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REGS : 10.09.65 Maryland Medicaid Managed Care Program: Managed Care Organizations (MEDICAL CARE PROGRAMS)

PROPOSAL
Maryland Register
Issue Date:  November 14, 2014
Volume 41 • Issue 23 • Pages 1395—1399
 
Title 10
DEPARTMENT OF HEALTH AND MENTAL HYGIENE
Subtitle 09 MEDICAL CARE PROGRAMS
10.09.65 Maryland Medicaid Managed Care Program: Managed Care Organizations
Authority: Insurance Article, §§15-112, 15-605, and 15-1008; Health-General Article, §§2-104, 15-102.3, and 15-103; Annotated Code of Maryland
Notice of Proposed Action
[14-330-P]
The Secretary of Health and Mental Hygiene proposes to amend Regulation .19 under COMAR 10.09.65 Maryland Medicaid Managed Care Program: Managed Care Organizations.
Statement of Purpose
The purpose of this action is to implement the midyear adjustment to the calendar year 2014 MCO’s HealthChoice rates and to add a supplemental payment for Hepatitis C therapy.
Comparison to Federal Standards
There is no corresponding federal standard to this proposed action.
Estimate of Economic Impact
I. Summary of Economic Impact. The net economic impact of the HealthChoice CY 2014 MCO mid-year rate adjustment is an increase of $14,045,025. The increase includes the update to the primary care physician’s rates (which was a decrease), the HSCRC inpatient and outpatient rate increase, legislative rate reduction down to the bottom of the range and removal from the rates of the PAC ACA tax that was originally built into the rates.
 
 
Revenue (R+/R-)
 
II. Types of Economic Impact.
Expenditure
(E+/E-)
Magnitude
 

 
 
 
 
 
A. On issuing agency:
(E+)
$14,045,025
B. On other State agencies:
NONE
 
C. On local governments:
NONE
 
 
 
Benefit (+)
Cost (-)
Magnitude
 

 
 
 
 
 
D. On regulated industries or trade groups:
(+)
$14,045,025
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. The rate increase is calculated by an actuarial consultant and Hilltop using data from CMS, other States, HSCRC and MCO data.
D. There will be a positive impact on the MCOs due to the overall rate increase. See IIA above.
Economic Impact on Small Businesses
The proposed action has minimal or no economic impact on small businesses.
Impact on Individuals with Disabilities
The proposed action has no impact on individuals with disabilities.
Opportunity for Public Comment
Comments may be sent to Michele Phinney, Director, Office of Regulation and Policy Coordination, Department of Health and Mental Hygiene, 201 West Preston Street, Room 512, Baltimore, MD 21201, or call 410-767-6499 (TTY 800-735-2258), or email to dhmh.regs@maryland.gov, or fax to 410-767-6483. Comments will be accepted through December 15, 2014. A public hearing has not been scheduled.
.19 MCO Reimbursement.
A. (text unchanged)
B. Capitation Rate-Setting Methodology.
(1)—(3) (text unchanged)
(4) Except to the extent of adjustments required by §D of this regulation or by Regulations .19-1—.19-4 of this chapter, the Department shall make payments monthly at the rates specified in the following tables:
 [(a)] [(d)] (proposed for repeal)
(a) Rate Table for Families and Children, Effective July 1, 2014 — December 31, 2014.
 
 
Age/RAC
Gender
PMPM
Baltimore
City
PMPM
Allegany, Frederick, Garrett, Montgomery, Prince George’s and Washington Counties
PMPM
Rest
of
State
 
Under age 1
Birth Weight
1500 grams or less
Both
$9,510.87
$8,041.20
$8,542.73
 
Under age 1
Birth Weight
over 1500 grams
Both
$451.78
$381.97
$405.80
 
1—5
Male
$224.24
$189.59
$201.41
 
 
Female
$185.40
$156.75
$166.53
 
6—14
Male
$111.26
$94.07
$99.93
 
 
Female
$105.16
$88.91
$94.95
 
15—20
Male
$137.14
$115.95
$123.18
 
 
Female
$187.80
$158.78
$168.69
 
21—44
Male
$310.56
$242.42
$283.98
 
 
Female
$461.47
$360.22
$421.97
 
45—64
Male
$596.74
$465.81
$545.66
 
 
Female
$656.74
$512.65
$600.52
ACG—adjusted cells
 
 
 
