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DHMHSTATEOFMARYLANDI.Offi of HealthServIces:PT28-03MedicalCareProgramsMaryland Department of Health and Mental Hygiene201 W. Preston Street. Baltimore, Maryland 2120 1R L fufidI, Jr.,Gov -Michael S. Steele,Ii. Governor-Ne J. Sabatini,SecrdaryMARYLAND MEDICAL ASSISTANCE PROGRAMOxygen Transmittal No. 24July 7, 2003TO:Oxygen and Related Resp atory Equipment ProvidersFROM:Susan J. Tucke xecutlveSUBJECT:Proposed Amendments to Oxygen and Related RespiratoryEquipment ServicesNOTE:Please ensure that appropriate staff members in your organizationare informed of the contents of this transmittal.k.l I f!rt).)I\ -k /"-/DirectorACTION:Proposed AmendmentsPROPOSED EFFECTIVE DATE:October 15, 2003WRITTEN COMMENTS:Michele Phinney, 201 West Preston StreetBaltimore, Maryland 21201Fax 410-333-7667Call 410-767-6499PROGRAM CONTACT PERSON:Jane Sacco, ChiefDivision of Community SupportServices410-767-1739COMMENT PERIOD EXPIRES JULY 21,2003The Maryland Medical Assistance Program proposes to amend Regulations06 and .07 under COMAR 10.09.18 Oxygen and Related Respiratory Equipment.These amendments will change the local procedure codes to NationalHCPCS Codes in order to comply with requirements of the Health InsurancePortability and Accountability Act (HIPM). These amendments will also eliminatepreauthorization requirements for certain low cost items on the fee schedule.Finally, these amendments permit providers to fax preauthorization requests undercertain conditions. Providers are directed, however, to notify the Program bytelephone when submitting a fax request. The Department is proposing to adoptthese amendments on a permanent basis effective October 15, 2003.Toll Free1-877-4MD-DHMH. TrY for Disab1ed-Maryland RelayService1-800-735-2258WebSite: www.dhmh.state.md.us

The proposed amendments, as submitted to be printed in the MarylandRegiste[. and the Oxygen and Related Respiratory Equipment Fee Schedulecontaining the new codes, are attached.Attachment

Title 10DEPARTMENT OF HEALTH AND MENTAL HYGIENESubtitle 09 MEDICAL CARE PROGRAMS10.09.18 Oxygen and Related Respiratory Equipment ServicesAuthority: Health-General Article, §§2-104(b), 15-103, and 15-105,Annotated Code of MarylandNotice of Proposed ActionThe Secretaryof Health and Mental Hygieneand .07 under COMARproposesto amend Regulations10.09.18 Oxygen and Related RespiratoryEquipmentServices.Statement of PurposeThe purpose of this action is to change the local procedure codes on the feeschedule to National HCPCS codes, and to eliminate preauthorizationrequirements for cer1ain low cost items.Comparison to Federal Standards(Check one option)xThere s no corresponding federal standard to this proposed regulation.QIThere is a corresponding federal standard to this proposed regulation, but the proposed regulation is not more restrictive or stringent.Q!:.06

In compliance with Executive Order 01.01.1996.03, this proposedregulation is more restrictive or stringent than corresponding federalstandards as follows:(1)Regulation citation and manner in which it is more restrictivethan .the applicable federal standard:(2)Benefit to the public health, safety or welfare, or the environment:(3)Analysis of additional burden or cost on the regulated person:(4)Justification for the need for more restrictive standards:Impact StatementsPart AEstimate of Economic ImpactX The proposed action has no economic impact.Q!The proposed action has an economic impact.Complete the following form in its entirety.ISummary of Economic Impact.Revenue .Types ofEconomic Impacts.A. On issuing agency:1 Medical Assistance ProgramB. On other State agencies:C. On local governments:(R /R-)Expenditures

\ ( )Cost-MaanitudeD. On regulated industries or trade groups:E. On otherjndustriesor trade groups:F. Direct and indirect effects on public:III.Assumptions. (Identified by Impact Letter and Number from Section II.Part 8(check one option)Economic Impact on Small BusinessesXThe proposed action has minimal or no economic impact on smallbusinesses.Q!The proposed action has a meaningful economic impact on smallbusinesses. An analysis of this economic impact follows.Opportunity for Public CommentComments may be sent to Michele Phinney, Regulations Coordinator,Department of Health and Mental Hygiene, 201 W. Preston Street, Room 521Baltimore, Maryland 21201, or fax to (410) 333-7687, or email toregs@dhmh.state.md.us,or-call-{410) 767-6499 or 1-877-4MD-DHMH,6499. These comments must be received byextension

A.E.F.Part C(For legislative use only; not for publication)Fiscal Year in which regulations will become effective: 2004B.Does the budget for fiscal year in whidl regulations become effectivecontain funds to implement the regulations?Yesc.NoXN/AIf yes state whether general, special (exact name), or federal funds will beused:D.If no, identify the source( s) of funds necessary for implementation of theseregulations:It does not result in increased or decreased payments to providersIf these regulations have no economic impact under Part A, indicatereason briefly:It does not result in increased or decreased payments to providers.If these regulations have minimal or no economic impact on smallbusinesses under Part B, indi-cate tnereason. , c It does not result in increased or decreased payments to providers.

