Md. Code Regs. 10.09.07.08

Current through Register Vol. 51, No. 22, November 1, 2024

Section 10.09.07.08 - Payment Procedures

A. Requests for Payment.

(1) All requests for payment of services rendered shall be submitted in accordance with COMAR 10.09.36.

(2) Billing time limitations for claims submitted pursuant to this chapter are set forth in COMAR 10.09.36.

B. Payment to a provider shall be limited to the number of days each participant attends the medical day care center, as authorized by a participant's home and community based services waiver service plan.

C. Payment shall be made only to a qualified medical day care provider. Payment may not be made to a participant, or to individual nurses, physicians, social workers, activity coordinators, or aides for services rendered in connection with the provision of medical day care.

D. Per Diem Rate.

(1) Payment to a medical day care services provider shall be as follows:

(a) For dates of service from January 1, 2021 through October 31, 2021, $88.95 per diem;

(b) For dates of service from November 1, 2021 through June 30, 2022, $93.58 per diem; and

(c) For dates of service on or after July 1, 2022, $104.81 per diem.

(2) Subject to the limitations of the State budget, the per diem rate shall increase on July 1 of each year by 4 percent.

E. Payment to a provider of medical day care services may not exceed the lesser of the:

(1) Per diem rate established under §D of this regulation; or

(2) Provider's customary charge to the general public for services covered by the Program, unless the service is free to individuals not covered by Medicaid.

F. If the service is free to individuals not covered by Medicaid:

(1) The provider:

(a) May charge the Program; and

(b) Shall be reimbursed in accordance with §D of this regulation; and

(2) The provider's reimbursement is not limited to the provider's customary charge.

Md. Code Regs. 10.09.07.08

Regulation .08A amended effective May 12, 1986 (13:9 Md. R. 1029)
Regulation .08 amended as an emergency provision effective July 1, 2008 (35:17 Md. R. 1480); amended permanently effective December 15, 2008 (35:25 Md. R. 2150)
Regulation .08D amended effective April 6, 2009 (36:7 Md. R. 523); February 22, 2010 (37:4 Md. R. 340); amended effective 43:03 Md. R. 272, eff.2/15/2016; amended effective 43:20 Md. R. 1109, eff. 10/10/2016; amended effective 46:10 Md. R. 485, eff. 5/20/2019; amended effective 47:10 Md. R. 516, eff. 5/18/2020; amended effective 49:23 Md. R. 995, eff. 11/14/2022; amended effective 50:20 Md. R. 886, eff. 10/16/2023