Md. Code Regs. 10.09.40.06

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

Section 10.09.40.06 - Payment Procedures

A. Request for Payment.

(1) Requests for payment of early intervention service coordination shall be submitted by an approved provider according to procedures established by the Department. The Department reserves the right to return to the provider, before payment, all claims not properly signed and completed.

(2) A provider shall submit a request for payment on the claim form designated by the Department. A separate claim shall be submitted for each participant.

(3) The completed claim form in §A(2)B of this regulation shall indicate the:

(a) Date or dates of service;

(b) Participant's name and Medical Assistance number;

(c) Provider's name, location, and provider number; and

(d) Nature, unit or units, and procedure code or codes of covered services provided.

(4) Providers shall bill the Program for the appropriate fee specified in §C of this regulation.

(5) The Program may not make direct payment to participants.

B. Billing Time Limitations. Billing time limitations shall be as set forth in COMAR 10.09.36.06K.

C. Payment shall be made:

(1) Only to a qualified provider for covered services rendered to a participant, as specified in these regulations;

(2) Only to one provider of early intervention service coordination rendered to a participant during a billing period; and

(3) According to the following fee-for-service schedule for early intervention service coordination:

(a) Initial service coordination (only one unit of service may be reimbursed per participant) ... $500;

(b) Ongoing service coordination (only one unit of service per month may be reimbursed for a participant after completion of initial service coordination or the annual IFSP review) ... $150;

(c) Annual IFSP review ... $275 per review.

Md. Code Regs. 10.09.40.06

Regulations .06 adopted as an emergency provision effective November 19, 1990 (17:24 Md. R. 2835); emergency status extended at 18:4 Md. R. 445 (February 22, 1991); adopted permanently effective February 18, 1991 (18:3 Md. R. 305); amended effective 50:22 Md. R. 973, eff. 11/13/2023