 2.000 mgd (peak day) (Docket No. 20130911).

Project Sponsor and Facility:  Transcontinental Gas Pipe Line Company, LLC.  Project:  Atlantic Sunrise (Fishing Creek), Sugarloaf Township, Columbia County, Pa.  Modification to add consumptive use of up to 0.200 mgd (peak day) to existing docket approval (Docket No. 20160913).

Project Sponsor and Facility:  Transcontinental Gas Pipe Line Company, LLC.  Project:  Atlantic Sunrise (Fishing Creek), Sugarloaf Township, Columbia County, Pa.  Modification to change authorized use of source to existing docket approval (Docket No. 20160913).

 

Project Applications Tabled:

The Commission tabled action on the following project applications:

Project Sponsor and Facility:  Houtzdale Municipal Authority, Gulich Township, Clearfield County, Pa.  Application for groundwater withdrawal of up to 1.008 mgd (30-day average) from Well 14R. 

Project Sponsor and Facility:  Village of Waverly, Tioga County, N.Y.  Application for groundwater withdrawal of up to 0.320 mgd (30-day average) from Well 1. 

Project Sponsor and Facility:  Village of Waverly, Tioga County, N.Y.  Application for groundwater withdrawal of up to 0.480 mgd (30-day average) from Well 2. 

Project Sponsor and Facility:  Village of Waverly, Tioga County, N.Y.  Application for groundwater withdrawal of up to 0.470 mgd (30-day average) from Well 3. 

 

AUTHORITY:  Pub.L. 91-575, 84 Stat. 1509 et seq., 18 CFR Parts 806, 807, and 808.

 

Dated:  September 19, 2017.

STEPHANIE L. RICHARDSON
Secretary to the Commission

[17-21-13]

 

SUSQUEHANNA RIVER BASIN COMMISSION

Projects Approved for Minor Modifications

 

AGENCY:  Susquehanna River Basin Commission.

 

ACTION:  Notice.

 

SUMMARY:  This notice lists the minor modifications approved for a previously approved project by the Susquehanna River Basin Commission during the period set forth in “DATES.”

 

DATES:  July 1-31, 2017.

 

ADDRESSES:  Susquehanna River Basin Commission, 4423 North Front Street, Harrisburg, PA  17110-1788.

 

FOR FURTHER INFORMATION CONTACT:  Jason E. Oyler, General Counsel, telephone: (717) 238-0423, ext. 1312; fax: (717) 238-2436; e-mail: joyler@srbc.net. Regular mail inquiries may be sent to the above address.

 

SUPPLEMENTARY INFORMATION:  This notice lists previously approved projects, receiving approval of minor modifications, described below, pursuant to 18 CFR 806.18 for the time period specified above:

 

Minor Modifications Issued Under 18 CFR 806.18

SWEPI LP, Docket No. 20161218-1, Deerfield Township, Tioga County, Pa.; approval to change the design of the surface water intake with respect to intake location; Approval Date:  July 14, 2017. 

 

AUTHORITY:  Pub. L. 91-575, 84 Stat. 1509 et seq., 18 CFR Parts 806, 807, and 808.

 

Dated:  September 20, 2017.

STEPHANIE L. RICHARDSON
Secretary to the Commission

[17-21-14]

 

SUSQUEHANNA RIVER BASIN COMMISSION

Projects Approved for Consumptive Uses of Water

 

AGENCY:  Susquehanna River Basin Commission.

 

ACTION:  Notice.

 

SUMMARY:  This notice lists the projects approved by rule by the Susquehanna River Basin Commission during the period set forth in “DATES.”

 

DATES:  July 1-31, 2017.

 

ADDRESSES:  Susquehanna River Basin Commission, 4423 North Front Street, Harrisburg, PA  17110-1788.

 

FOR FURTHER INFORMATION CONTACT:  Jason E. Oyler, General Counsel, 717-238-0423, ext. 1312, joyler@srbc.net. Regular mail inquiries may be sent to the above address.

