Md. Code Regs. 10.09.27.06

Current through Register Vol. 51, No. 25, December 13, 2024

Section 10.09.27.06 - Payment Procedures

A. Payment procedures as set forth in COMAR 10.09.36 apply.

B. Payments.

(1) Payments shall be made directly to a qualified provider.

(2) Providers shall be paid the lesser of:

(a) The provider's customary charge to the general public unless the service is free to individuals not covered by Medicaid; or

(b) The rate established according to the fee schedule published by the Department.

C. Rates.

(1) The Department shall publish a fee schedule for services covered under this chapter that shall be publicly available and updated at least annually or upon any changes made by the Department.

(2) Effective July 1, 2022, rates for services governed by this chapter are as follows:

(a) For home health aide or certified nursing assistant services provided to one participant:

(i) $5.0809 per 15 minutes of services; or

(ii) If the services are rendered by a home health aide or certified nursing assistant who is also a certified medical technician, $6.1208 per 15 minutes of services;

(b) For home health aide or certified nursing assistant services provided to two or more participants in the same residence:

(i) $3.5044 per 15 minutes of services per participant; or

(ii) If the services are rendered by a home health aide or certified nursing assistant who is also a certified medical technician, $4.2232 per 15 minutes of service per participant; and

(c) Payments for home care case management services shall be made as follows:

(i) Waiver enrollment process-$1,181.61;

(ii) First month of home care case management-$1,181.61; and

(iii) The second and any subsequent month of home care case management-$590.80.

(3) Subject to the limitations of the State budget, the Program's rates as specified in this regulation shall increase by 4 percent each year through Fiscal Year 2026.

Md. Code Regs. 10.09.27.06

Regulations .06 adopted as an emergency provision effective May 10, 1985 (12:11 Md. R. 1041); emergency status extended at 12:19 Md. R. 1843 and 13:6 Md. R. 669; adopted permanently effective March 10, 1986 (13:5 Md. R. 543)
Regulations .06 amended as an emergency provision effective March 11, 1991 (18:7 Md. R. 765); amended permanently effective July 1, 1991 (18:12 Md. R. 1339)
Regulations .06A_C effective July 1, 1989 (16:12 Md. R. 1336)
Regulation .06B amended as an emergency provision effective January 28, 1991 (18:3 Md. R. 301); emergency status expired April 8, 1991 (18:9 Md. R. 1004)
Regulation .06B amended as an emergency provision effective April 9, 1991 (18:9 Md. R. 1005); amended permanently effective October 7, 1991 (18:18 Md. R. 2004)
Regulation .06C amended effective August 25, 1986 (13:17 Md. R. 1922)
Regulation .06A, C amended effective July 17, 2006 (33:14 Md. R. 1163)
Regulation .06A, C amended as an emergency provision effective July 1, 2008 (35:17 Md. R. 1481); amended permanently effective December 1, 2008 (35:24 Md. R. 2077)
Regulation .06C amended as an emergency provision effective July 1, 2007 (34:15 Md. R. 1346); amended permanently effective October 8, 2007 (34:20 Md. R. 1739)
Regulation .06C amended effective April 6, 2009 (36:7 Md. R. 523); February 8, 2010 (37:3 Md. R. 175); amended effective 43:13 Md. R. 713, eff. 7/4/2016; amended effective 46:10 Md. R. 485, eff. 5/20/2019; amended effective 50:16 Md. R. 725, eff. 8/21/2023