§ 15-103. Maryland Medical Assistance Program
West's Annotated Code of MarylandHealth--GeneralEffective: January 1, 2024
Effective: January 1, 2024
MD Code, Health - General, § 15-103
§ 15-103. Maryland Medical Assistance Program
<Section effective upon occurrence of contingency in Acts 2022, c. 504, § 3; Acts 2022, c. 505, § 3. See, also, section 15-103 effective until occurrence of contingency in Acts 2022, c. 504, § 3; Acts 2022, c. 505, § 3.>
(a)(1) The Secretary shall administer the Maryland Medical Assistance Program.
(ii) Shall provide, subject to the limitations of the State budget, comprehensive medical, dental, and other health care services for all eligible pregnant women whose family income is at or below 250 percent of the poverty level for the duration of the pregnancy and for 1 year immediately following the end of the woman's pregnancy, as permitted by the federal law;
(v) Shall provide, subject to the limitations of the State budget, comprehensive medical and other health care services for all children from the age of 1 year up through and including the age of 5 years whose family income falls below 133 percent of the poverty level, as permitted by the federal law;
(vi) Beginning on January 1, 2014, shall provide, subject to the limitations of the State budget, comprehensive medical care and other health care services for all children who are at least 6 years of age but are under 19 years of age whose family income falls below 133 percent of the poverty level, as permitted by federal law;
(vii) Shall provide, subject to the limitations of the State budget, comprehensive medical care and other health care services for all legal immigrants who meet Program eligibility standards and who arrived in the United States before August 22, 1996, the effective date of the federal Personal Responsibility and Work Opportunity Reconciliation Act,1 as permitted by federal law;
(viii) Shall provide, subject to the limitations of the State budget and any other requirements imposed by the State, comprehensive medical care and other health care services for all legal immigrant children under the age of 18 years and pregnant women who meet Program eligibility standards and who arrived in the United States on or after August 22, 1996, the effective date of the federal Personal Responsibility and Work Opportunity Reconciliation Act;
2. Beginning on January 1, 2023, shall provide, subject to the limitations of the State budget, and as permitted by federal law, dental services for adults, including diagnostic, preventive, restorative, and periodontal services, whose annual household income is at or below 133 percent of the federal poverty level;
(xvi) Beginning on January 1, 2021, shall provide, subject to the limitations of the State budget and § 15-855(b)(2) of the Insurance Article, and as permitted by federal law, services for pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections and pediatric acute onset neuropsychiatric syndrome, including the use of intravenous immunoglobulin therapy, for eligible Program recipients, if pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections and pediatric acute onset neuropsychiatric syndrome are coded for billing and diagnosis purposes in accordance with § 15-855(d) of the Insurance Article;
(xvii) Beginning on January 1, 2022, may not include, subject to federal approval and limitations of the State budget, a frequency limitation on covered dental prophylaxis care or oral health exams that requires the dental prophylaxis care or oral health exams to be provided at an interval greater than 120 days within a plan year;
2. Reimbursement of health care provider and other staff time used for patient training, transmission of blood pressure data, interpretation of blood pressure readings and reporting, and the delivery of co-interventions, including educational materials or classes, behavioral change management, and medication management;
(iii) To the extent that a waiver is needed to maximize the number of State residents who may qualify for the Express Lane Eligibility Program, shall apply to the Centers for Medicare and Medicaid Services for one or more waivers under § 1115 of the federal Social Security Act to implement the Express Lane Eligibility Program; and
(iv) Shall make all reasonable efforts to expedite enrollment of eligible individuals in the Express Lane Eligibility Program, provided that the Department may propose or implement the use of Express Lane Eligibility for renewals before proposing or implementing the use of Express Lane Eligibility for initial enrollment.
(b)(1) As permitted by federal law or waiver, the Secretary may establish a program under which Program recipients are required to enroll in managed care organizations.
(ii) Subject to the limitations of the State budget and as permitted by federal law or waiver, the Department shall provide reimbursement for medically necessary and appropriate inpatient, intermediate care, and halfway house substance abuse treatment services for substance abusing enrollees 21 years of age or older who are recipients of temporary cash assistance under the Family Investment Program.
(3) Subject to the limitations of the State budget and as permitted by federal law or waiver, the program developed under paragraph (1) of this subsection and the program developed under § 15-301 of this title may provide guaranteed eligibility for each enrollee for up to 6 months, unless an enrollee obtains health insurance through another source.
(ii) For any populations or services excluded under this paragraph, the Secretary may authorize a managed care organization, to provide the services or provide for the population, including authorization of a separate dental managed care organization or a managed care organization to provide services to Program recipients with special needs.
2. Medical screening services rendered to meet the requirements of the federal Emergency Medical Treatment and Active Labor Act;2
(v) In addition to the provisions of subparagraph (iv) of this paragraph, if a managed care organization does not comply with the requirements of paragraph (9) of this subsection or fails to provide evidence of compliance to the Department under subparagraph (ii) of this paragraph, the Department may:
(17) For a managed care organization with which the Secretary contracts to provide services to Program recipients under this subsection, the Secretary shall establish a mechanism to initially assure that each historic provider that meets the Department's quality standards has the opportunity to continue to serve Program recipients as a subcontractor of at least one managed care organization.