 

SUPPLEMENTARY INFORMATION:  This notice lists the projects, described below, receiving approval for the consumptive use of water pursuant to the Commission’s approval by rule process set forth in 18 CFR §806.22(e) and §806.22 (f) for the time period specified above:

 

Approvals By Rule Issued Under 18 CFR 806.22(e):

DelGrosso Foods Inc., ABR-201707002, Antis Township, Blair County, Pa.; Consumptive Use of Up to 0.2500 mgd; Approval Date: July 25, 2017.

 

Approvals By Rule Issued Under 18 CFR 806.22(f):

SWN Production Company, LLC, Pad ID: ENDLESS MOUNTAIN RECREATION, ABR-201209001.R1, New Milford Township, Susquehanna County, Pa.; Consumptive Use of Up to 4.9990 mgd; Approval Date: July 14, 2017.

SWN Production Company, LLC, Pad ID: WOOSMAN PAD, ABR-201209006.R1, New Milford Township, Susquehanna County, Pa.; Consumptive Use of Up to 4.9990 mgd; Approval Date: July 14, 2017.

Cabot Oil & Gas Corporation, Pad ID: Rag Apple LLC P1, ABR-201207015.R1, Jessup Township, Susquehanna County, Pa.; Consumptive Use of Up to 5.0000 mgd; Approval Date: July 18, 2017.

Cabot Oil & Gas Corporation, Pad ID: FlowerT P1, ABR-201207016.R1, Springville Township, Susquehanna County, Pa.; Consumptive Use of Up to 5.0000 mgd; Approval Date: July 18, 2017.

Cabot Oil & Gas Corporation, Pad ID: ReillyJ P1, ABR-201207017.R1, Gibson Township, Susquehanna County, Pa.; Consumptive Use of Up to 5.0000 mgd; Approval Date: July 18, 2017.

Range Resources – Appalachia, LLC, Pad ID: State Game Lands 075A – West Pad, ABR-201207002.R1, Pine Township, Lycoming County, Pa.; Consumptive Use of Up to 1.0000 mgd; Approval Date: July 18, 2017.

Inflection Energy (PA), LLC, Pad ID: Converse Well Site, ABR-201707001, Mill Creek and Wolf Townships, Lycoming County, Pa.; Consumptive Use of Up to 4.0000 mgd; Approval Date: July 20, 2017.

Repsol Oil & Gas USA, LLC, Pad ID: KUHLMAN (05 258) M, ABR-201208023.R1, Windham Township, Bradford County, Pa.; Consumptive Use of Up to 6.0000 mgd; Approval Date: July 20, 2017.

SWN Production Company, LLC, Pad ID: SWOPE PAD, ABR-201209007.R1, Jackson Township, Susquehanna County, Pa.; Consumptive Use of Up to 4.9990 mgd; Approval Date: July 24, 2017.

SWN Production Company, LLC, Pad ID: MULLOY PAD, ABR-201209008.R1, Jackson Township, Susquehanna County, Pa.; Consumptive Use of Up to 4.9990 mgd; Approval Date: July 24, 2017.

SWN Production Company, LLC, Pad ID: MARVIN PAD, ABR-201209009.R1, Jackson Township, Susquehanna County, Pa.; Consumptive Use of Up to 4.9990 mgd; Approval Date: July 24, 2017.

SWN Production Company, LLC, Pad ID: FREITAG PAD, ABR-201209010.R1, Jackson Township, Susquehanna County, Pa.; Consumptive Use of Up to 4.9990 mgd; Approval Date: July 24, 2017.

Carrizo (Marcellus), LLC, Pad ID: Ricci Well Pad, ABR-201208019.R1, Bridgewater Township, Susquehanna County, Pa.; Consumptive Use of Up to 2.1000 mgd; Approval Date: July 26, 2017.

Chief Oil & Gas, LLC, Pad ID: Bishop Drilling Pad, ABR-201212014.R1, Auburn Township, Susquehanna County, Pa.; Consumptive Use of Up to 2.0000 mgd; Approval Date: July 31, 2017.

 

AUTHORITY:  Pub. L. 91-575, 84 Stat. 1509 et seq., 18 CFR Parts 806, 807, and 808.

 

Dated:  September 20, 2017.

