PT 30-06 STATE OF MARYLAND DHMH Maryland Department of Health and Mental Hygiene 201 w. Preston Street. Baltimore, Maryland 21201 Robert L. Ehrlich, Jr., Governor -Michael S. Steele, Lt. Governor -S. Anthony McCann, Secretary MARYLAND MEDICAL ASSISTANCE PROGRAM Hospital Transmittal #193 June 14, 2006 TO: HospitalProviders ()'\ ~ 'j!'JJ!"{\":1 FROM: PaulGurny, Deputysecret~~' HealthCareFinancin g .(~ Brian Hepburn, MD, Director ~ tJfbt~~ Mental HygieneAdministration RE: Fee-for-Service Hospital Day Limits The purpose of this transmittal is to inform you of changes in the hospital daylimits. For admissions on or afterJulyl, 2006,the daylimits will be adjusted from 105% of the average length of stay to 120% of the average lengthof stayby diagnosis relatedgroups. See Attachment A for the new daylimits. The HealthServices CostReviewCommission assisted the Department in establishing the new daylimits, which arebased on the Centers for Medicare andMedicaidDRG Grouper Version 23. TheeDepartment hassubmitted proposed regulations that reflectthe new daylimits (COMAR 10.09.06.04 ) to the Administrative, Executive andLegislative ReviewCommittee. The newregulations establish an effectivedateof July1,2006. The procedure of how daylimits will be processed by Medical Assistance will not change. The only change is thatthe daylimits will be higher for some diagnosis related groups. Any questions regarding this transmittalfor non-psychiatric acute careservices should be directed to Stephanie Oliver, Division Chief, at 410767 -1722. For psychiatricservices, please directquestions to Susan Steinberg, Mental Hygiene Administration, 410-767-8451. If you havespecificquestions for Delmarva Foundation for Medical Care, please call Peg Barnaba at 410-712-7405 (email: barmabapdfmc.org). If you havequestions for MAPS, please call Nancy Calvertat410-277-0513. Attachment Toll Free 1-877 -4MD-DHMH .TTY for Disabled -Maryland Relay Service 1-800-735-2258 Web Site:www.dhmh.state.rnd.us @ c,."'" ~.. ,,","' """,,,,".
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PT 30-06STATE OF MARYLAND
DHMHMaryland Department of Health and Mental Hygiene201 w. Preston Street. Baltimore, Maryland 21201Robert L. Ehrlich, Jr., Governor -Michael S. Steele, Lt. Governor -S. Anthony McCann, Secretary
MARYLAND MEDICAL ASSISTANCE PROGRAMHospital Transmittal #193
June 14, 2006
TO: Hospital Providers ()'\ ~ 'j!'JJ!"{\":1
FROM: Paul Gurny, Deputy secret~~'Health Care Financing .(~
Brian Hepburn, MD, Director ~ tJfbt~~Mental Hygiene Administration
RE: Fee-for-Service Hospital Day Limits
The purpose of this transmittal is to inform you of changes in the hospital day limits. Foradmissions on or after Julyl, 2006, the day limits will be adjusted from 105% of theaverage length of stay to 120% of the average length of stay by diagnosis related groups.See Attachment A for the new day limits.
The Health Services Cost Review Commission assisted the Department in establishingthe new day limits, which are based on the Centers for Medicare and Medicaid DRGGrouper Version 23. Thee Department has submitted proposed regulations that reflect thenew day limits (COMAR 10.09.06.04 ) to the Administrative, Executive and LegislativeReview Committee. The new regulations establish an effective date of July1, 2006.
The procedure of how day limits will be processed by Medical Assistance will notchange. The only change is that the day limits will be higher for some diagnosis relatedgroups.
Any questions regarding this transmittal for non-psychiatric acute care services should bedirected to Stephanie Oliver, Division Chief, at 410767 -1722. For psychiatric services,please direct questions to Susan Steinberg, Mental Hygiene Administration,410-767-8451.
If you have specific questions for Delmarva Foundation for Medical Care, please call PegBarnaba at 410-712-7405 (email: barmabapdfmc.org). If you have questions for MAPS,please call Nancy Calvert at 410-277-0513.