(iii) In actuarially adjusting capitation payments under subparagraph (ii)2 of this paragraph, the Secretary, in consultation with the Insurance Commissioner, shall take into account, to the extent allowed under federal law, the expenses incurred by the managed care organization applicable to the business of providing care to enrolled individuals.
(24) The Department or its subcontractor, to the extent feasible in its marketing or enrollment programs, shall hire individuals receiving assistance under the program of Aid to Families with Dependent Children established under Title IV, Part A, of the Social Security Act,3 or the successor to the program.
B. Is entitled to reimbursement for expenses under the Standard State Travel Regulations,4 as provided in the State budget.
(28)(i) The Department shall ensure that payments for services provided by a hospital located in a contiguous state or in the District of Columbia to an enrollee under the Program shall be reduced by 20% if the hospital fails to submit discharge data on all Maryland patients receiving care in the hospital to the Health Services Cost Review Commission in a form and manner the Commission specifies.
(3) The Secretary may contract with insurance companies or nonprofit health service plans or with individuals, associations, partnerships, incorporated or unincorporated groups of physicians, chiropractors, dentists, podiatrists, optometrists, pharmacists, hospitals, nursing homes, nurses, including nurse anesthetists, nurse midwives and certified nurse practitioners, opticians, and other health practitioners who are licensed or certified in this State and perform services on the prescription or referral of a physician.
(d) As permitted by federal law or waiver, the Secretary may administer the Medicare Option Prescription Drug Program, established under § 15-124.3 of this subtitle, as part of the Maryland Medical Assistance Program.
(e) By regulation, the Department shall adopt a methodology to ensure that federally qualified health centers are paid reasonable cost-based reimbursement that is consistent with federal law.
(f)(1) The Department shall establish mechanisms for:
(2) If a Program recipient enrolls in a managed care organization and requests assignment to a particular primary care provider who has a contract with the managed care organization or a contracted group of the managed care organization, the managed care organization shall assign the recipient to the primary care provider.
(3) A Program recipient may request a change of primary care providers within the same managed care organization at any time and, if the primary care provider has a contract with the managed care organization or a contracted group of the managed care organization, the managed care organization shall honor the request.
Credits
Added by Acts 1982, c. 21, § 2, eff. July 1, 1982. Amended by Acts 1984, c. 424, § 1, eff. July 1, 1984; Acts 1987, c. 109, § 1, eff. July 1, 1987; Acts 1987, c. 286, § 1, eff. July 1, 1987; Acts 1989, c. 614, § 1, eff. June 1, 1989; Acts 1990, c. 6, § 11, eff. Feb. 16, 1990; Acts 1990, c. 418, § 1, eff. June 1, 1990; Acts 1991, c. 55, § 6, eff. April 9, 1991; Acts 1992, c. 147, § 1, eff. July 1, 1992; Acts 1993, c. 446, § 1, eff. July 1, 1993; Acts 1993, c. 601, § 1, eff. July 1, 1993; Acts 1994, c. 440, § 1, eff. Oct. 1, 1994; Acts 1994, c. 662, § 6, eff. Oct. 1, 1994; Acts 1995, c. 500, § 1, eff. July 1, 1995; Acts 1996, c. 10, § 1, eff. April 9, 1996; Acts 1996, c. 352, § 1, eff. July 1, 1996; Acts 1997, c. 14, § 1, eff. April 8, 1997; Acts 1997, c. 593, § 1, eff. July 1, 1997; Acts 1997, c. 635, § 9, eff. July 1, 1997; Acts 1997, c. 636, § 9, eff. July 1, 1997; Acts 1998, c. 21, § 1, eff. April 14, 1998; Acts 1998, c. 110, § 2, eff. April 28, 1998; Acts 1998, c. 113, § 1, eff. Oct. 