STEPHANIE L. RICHARDSON
Secretary to the Commission

[17-21-15]

 

                                                                                                                                                                                               

SUSQUEHANNA RIVER BASIN COMMISSION

Public Hearing

 

AGENCY:  Susquehanna River Basin Commission.

 

ACTION:  Notice.

 
SUMMARY:  The Susquehanna River Basin Commission will hold a public hearing on November 2, 2017, in Harrisburg, Pennsylvania. At this public hearing, the Commission will hear testimony on the projects listed in the Supplementary Information section of this notice. Such projects are intended to be scheduled for Commission action at its next business meeting, tentatively scheduled for December 7, 2017, which will be noticed separately. The public should take note that this public hearing will be the only opportunity to offer oral comment to the Commission for the listed projects. The deadline for the submission of written comments is November 13, 2017.

 

DATES:  The public hearing will convene on November 2, 2017, at 2:30 p.m.  The public hearing will end at 5:00 p.m. or at the conclusion of public testimony, whichever is sooner.  The deadline for the submission of written comments is November 13, 2017.

 

ADDRESSES:  The public hearing will be conducted at the Pennsylvania State Capitol, Room 8E-B, East Wing, Commonwealth Avenue, Harrisburg, Pa.

 
FOR FURTHER INFORMATION CONTACT:  Jason Oyler, General Counsel, telephone:  (717) 238-0423, ext. 1312; fax:  (717) 238-2436.  
Information concerning the applications for these projects is available at the SRBC Water Application and Approval Viewer at http://mdw.srbc.net/waav. Additional supporting documents are available to inspect and copy in accordance with the Commission’s Access to Records Policy at www.srbc.net/pubinfo/docs/2009-02_Access_to_Records_Policy_20140115.pdf. 

 

SUPPLEMENTARY INFORMATION: The public hearing will cover the following projects:

 

Projects Scheduled for Action:

Project Sponsor and Facility:  Beech Creek Borough Authority, Beech Creek Borough, Clinton County, Pa.  Application for renewal of groundwater withdrawal of up to 0.220 mgd (30-day average) from Well 2 (Docket No. 19870602). 

Project Sponsor and Facility:  Brymac, Inc. dba Mountain View Country Club (Pond 3/4), Harris Township, Centre County, Pa.  Application for surface water withdrawal of up to 0.240 mgd (peak day). 

Project Sponsor and Facility:  Cabot Oil & Gas Corporation (East Branch Tunkhannock Creek), Lenox Township, Susquehanna County, Pa.  Application for surface water withdrawal of up to 1.000 mgd (peak day). 

Project Sponsor and Facility:  Cabot Oil & Gas Corporation (Meshoppen Creek), Lemon Township, Wyoming County, Pa.  Modification to increase surface water withdrawal by an additional 0.500 mgd (peak day), for a total surface water withdrawal of up to 1.000 mgd (peak day) (Docket No. 20170302). 

Project Sponsor and Facility:  Chesapeake Appalachia, L.L.C. (Susquehanna River), Athens Township, Bradford County, Pa.  Application for renewal of surface water withdrawal of up to 0.750 mgd (peak day) (Docket No. 20131202). 

Project Sponsor and Facility:  Houtzdale Municipal Authority, Gulich Township, Clearfield County, Pa.  Application for groundwater withdrawal of up to 1.008 mgd (30-day average) from Well 14R. 

Project Sponsor and Facility:  LHP Management, LLC (Fishing Creek), Bald Eagle Township, Clinton County, Pa.  Application for surface water withdrawal of up to 0.999 mgd (peak day).

Project Sponsor and Facility:  Martinsburg Municipal Authority, North Woodbury Township, Blair County, Pa.  Application for renewal of groundwater withdrawal of up to 0.346 mgd (30-day average) from Wineland Well 3 (Docket No. 19870304). 

Project Sponsor and Facility:  Borough of Mifflinburg, West Buffalo Township, Union County, Pa.  Modification to request a reduction in the withdrawal rate of Well PW-2 from 0.554 mgd to 0.396 mgd (30-day average), and to eliminate wetlands monitoring condition (Docket No. 20141203).