.06 Pre-AuthorizationRequirements. . All services and items provided under this chapter require preauthorization with the exception of replacementitems costing lessthan 5 for components of complete set ups].B. Pre-authorization is issued when:(1) -(2) (text unchanged)

D. Pre-Authorization. whenr ed.emavbe r uested via a facsimilemachinetoor othermedicalinstitutional dischar e or inemergency situations aQQrovedby the Progrnm. In this case. the facsimile of thecom leted re-authorization fo shaDbe followed bx a written r uest forthe De}2artment.[F.] (text unchanged) A-C.(text unchanged)W. The' Department's fee schedule for services covered in this chapter is contained in the Medical Assistance Provider Fee Manual datedOctober 1, 1986, all the prQvisions,Q{ which are incorporated by reference with the following a.mendme.n .(1) Oxygen and Related RespiratorySchedule, Supplement No. IJEquipmentServices Fee'12 Ihe Maryland Medical Assistance Program Oxygen and Related vision2003. is containedin the Medical.Assistance Provider Fee Manual. dated October 1. 1986. All the Qrovisions of thisdocument are incomorated by reference.

E. -O. (text unchanged)NELSONJ. SABATINISecretaryof Health and Mental Hygiene

MARYLAND MEDICAL ASSISTANCE PROGRAMDEPARTMENT OF HEALTH AND MENTAL HYGIENEOXYGEN AND RELATED RESPIRATORY EQUIPMENTSERVICESPROVIDER FEE SCHEDULEREVISION 2003COMAR 10.09.18

MARYLAND MEDICAL ASSISTANCEPROGRAMOXYGEN AND RELATED RESPIRATORYEQUIPMENT SERVICESPROCEDURECODESAND MAXIMUM ALLOWABLE COST FOR PURCHASEDOR RENTAL OF OXYGEN, CONCENTRATORSAND RELATED RESPIRATORY EQUIPMENTOXYGEN AND RELATED RESPIRATORY EQUIPMENTProcedure MaximumPurchaseChargeMaximumRentalChargeIPPB AND RELA TED EOUIP NTJPPBMachineall types,with builtin nebulization;manualor automaticvalves;internalor externalpowersourceEO500 600.00 46.15ACCESSORIESVariableConcentrationMaskA 46204.26OXYGEN CONCENTRATORSOxygen concentrator, capable ofdelivering 85 percent or greateroxygen concentration at theprescribed flow rateE1390220.00EO42450.00OXYGEN SYSTEMSStationary compressedgaseousoxygen system, rental; includescontainer, contents, regulator, flowmeter, humidifier, nebulizer, cannulaor mask, and tubing

MaximumRentalCharge r,humidifier,cannulaor maskandtubingEO431 Portable liquid oxygen system,rental;includes portable container, supplyreservoir, humidifier, flowmeter, refilladaptor, contents gauge, cannula ormask, and tubingE043445.00Stationary liquid oxygen system,rental;includes container, contents, regulator,flowmeter, humidifier, nebulizer, cannulaor mask, and tubingE043960.00Purchased 45.00OXYGEN CONTENTSE0441Oxygencontents,gaseous(for use withownedgaseousstationarysystemsor whenboth a stationaryandportablegaseoussystemare owned)Oxygen contents, liquid (for use withowned liquid stationary systemsor whenboth a stationary and portable liquidsystemare owned) 0442Portable oxygen contents, gaseous(for use only with portable systemswhenno stationary gas or liquid systemis used)EO443Portable o .rygencontents, liquid(for use only with portable liquidsystemswhen no stationary gas orliquid systemis used)EO444151.2117.00

Procedure OMYEOUIPMENTTracheostomymaskor collarA4621 5.00Tracheostomy or laryngectomy tubeA462266.40Tracheostomy, inner cannula (re-A4623 placement only)Tracheal suction catheter, any type,A4624eachTracheostomycare kit for newA4625tracheostomyTracheostomycare kit for establishedtracheostomyA4629CONTINOUS POSITIVEAIRWAY PRESSURE(CPAP) SYSTEM AND ACCESSORIESContinuousairwaypressure(CPAP) deviceE0601940.00Full face maskused with positive airwaypressuredevice, eachA7030188.64Face mask interface, replacementfor full face A7031mask, eachReplacementcushion for nasal applicationdevice, eachA7032Replacementpillows for nasalapplicationdevice,pairA7033Nasal interface (mask or cannula type)device, with or without head strapA7034Headgear used with positive airway pressure A7035device42.5344.0072.31

Procedure Chinstrapusedwith positive airwaypressure A7036MaximumPurchasedChargeMaximumRentalCharge 20.00deviceTubing used with positive airway pressureDeviceA7037Filter, disposable,usedwith positive airwaypressuredeviceA70386.00Filter, non-disposable,used with positiveairway pressuredeviceA703913.99EO565397.0045.00HUMIDITY SYSTEMCompressor, air power source forequipment which is not self-containedor ylinder driven30.54**See the DMS/DME Approved List of Items for other respiratory supplies and equipment.

Oxygen contents, liquid (for use with owned liquid stationary systems or when both a stationary and portable liquid system are owned) 0442 151.21 Portable oxygen contents, gaseous EO443 17.00 (for use only with portable systems when no stationary gas or liquid system is used) Portable o .rygen contents, liquid (for use only with portable liquid

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