Md. Code Regs. 10.09.46.12

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

Section 10.09.46.12 - Payment Procedures

A. Request for Payment.

(1) An approved provider, with the exception of a medical day care provider, shall submit requests for payment to BHA or its authorized representative for the services covered under this chapter, according to procedures set forth in COMAR 10.09.36.04 or otherwise established by the Department. Medical day care providers shall submit requests for payment to the Department in accordance with COMAR 10.09.07.08.

(2) The provider shall:

(a) Bill the Department in accordance with the payment methodology specified in §C of this regulation;

(b) Accept payment from the Department as payment in full for the services covered under this chapter and make no additional charge for the covered services to the participant or any other party; and

(c) Submit a request for payment in a manner approved by the Department, which includes the:

(i) Date or dates of service;

(ii) Participant's name and Medicaid number;

(iii) Provider's name, location, and Program identification number;

(iv) Type, procedure code or codes, and unit or units of covered services provided; and

(v) Amount of reimbursement requested.

B. Billing time limitations for the services covered under this chapter are the same as those set forth in COMAR 10.09.36.06D.

C. Payments.

(1) Payments shall be made only to a qualified provider for services covered under this chapter which are rendered to a participant.

(2) The Program shall pay according to the following fee-for-service schedule:

(a) Residential habilitation reimbursed at:

(i) $276.59 from July 1, 2022 to September 30, 2022, then effective October 1, 2022 at $266.64 per day for Level 1;

(ii) $366.22 from July 1, 2022 to September 30, 2022, then effective October 1, 2022 at $353.06 per day for Level 2; and

(iii) $506.64 from July 1, 2022 to September 30, 2022, then effective October 1, 2022 at $488.43 per day for Level 3;

(b) Day habilitation reimbursed at:

(i) $71.41 from July 1, 2022 to September 30, 2022, then effective October 1, 2022 at $68.84 per day for Level 1;

(ii) $124.57 from July 1, 2022 to September 30, 2022, then effective October 1, 2022 at $120.09 per day for Level 2; and

(iii) $175.24 from July 1, 2022 to September 30, 2022, then effective October 1, 2022 at $168.84 per day for Level 3;

(c) Supported employment reimbursed at:

(i) $42.36 from July 1, 2022 to September 30, 2022, then effective October 1, 2022 at $40.84 per day for Level 1;

(ii) $71.41 from July 1, 2022 to September 30, 2022, then effective October 1, 2022 at $68.84 per day for Level 2; and

(iii) $175.24 from July 1, 2022 to September 30, 2022, then effective October 1, 2022 at $168.84 per day for Level 3; and

(d) Individual support services (ISS): reimbursed at the maximum rate of $8.6553 per 15 minutes from July 1, 2022 to September 30, 2022, then effective October 1, 2022 at $8.3440 per 15 minutes.

(3) The Program shall pay for medical day care services in accordance with COMAR 10.09.07 and the participant's approved plan of care.

(4) Program rates specified in this regulation shall increase each fiscal year through FY 2026, subject to the limitations of the State budget.

Md. Code Regs. 10.09.46.12

Regulations .12 adopted as an emergency provision effective July 1, 2003 (30:14 Md. R. 933); adopted permanently effective December 11, 2003 (30:24 Md. R. 1740)
Regulation .12A, C amended as an emergency provision effective July 1, 2008 (35:17 Md. R. 1481); amended permanently effective October 6, 2008 (35:20 Md. R. 1774); amended effective 47:10 Md. R. 516, eff. 5/18/2020; amended effective 50:8 Md. R. 338, eff. 5/1/2023