Project Sponsor and Facility:  Repsol Oil & Gas USA, LLC (Choconut Creek), Choconut Township, Susquehanna County, Pa.  Application for renewal of surface water withdrawal of up to 0.999 mgd (peak day) (Docket No. 20131211). 

Project Sponsor and Facility:  Schuylkill Energy Resources, Inc., Mahanoy Township, Schuylkill County, Pa.  Application for renewal of groundwater withdrawal of up to 5.000 mgd (30-day average) from Maple Hill Mine Shaft Well (Docket No. 19870101). 

Project Sponsor and Facility:  Schuylkill Energy Resources, Inc., Mahanoy Township, Schuylkill County, Pa.  Application for renewal of consumptive use of up to 2.550 mgd (peak day) (Docket No. 19870101). 

Project Sponsor:  SUEZ Water Pennsylvania Inc.  Project Facility:  Shavertown Operation, Dallas Township, Luzerne County, Pa.  Application for groundwater withdrawal of up to 0.288 mgd (30-day average) from the Salla Well. 

Project Sponsor and Facility:  SWN Production Company, LLC (Lycoming Creek), Lewis Township, Lycoming County, Pa.  Application for renewal of surface water withdrawal of up to 0.500 mgd (peak day) (Docket No. 20131209). 

Project Sponsor and Facility:  SWN Production Company, LLC (Lycoming Creek), McIntyre Township, Lycoming County, Pa.  Application for renewal of surface water withdrawal of up to 0.500 mgd (peak day) (Docket No. 20131210). 

Project Sponsor and Facility:  Village of Waverly, Tioga County, N.Y.  Application for groundwater withdrawal of up to 0.320 mgd (30-day average) from Well 1. 

Project Sponsor and Facility:  Village of Waverly, Tioga County, N.Y.  Application for groundwater withdrawal of up to 0.480 mgd (30-day average) from Well 2. 

Project Sponsor and Facility:  Village of Waverly, Tioga County, N.Y.  Application for groundwater withdrawal of up to 0.470 mgd (30-day average) from Well 3. 

 

Opportunity to Appear and Comment:

Interested parties may appear at the hearing to offer comments to the Commission on any project listed above. The presiding officer reserves the right to limit oral statements in the interest of time and to otherwise control the course of the hearing. Guidelines for the public hearing will be posted on the Commission’s website, www.srbc.net, prior to the hearing for review. The presiding officer reserves the right to modify or supplement such guidelines at the hearing. Written comments on any project listed above may also be mailed to Mr. Jason Oyler, General Counsel, Susquehanna River Basin Commission, 4423 North Front Street, Harrisburg, Pa. 17110-1788, or submitted electronically through www.srbc.net/pubinfo/publicparticipation.htm. Comments mailed or electronically submitted must be received by the Commission on or before November 13, 2017, to be considered.

 

AUTHORITY:  Pub. L. 91-575, 84 Stat. 1509 et seq., 18 CFR Parts 806, 807, and 808.

 

Dated:  September 29, 2017.

STEPHANIE L. RICHARDSON
Secretary to the Commission

[17-21-24]

 

PUBLIC HEARING ANNOUNCEMENT — PROPOSED RELICENSING OF THE CONOWINGO HYDROELECTRIC PROJECT APPLICATION FOR WATER QUALITY CERTIFICATION

Date:  October 13, 2017

 

Exelon Corporation, on behalf of its wholly owned subsidiary, Exelon Generation Company, LLC (Exelon), has filed with the Federal Energy Regulatory Commission (FERC) an application for a New License for the continued operation of the Conowingo Hydroelectric Project.  Under federal law and as part of FERC’s relicensing process, Exelon is required to obtain a Clean Water Act (CWA), Section 401 Water Quality Certification (WQC) from the Maryland Department of the Environment (“MDE” or “the Department”).  Section 401 of the CWA requires that any applicant for a federal license or permit for any activity that may result in any discharge into navigable waters obtain from the State in which the discharge originates a certification that any such discharge meets State water quality standards and limitations.  In accordance with this requirement, Exelon applied to MDE for the WQC on May 16, 2017. 