Attachment
Toll Free 1-877 -4MD-DHMH .TTY for Disabled -Maryland Relay Service 1-800-735-2258Web Site: www.dhmh.state.rnd.us
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ATTACHMENT A DAY LIMITS BY DIAGNOSIS RELATED GROUP(based on 120% of the average length of stay)
DIAGNOSISRELATEDGROUP DIAGNOSIS RELATED GROUP DESCRIPTIONS DAY LIMIT
1 ~~~I_<?~9_~X_~~~-~-~?_~-~-~ -13
? ~~~I_<?~9_~X_~~~~-~?- ~~9- f~ 66 CARPAL TUNNEL RELEASE 27 PERI PH & CRANIAL NERVE & OTHER NERV SYST PROC W CC 1-1
8 PERI PH & CRANIAL NERVE & OTHER NERV SYST PROC WIO CC 4
~~ T_~~~_~.A:Tl~_~T_l!~_9_f3- ~- ~9_~.A::.f~~~- ~~~~-~ti_~~-~_I:I~~F3~_::= -T~~_~- ~?- ~ -~c:; ?29 TRAUMATIC STUPOR & COMA, COMA LESS THAN 1 HOUR, > THAN 17 WIO CC 3
~~:~~~~~~~~~~~1 :::::::::::::::~32 CONCUSSION AGE >17 WIO CC 2
ATTACHMENT A DAY LIMITS BY DIAGNOSIS RELATED GROUP(based on 120% of the average length of stay)
DIAGNOSISRELATEDGROUP DIAGNOSIS RELATED GROUP DESCRIPTIONS DAY LIMIT
f.~~ !.~~.~~ .~~ .~tI.~.?~~~ -~!~.~~ 2f.~? ~~~ .<?~ -~~I_~ .I?l.s. <?F3~~ .F3.s. Y'l. f~ ..~ ~ ~ ~ ~ ~ ~ ~. 5284 MINOR SKIN DISORDERS WIO CC 3285 AMPUTAT OF LOWER LIMB FOR ENDOCRINE ' 1.2
286 1- 6287 SKIN GRAFTS & WOUND DEBRID FOR ENDOC 9288 O~R~. PROC.EOURES. FOR .OBESI;:Y 4289 PARATHYROID PROCEDURES 6290 THYR-OiOPROCEDURES 4291 THYR.OGLOSSAL. P-ROCEOU. REs 1
~~~~~~~~~~~~~? 1.6293 OTHER ENDOCRINE WIO CC 3294 OiABETESAGE.;35 4f_~? ~1~~~!.~.s.~~~.9:~.5 4;f_~? ~~_~~I~I.<?~~.~ -~. ~.I.s.~. ~~.~ ~.~~~!~. ~~~~~_I?~~.~. ~.C?~.>.!? ~. ~~- ?297 NUTRITIONAL & MISC METABOLIC DISORDERS AGE >17 WIO CC 3299 INBORN ERRORS OF METABOLISM 4300 ENDOCRINE DISORDERS W CC 5301 ENDOCRINE DISORDERS WIO CC 3302 KIDNEY TRANSPLANT 19303 KIDNEY 8304 KIDNEY W CC 8305 KIDNEY WIO CC 4306 PROSTATECTOMY W CC 120 0 307 PROSTATECTOMY W 10 CC 2
308 MINOR BLADDER PROCEDURES W CC 5309 MINOR BLADDER PROCEDURES WIO CC 30 310 TRANSURETHRAL PROCEDURES W CC 5
311 TRANSURETHRAL PROCEDURES WIO CC 3312 URETHRAL PROCEDURES W CC 6313 URETHRAL PROCEDURES WIO CC 40 315 OTHER KIDNEY & URINARY TRACT PROCEDURES 14
316 RENAL FAILURE 70 317 ADMIT FOR RENAL DIALYSIS 8
318 KIDNEY & URINARY TRACT NEOPLASMS W CC 6319 KIDNEY & URINARY TRACT NEOPLASMS WIO CC 2320 KIDNEY & URINARY TRACT INFECTIONS AGE >17 W CC 5321 3323 URINARY STONES W CC 3324 2325 5326 4328 ' 3
331 5332 3334 4335 3336 30 6/2/2006 6
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ATTACHMENT A DAY LIMITS BY DIAGNOSIS RELATED GROUP