 
 
ACG 100, 200, 300, 400, 500, 600, 700, 900, 1000, 1100, 1200, 1300, 1600, 1710, 1711, 1712, 1720, 1721, 1722, 1730, 1731, 1732, 1800, 1900, 2000, 2100, 2200, 2300, 2400, 2500, 2800, 2900, 3000, 3100, 3200, 3300, 3400, 3500, 3800, 4210, 5100, 5110, 5200 5230, 5310, 5339
 
RAC 1F
Both
$232.29
$181.32
$212.41
ACG 800, 1740, 1741, 1742, 1750, 2700, 3600, 1750, 1751, 1752, 2700, 3600, 3700, 3900, 4000, 4100, 4220, 4310, 4410, 4510, 4610, 4710, 4720, 4810, 5340
 
RAC 2F
Both
$397.30
$310.13
$363.29
ACG 1400, 1500, 1750, 1761, 1762, 1770, 1771, 1772, 2600, 4320, 4520, 4620, 4820
 
RAC 3F
Both
$476.39
$371.87
$435.61
ACG 4330, 4420, 4830, 4910, 4920, 5010, 5020, 5040
 
RAC 4F
Both
$663.79
$518.15
$606.97
ACG 4430, 4730, 4930, 5030, 5050
RAC 5F
Both
$926.17
$722.97
$846.90
ACG 4940, 5060
 
RAC 6F
Both
$1,166.70
$910.73
$1,066.84
ACG 5070
 
RAC 7F
Both
$1,697.40
$1,324.99
$1,552.11
ACG 100, 200, 300, 500, 600, 1100, 1600, 2000, 2400, 3400, 5100, 5110, 5200
 
RAC 1G
Both
$96.94
$81.96
$87.07
ACG 400, 700, 900, 1000, 1200, 1300, 1710, 1711, 1712, 1800, 1900, 2100, 2200, 2300, 2800, 2900, 3000, 3100, 5310
 
RAC 2G
Both
$127.57
$107.85
$114.58
 
ACG 1720, 1721, 1722, 1731, 1732, 1730, 2500, 3200, 3300, 3500, 3800, 4210, 5230, 5339
 
RAC 3G
Both
$157.46
$133.13
$141.43
ACG 800, 1740, 1741, 1742, 1750, 2700, 3600, 1750, 1751, 1752, 2700, 3600, 3700, 3900, 4000, 4100, 4220, 4310, 4410, 4510, 4610, 4710, 4720, 4810, 5340
 
RAC 4G
Both
$222.18
$187.85
$199.57
ACG 1400, 1500, 1750, 1761, 1762, 1770, 1771, 1772, 2600, 4320, 4520, 4620, 4820
 
RAC 5G
Both
$295.90
$250.17
$265.78
ACG 4330, 4420, 4830, 4910, 4920, 5010, 5020, 5040
 
RAC 6G
Both
$377.03
$318.77
$338.65
ACG 4430, 4730, 4930,4940, 5030, 5050, 5060, 5070
 
RAC 7G
Both
$813.34
$687.66
$730.55
SOBRA Mothers
 
 
 
$796.07
$621.42
$727.93
 
Persons with HIV
All
Both
$627.48
$627.48
$627.48
 
(b) Rate Table for Disabled Individuals, Effective July 1, 2014—December 31, 2014.
 