 

Applicant:  Exelon Generation Company, LLC 

                   300 Exelon Way              

                   Kennett Square, PA 19348

                    

Application # 17-WQC-02

Lower Susquehanna River and Upper Chesapeake Bay

Use I &2 Waters

 

The purpose of this public notice is to announce the date of a public hearing on the subject application.  A public hearing on the application has been scheduled for the following date, time, and location:

 

Date:  December 5, 2017

Time: 6:00 pm

Location: Harford Community College

Darling Hall, room 202 A,B&C

401 Thomas Run

Bel Air, Maryland 21015

 

The purpose of the public hearing is to take testimony/statements from interested persons/parties.  Depending on the number of speakers, a time limit per speaker may be imposed to ensure that all interested parties have an opportunity to present their views.

 

Background Information:  Exelon’s application for the WQC was received on May 16, 2017.  The Department’s final decision on the application must be rendered by May 15, 2018.  On July 10, 2017, pursuant to the Code of Maryland Regulations (COMAR) 26.08.02, Regulation .10 Water Quality Certification, MDE issued a public notice soliciting comments on Exelon’s application.  The end of the public comment period was subsequently extended from August 9 to August 23, 2017. 

 

The public comments received in response to the Department’s July 10, 2017 public notice are posted on the Department’s website at the following link:  http://mde.maryland.gov/programs/Water/WetlandsandWaterways/Pages/chp-comments.aspx

 

Exelon’s application for the WQC and supporting information is available on the Department’s website at the following link:

http://mde.maryland.gov/programs/Water/WetlandsandWaterways/Pages/ExelonMD-Conowingo-WQCApp.aspx

 

Any additional comments on this application may be submitted in writing to Elder Ghigiarelli, Jr., Deputy Program Administrator, Wetlands and Waterways Program, Water and Science Administration, Maryland Department of the Environment, 1800 Washington Boulevard, Suite 430, Baltimore, MD 21230, or email comments to elder.ghigiarelli@maryland.gov.  Comments may also be submitted at the public hearing on December 5, 2017.  All comments must be received by December 5, 2017. 

[17-21-25]

 

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MARYLAND HEALTH CARE COMMISSION

SCHEDULES FOR CERTIFICATE OF NEED REVIEW

The Maryland Health Care Commission provides the following schedules to interested members of the public and sponsors of health care facility and service projects subject to Certificate of Need (“CON”) review and approval.

The general criteria for Certificate of Need review are set forth at COMAR 10.24.01.08G(3). An applicant must demonstrate that the proposed project is consistent with these review criteria.  It will be noted that the first criterion is evaluation of the project according to all relevant State Health Plan standards, policies and criteria.  

This Certificate of Need review schedule updates the schedule published in the Maryland Register, Volume 44, Issue 8, pages 422-425 (April 14, 2017). This review schedule is not a solicitation by the Commission for Certificate of Need applications, and does not indicate, in itself, that additional capacity is needed in services subject to Certificate of Need review, or that Certificate of Need applications submitted for the services described will be approved by the Commission.

Applicants are encouraged to discuss their development plans and projects with the Commission Staff prior to filing letters of intent or applications.

Letters of Intent and applications for scheduled reviews may only be received and reviewed according to these published schedules.   All Letters of Intent and Certificate of Need applications, including all of the required number of copies of CON applications, must be received at the offices of the Maryland Health Care Commission, 4160 Patterson Avenue, Baltimore, Maryland  21215, no later than 4:30 p.m. on the scheduled date of submission.  Letters of intent for projects not covered by this review schedule may be filed at any time.

For further information about review schedules or procedures, call Kevin McDonald, Chief, Certificate of Need, at (410) 764-5982.

