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REGS : 10.09.02 Physicians’ Services (MEDICAL CARE PROGRAMS)

Maryland Register
Issue Date:  January 23, 2015
Volume 42 • Issue 2 • Page 181
Title 10
10.09.02 Physicians’ Services
Authority: Health-General Article, §§2-104(b), 15-103, and 15-105, Annotated Code of Maryland
Notice of Proposed Action
The Secretary of Health and Mental Hygiene proposes to amend Regulation .05 under COMAR 10.09.02 Physicians’ Services.
Statement of Purpose
The purpose of this action is to align Medicaid coverage of gender reassignment with the Maryland State Employees’ Health Benefit program and recent changes in Medicare policy.
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
I. Summary of Economic Impact. The Department is proposing the removal of limitations on gender reassignment surgery. The additional coverage represents an overall cost to the Department.
Revenue (R+/R-)
II. Types of Economic Impact.
Expenditure (E+/E-)

A. On issuing agency:
B. On other State agencies:
C. On local governments:
Benefit (+)
Cost (-)

D. On regulated industries or trade groups:
E. On other industries or trade groups:
F. Direct and indirect effects on public:
III. Assumptions. (Identified by Impact Letter and Number from Section II.)
A. and D. There are an estimated 400 transgender individuals currently enrolled in the Maryland Medical Assistance (MA) Program. If approximately two and a half percent of this population request the procedure(s) and meet the prior authorization criteria for the surgery, this could result in 10 gender reassignments. At the estimated cost of $65,000 per surgery, this would be an additional cost of $650,000 over the next 5 years. Not all individuals will have the surgery in the first year it is covered. We estimate that two individuals will have the surgery in the remaining part of FY15 at a cost of $120,000 and 4 individuals will have the surgery in FY16 at a cost of $240,000.
Economic Impact on Small Businesses
The proposed action has minimal or no economic impact on small businesses.
Impact on Individuals with Disabilities
The proposed action has no impact on individuals with disabilities.
Opportunity for Public Comment
Comments may be sent to Michele Phinney, Director, Office of Regulation and Policy Coordination, Department of Health and Mental Hygiene, 201 West Preston Street, Room 512, Baltimore, MD 21201, or call 410-767-6499 (TTY 800-735-2258), or email to, or fax to 410-767-6483. Comments will be accepted through February 23, 2015. A public hearing has not been scheduled.
.05 Limitations.
A. Services which are not covered are:
(1)—(19) (text unchanged)
[(20) Gender change or sex reassignment procedures;]
[(21)] (20)[(22)] (21) (text unchanged)
B.—H. (text unchanged)
Secretary of Health and Mental Hygiene

 Content Editor