 
Age/RAC
Gender
PMPM
Baltimore
City
PMPM
Allegany, Frederick, Garrett, Montgomery, Prince George’s and Washington Counties
PMPM
Rest
of
State
 
Under Age 1
Both
$5,404.29
$5,404.29
$5,404.29
 
1—5
Male
$995.06
$995.06
$995.06
 
 
Female
$1,173.64
$1,173.64
$1,173.64
 
6—14
Male
$250.58
$250.58
$250.58
 
 
Female
$409.13
$409.13
$409.13
 
15—20
Male
$238.97
$238.97
$238.97
 
 
Female
$389.24
$389.24
$389.24
 
21—44
Male
$1,310.55
$1,029.20
$1,072.88
 
21—44
Female
$1,268.92
$996.50
$1,038.79
 
45—64
Male
$2,053.99
$1,613.04
$1,681.49
 
45—64
Female
$2,118.26
$1,663.51
$1,734.11
ACG—adjusted cells
 
 
 
 
 
ACG 100, 200, 300, 1100, 1300, 1400, 1500, 1600, 1710, 1711, 1712, 1720, 1721, 1722, 1730, 1731, 1732, 1900, 2400, 2600, 2900, 3400, 5100, 5110, 5200, 5310
 
RAC 10
Both
$301.99
$237.16
$247.22
 
ACG 400, 500, 700, 900, 1000, 1200, 1740, 1741, 1742, 1750, 1751, 1752 1800, 2000, 2100, 2200, 2300, 2500, 2700, 2800, 3000, 3100, 3200, 3300, 3500, 3900, 4000, 4310, 5330
 
RAC 11
Both
$361.70
$284.05
$296.11
ACG 600, 1760, 1761, 1762, 3600, 3700, 4100, 4320, 4410, 4710, 4810, 4820
 
RAC 12
Both
$686.01
$538.74
$561.60
ACG 3800, 4210, 4220, 4330, 4420, 4720, 4910, 5320
 
RAC13
Both
$772.43
$606.61
$632.35
ACG 800, 4430, 4510, 4610, 5040, 5340
 
RAC14
Both
$980.84
$770.27
$802.96
ACG 1770, 1771, 1772, 4520, 4620, 4830, 4920, 5050
 
RAC15
Both
$1,383.38
$1,086.39
$ 1,132.50
ACG 4730, 4930, 5010
 
RAC16
Both
$1,503.63
$1,180.83
$1,230.94
ACG 4940, 5020, 5060
 
RAC17
Both
$2,007.86
$1,576.81
$1,643.73
ACG 5030, 5070
 
RAC 18
Both
$3,413.99
$2,681.07
$2,794.85
Persons with AIDS
 
All
Both
$2,494.37
$1,620.85
$1,620.85
Persons with HIV
All
Both
$1,777.04
$1.777.04
$1,777.04
 
(c) Rate Table for Supplemental Payments for Delivery/Newborn and Hepatitis C Therapy, Effective July 1, 2014—December 31, 2014.
 
 
Age
Gender
Baltimore City
Allegany, Frederick, Garrett, Montgomery, Prince George’s and Washington Counties
Rest of State
Supplemental Payment Cells
 
 
 
 
 
Delivery/Newborn-all births except live birth weight 1,500 grams or less
 
All
Both
$14.456.27
$11,147.75
$12,141.49
Delivery/Newborn-live birth weight 1,500 grams or less
All
Both
$81,301.77
$81,301.77
$81,301.77
Delivery/Newborn by same enrollee-subsequent live birth weight 1,500 grams or less
All
Both
$14,456.27
$11,147.75
$12,141.49
Hepatitis C therapy (per member per month)
All
Both
$34,121.91
$34,121.91
$34,121.91
 
(d) Rate Table for Childless Adult Population, Effective July 1, 2014—December 31, 2014.
 
 
PMPM
Baltimore City
PMPM
Rest of State
Under 45 Male
$477.60
$436.72
Under 45 Female
 
$596.25
$545.22
45—64 Male
$826.40
$755.66
45—64 Female
$993.03
$908.03
 
(e) — (h) (text unchanged)
(5) (text unchanged)
C.—D. (text unchanged).
JOSHUA M.SHARFSTEIN, MD
Secretary of Health and Mental Hygiene
 
 

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