The Commission will use the following regional configuration of jurisdictions for the General Hospital Project, Special Hospital Project, Freestanding Ambulatory Surgical Facility Project, and Schedule Two Comprehensive Care Facility Project Review Schedules:

 

Western Maryland: 

Allegany, Frederick, Garrett, and Washington

Central Maryland: 

Anne Arundel, Baltimore, Carroll, Harford, Howard, and Baltimore City

Eastern Shore: 

Caroline, Cecil, Dorchester, Kent, Queen Anne's, Somerset, Talbot, Wicomico, and Worcester

Montgomery & Southern Maryland:  

Calvert, Charles, Montgomery, Prince George's, and St. Mary's

 

General Hospital Projects

     The Commission hereby publishes the following schedules for the submission of Certificate of Need applications by general hospitals, for projects that involve: (1) capital expenditures by or on behalf of general hospitals that exceed the applicable capital expenditure threshold referenced at COMAR 10.24.01.02A(5); (2) proposed changes in bed capacity or operating room capacity at existing hospitals; (3) the relocation of a general hospital; and/or (4) a change in the type or scope of any health care service offered by a general hospital, as specified at COMAR 10.24.01.02A, except for neonatal intensive care.  Please note that the following schedule does not apply to a project to establish a new general hospital.

Schedule One
All General Hospital Projects

 

Region

Letter of Intent
Due Date

Pre-Application
Conference Date

Application
Submission Date

Western Maryland

November 3, 2017

November 15, 2017

January 5, 2018

Central Maryland

December 1, 2017

December 13, 2017

February 2, 2108

Eastern Shore

January 5, 2018

January 17, 2018

March 9, 2018

Montgomery & Southern Maryland

February 2, 2108

February 14, 2018

April 6, 2018

 

Schedule Two

All General Hospital Projects

 

Region

Letter of Intent
Due Date

Pre-Application
Conference Date

Application
Submission Date

Western Maryland

May 4, 2018

May 16, 2018

July 6, 2018

Central Maryland

June 1, 2018

June 13, 2018

August 3, 2018

Eastern Shore

July 6, 2018

July 18, 2018

September 7, 2018

Montgomery & Southern Maryland

August 3, 2018

August 15, 2018

October 5, 2018

 

Special Hospital Projects (Pediatric, Psychiatric, Chronic, and Rehabilitation)

The Commission hereby publishes the following schedules for the submission of Certificate of Need applications by special hospitals, for projects that involve: (1) capital expenditures by or on behalf of special hospitals that exceed the applicable capital expenditure threshold referenced at COMAR 10.24.01.02A(5); (2) proposed changes in bed capacity at existing hospitals; (3) the relocation of a special hospital; and/or (4) a change in the type or scope of any health care service offered by a special hospital, as specified at COMAR 10.24.01.02A.  Please note that the following schedule does not apply to a project to establish a new special hospital.

 

Schedule One

Special Hospitals (Pediatric, Psychiatric, Chronic, and Rehabilitation)

 

Region

Letter of Intent
Due Date

Pre-Application
Conference Date

Application
Submission Date

Western Maryland

November 3, 2017

November 15, 2017

January 5, 2018

Montgomery & Southern Maryland

January 5, 2018

January 17, 2018

March 9, 2018

Central Maryland

February 2, 2108

February 14, 2018

April 6, 2018

Eastern Shore

March 2, 2018

March 14, 2018

May 4, 2018

 

Schedule Two

Special Hospital Projects (Pediatric, Psychiatric, Chronic, and Rehabilitation)

 

Region

Letter of Intent
Due Date

Pre-Application
Conference Date

Application
Submission Date

Western Maryland

May 4, 2018

May 16, 2018

July 6, 2018

Central Maryland

June 1, 2018

June 13, 2018

August 3, 2018

Eastern Shore

July 6, 2018

July 18, 2018

September 7, 2018

Montgomery & Southern Maryland

August 3, 2018

August 15, 2018

October 5, 2018

 

Freestanding Ambulatory Surgical Facility Projects

The Commission hereby publishes the following schedules for the submission of applications to establish freestanding ambulatory surgical facilities, add operating rooms at an existing freestanding ambulatory surgical facility, or make a capital expenditure by or on behalf of a freestanding ambulatory surgical facility that requires Certificate of Need review and approval.  The definition of freestanding ambulatory surgical facility can be found at Health-General Article §19-114(b).