(based on 120% of the average length of stay)
DIAGNOSISRELATEDGROUP DIAGNOSIS RELATED GROUP DESCRIPTIONS DAY LIMIT
337 TRANSURETHRAL PROSTATECTOMY WIO CC 2
3_~~ !.~~T~_-?_~_I3~~~~~_I3~?!_~~~ ~~~!~-ty~~-~X- 28339 TESTES PROCEDURES, FOR NON-MALIGNANCYAGE-GREATE-R-THAN-17 1-1
3_~ ~ ~~~!-?_~_I3~~-~.o.~_I3~? 8344 OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES FOR-MALiGNANCY 1-0
345 OTHER MALE REPRODUCTIVE SYSTEM O.R. PROC EXCEPT FO-R MALIGNANCY 1-1
346 MALIGNANCY MALE REPRODUCTIVE SYSTEM WITH CC 6
347 MALIGNANCY MALE REPRODUCTIVE SYSTEM WITHOUT CC 3
348 BENIGN PROSTATIC HYPERTROPHY W CC 4
349 BENIGN PROSTATIC HYPERTROPHY WIO cc 1
350 INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM 5
352 OTHER MALE REPRODUCTIVE SYSTEM DIAGNOSES 7
353 PELVIC EVISCERATION 8
354 UTERINE W CC 5
355 UTERINE WIO CC 3
356 FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES 2
357 UTERINE & ADNEXA PROC FOR OVARIAN OR ADNEXAL MALIGNANCY 10
358 UTERINE & ADNEXA PROC FOR NON-MALIGNANCY W CC 3
359 UTERINE & ADNEXA PROC FOR NON-MALIGNANCY WIO CC 3
499 BACK & NECK PROCEDURES EXCEPT SPINAL FUSION W CC 4
500 BACK & NECK PROCEDURES EXCEPT SPINAL FUSION W/O CC 2
501 KNEE PROCEDURES W PDX OF INFECTION W CC 10
502 KNEE PROCEDURES W PDX OF INFECTION W/O CC 8
503 KNEE PROCEDURES W/O PDX OF INFECTION 5
504 EXTENSIVE BURNS OR FULL THICKNESS BURNS W MV 96+ HRS W SKIN GRAFT 46,--- 505 EXTENSIVE BURNS OR FULL THICKNESS BURNS W MV 96+ HRS W/O SKIN GRAFT 12
506 FULL THICKNESS BURN W SKIN GRAFT OR INHAL INJ W CC OR SIG TRAUMA 18
507 FULL THICKNESS BURN W SKIN GRFT OR INHAL INJ W/O CC OR SIG TRAUMA 14
508 FULL THICKNESS BURN W/O SKIN GRFT OR INHAL INJ W CC OR SIG TRAUMA 5,.- 509 FULL THICKNESS BURN W/O SKIN GRFT OR INH INJ W/O CC OR SIG TRAUMA 6
510 NON-EXTENSIVE BURNS W CC OR SIGNIFICANT TRAUMA 11
511 NON-EXTENSIVE BURNS W/O CC OR SIGNIFICANT TRAUMA 4
512 SIMULTANEOUS PANCREASE/KIDNEY TRANSPLANT 10
515 6518 PERCUTANEOUS CARDIOV ASC PROC W 10 CORONARY ARTERY STENT OR AMI 4' 519 '--.6
520 CERVICAL SPINAL FUSION W/O CC 3
521 ALCOHOUDRUG ABUSE OR DEPENDENCE W CC 4
522 '--'4'-"".523 "-" ' 4
6/2/2006 9
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ATTACHMENT A DAY LIMITS BY DIAGNOSIS RELATED GROUP '¥
(based on 120% of the average length of stay)
DIAGNOSIS
RELATEDGROUP DIAGNOSIS RELATED GROUP DESCRIPTIONS DAY LIMIT