1, 1998; Acts 1998, c. 434, § 1, eff. July 1, 1998; Acts 1998, c. 435, § 1, July 1, 1998; Acts 1998, c. 631, § 1, eff. Oct. 1, 1998; Acts 1998, c. 637, § 1, eff. June 1, 1998; Acts 1999, c. 127, § 2, eff. July 1, 2000; Acts 1999, c. 128, § 2, eff. July 1, 2000; Acts 1999, c. 261, §§ 1, 2, eff. July 1, 1999; Acts 1999, c. 471, § 1, eff. June 1, 1999; Acts 1999, c. 678, § 1, eff. Oct. 1, 1999; Acts 1999, c. 702, § 5, eff. Oct. 1, 1999; Acts 2000, c. 15, § 2, eff. July 1, 2001; Acts 2000, c. 16, § 2, eff. July 1, 2001; Acts 2000, c. 61, § 1, eff. April 25, 2000; Acts 2000, c. 437, § 1, eff. Oct. 1, 2000; Acts 2001, c. 77, § 1, eff. July 1, 2001; Acts 2001, c. 134, § 1; Acts 2001, c. 135, § 1; Acts 2001, c. 314, § 1, eff. Oct. 1, 2001; Acts 2001, c. 413, § 1, eff. Oct. 1, 2001; Acts 2001, c. 546, § 1, eff. June 1, 2001; Acts 2001, c. 734, § 1, eff. Oct. 1, 2001; Acts 2003, c. 448, § 1; Acts 2004, c. 399, § 1, eff. Oct. 1, 2004; Acts 2005, c. 1, § 1, eff. April 1, 2005; Acts 2005, c. 25, § 8, eff. April 12, 2005; Acts 2005, c. 281, § 3, eff. July 1, 2005; Acts 2005, c. 282, § 3, eff. July 1, 2005; Acts 2006, c. 44, § 1, eff. April 8, 2006; Acts 2006, c. 439, § 1, eff. June 1, 2006; Acts 2006, c. 440, § 1, eff. June 1, 2006; Acts 2007, c. 8, § 1, eff. Oct. 1, 2007; Acts 2007, c. 75, § 1, eff. Oct. 1, 2007; Acts 2007, 1st Sp. Sess., c. 7, § 1, eff. Nov. 19, 2007; Acts 2007, 1st Sp. Sess., c. 7, § 1, eff. July 1, 2008; Acts 2009, c. 331, § 1, eff. Jan. 1, 2010; Acts 2009, c. 332, § 1, eff. Jan. 1, 2010; Acts 2009, c. 656, § 1, eff. Oct. 1, 2009; Acts 2009, c. 681, § 1, eff. Oct. 1, 2009; Acts 2010, c. 72, § 1, eff. April 13, 2010; Acts 2011, c. 537, § 1, eff. Oct. 1, 2011; Acts 2011, c. 538, § 1, eff. Oct. 1, 2011; Acts 2013, c. 159, § 1, eff. Jan. 1, 2014; Acts 2014, c. 45, § 5; Acts 2014, c. 104, § 2, eff. Oct. 1, 2014; Acts 2016, c. 57, § 1, eff. July 1, 2016; Acts 2016, c. 58, § 1, eff. July 1, 2016; Acts 2017, c. 62, § 6; Acts 2017, c. 721, § 2, eff. June 1, 2017; Acts 2019, c. 412, § 1, eff. June 1, 2019; Acts 2019, c. 451, § 1, eff. Oct. 1, 2019; Acts 2020, c. 17, § 1, eff. April 3, 2020; Acts 2020, c. 18, § 1, eff. April 3, 2020; Acts 2020, c. 560, § 1, eff. Jan. 1, 2021; Acts 2021, c. 70, § 1, eff. July 1, 2021; Acts 2021, c. 71, § 1, eff. July 1, 2021; Acts 2021, c. 151, § 1, eff. May 18, 2021; Acts 2021, c. 152, § 1, eff. May 18, 2021; Acts 2021, c. 470, § 1, eff. Jan. 1, 2022; Acts 2021, c. 477, § 1, eff. Oct. 1, 2021; Acts 2021, c. 478, § 1, eff. Oct. 1, 2021; Acts 2022, c. 28, § 1, eff. July 1, 2022; Acts 2022, c. 56, § 2, eff. July 1, 2022; Acts 2022, c. 251, § 1, eff. May 12, 2022; Acts 2022, c. 302, § 1, eff. Jan. 1, 2023; Acts 2022, c. 303, § 1, eff. Jan. 1, 2023; Acts 2022, c. 311, § 1, eff. Jan. 1, 2023; Acts 2022, c. 312, § 1, eff. Jan. 1, 2023; Acts 2022, c. 504, § 1; Acts 2022, c. 505, § 1; Acts 2022, c. 669, § 1, eff. Oct. 1, 2022; Acts 2022, c. 670, § 1, eff. Oct. 1, 2022; Acts 2022, c. 684, § 1, eff. Jan. 1, 2023; Acts 2023, c. 252, § 1, eff. Oct. 1, 2023; Acts 2023, c. 253, § 1, eff. Oct. 1, 2023; Acts 2023, c. 322, § 1, eff. Jan. 1, 2024; Acts 2023, c. 323, § 1, eff. Jan. 1, 2024; Acts 2023, c. 355, § 1, eff. Jan. 1, 2024; Acts 2023, c. 282, § 1, eff. Oct. 1, 2023; Acts 2023, c. 283, § 1, eff. Oct. 1, 2023.
Footnotes
Pub.L. 104-193, Aug. 22, 1996, 110 Stat. 2105.
Aug. 14, 1935, ch. 531, Title XVIII, 1867, as added Apr. 7, 1986, Pub.L. 99-272, Title IX, 9121(b), 100 Stat. 164.
Aug. 14, 1935, ch. 531, 49 Stat. 620, codified at 42 U.S.C.A. § 301 et seq.
COMAR 23.02.01.01 et seq.
MD Code, Health - General, § 15-103, MD HEALTH GEN § 15-103
Current through legislation effective through April 9, 2023, from the 2024 Regular Session of the General Assembly. Some statute sections may be more current, see credits for details.
End of Document |