 

Schedule One

Freestanding Ambulatory Surgical Facility Projects

 

Region

Letter of Intent
Due Date

Pre-Application
Conference Date

Application
Submission Date

Montgomery & Southern Maryland

November 3, 2017

November 15, 2017

January 5, 2018

Central Maryland

December 1, 2017

December 13, 2017

February 2, 2108

Eastern Shore

January 5, 2018

January 17, 2018

March 9, 2018

Western Maryland

February 2, 2108

February 14, 2018

April 6, 2018

 

Schedule Two
Freestanding Ambulatory Surgical Facility Projects

 

Region

Letter of Intent
Due Date

Pre-Application
Conference Date

Application
Submission Date

Western Maryland

May 4, 2018

May 16, 2018

July 6, 2018

Central Maryland

June 1, 2018

June 13, 2018

August 3, 2018

Eastern Shore

July 6, 2018

July 18, 2018

September 7, 2018

Montgomery & Southern Maryland

August 3, 2018

August 15, 2018

October 5, 2018

 

 

Comprehensive Care Facility Projects

The Commission hereby publishes the following two schedules for Certificate of Need review of proposed projects affecting comprehensive care facilities (“CCFs”). Schedule One identifies the review cycles for proposals involving the addition of CCF beds in Maryland jurisdictions in which the most recent State Health Plan need projection (COMAR 10.24.08, effective October 3, 2014) identifies a net need for beds in the forecast year of 2016 and for which no letters of intent or applications have been filed.. Persons interested in submitting Certificate of Need applications involving the addition of beds in these jurisdictions should contact the Maryland Health Care Commission to ascertain the current level of net bed need, if any, identified for these jurisdictions prior to the filing of a Certificate of Need application.  Schedule Two establishes submission dates for Certificate of Need applications related to all other CCF projects that do not involve an increase in CCF bed capacity in a jurisdiction.  These include projects that involve a proposed capital expenditure for new construction or renovation at an existing CCF, the relocation of an existing facility, or the proposed relocation of some or all of the CCF bed capacity from an existing facility to a new site within the same jurisdiction.

 

Schedule One
Projects Proposing New Comprehensive Care Facility Beds

 

Jurisdiction

Letter of
Intent
Due Date

Pre-Application
Conference
Date

Application
Submission
Date

Howard County

January 5, 2018

January 10, 2018

March 9, 2018

St. Mary’s County

February 2, 2018

February 14, 2018

April 6, 2018

Queen Anne’s County

March 2, 2018

March 14, 2018

June 8, 2018

Worcester County

April 6, 2018

April 18, 2018

July 6, 2018

Harford County

May 4, 2018

May 16, 2018

August 10, 2018

 

Schedule One

Part B: Other Comprehensive Care Facility Projects

 

Region

Letter of Intent
Due Date

Pre-Application
Conference Date

Application
Submission Date

Eastern Shore

November 3, 2017

November 15, 2017

January 5, 2018

Western Maryland

December 1, 2017

December 13, 2017

February 2, 2108

Central Maryland

February 2, 2108

February 14, 2018

April 6, 2018

Montgomery & Southern Maryland

March 2, 2018

March 14, 2018

May 4, 2018

 

Schedule Two
Part A: Other Comprehensive Care Facility Projects

 

Region

Letter of Intent
Due Date

Pre-Application
Conference Date

Application
Submission Date

Western Maryland

May 4, 2018

May 16, 2018

July 6, 2018

Central Maryland

June 1, 2018

June 13, 2018

August 3, 2018

Eastern Shore

July 6, 2018

July 18, 2018

September 7, 2018

Montgomery & Southern Maryland

August 3, 2018

August 15, 2018

October 5, 2018

 

Freestanding Medical Facility Projects  

The Commission hereby publishes the following statewide schedule for Certificate of Need review of proposed projects to establish or relocate freestanding medical facilities (FMFs) and proposed capital expenditures by or on behalf of FMFs that require CON review and approval.  Please note that these schedules do not apply to the filing of a request for an Exemption from Certificate of Need by a general hospital seeking to convert to a freestanding medical facility.

 

Schedule One
Freestanding Medical Facility Projects

 

Letter of Intent Due Date