Md. Code Regs. 10.09.53.07

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

Section 10.09.53.07 - Payment Procedures

A. Payment procedures are as set forth in COMAR 10.09.36.04 and .06.

B. Payments.

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

(2) To receive payment for services under Regulation .04 of this chapter, a provider and its workers shall use the electronic visit verification method and data management system approved by the Department to document time and submit claims in accordance with COMAR 10.09.36.03-2.

(3) 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) Effective July 1, 2022, rates for the services outlined in this regulation shall be as follows:

(a) $17.87 for 15 minutes of services provided by a registered nurse to one participant;

(b) $12.32 for 15 minutes of services provided by a registered nurse to each of two or more participants in the same residence;

(c) $11.58 for 15 minutes of services provided by a licensed practical nurse to one participant;

(d) $7.99 for 15 minutes of services provided by a licensed practical nurse to each of two or more participants in the same residence;

(e) $6.12 for 15 minutes of services provided by a CNA or HHA who is also certified as a CMT to one participant;

(f) $4.22 for 15 minutes of services provided by a CNA or HHA who is also certified as a CMT to each of two or more participants in the same residence;

(g) $5.08 for 15 minutes of services provided by a CNA or HHA to one participant;

(h) $3.50 for 15 minutes of services provided by a CNA or HHA to two or more participants in the same residence; and

(i) A flat rate of $71.41 per visit for a registered nurse supervisory visit of a nurse, CNA, or HHA.

(2) Effective July 1, 2021, the Program's rates as specified in this regulation shall increase by 4 percent each year, subject to the limitations of the State budget.

D. The nursing services provider shall identify the individual who ordered the nursing services by recording the individual practitioner's National Provider Identifier (NPI) number on the claim.

Md. Code Regs. 10.09.53.07

Regulations .07 adopted as an emergency provision effective May 5, 1993 (20:11 Md. R. 911); adopted permanently effective August 2, 1993 (20:15 Md. R. 1220)
Regulations .07 amended as an emergency provision effective June 1, 1994 (21:13 Md. R. 1152); amended permanently effective September 26, 1994 (21:19 Md. R. 1635)
Regulation .07 amended effective July 3, 2006 (33:13 Md. R. 1064); October 31, 2011 (38:22 Md. R. 1345);41:6 Md. R. 379, eff. 4/1/2014
Regulation .07B amended as an emergency provision effective January 1, 2000 (27:2 Md. R. 140); amended permanently effective May 1, 2000 (27:8 Md. R. 798)
Regulation .07B amended as an emergency provision effective June 12, 2008 (35:14 Md. R. 1243); amended permanently effective December 1, 2008 (35:24 Md. R. 2077)
Regulation .07B amended effective April 6, 2009 (36:7 Md. R. 524)
Regulation .07D amended as an emergency provision effective July 1, 2007 (34:15 Md. R. 1347); amended permanently effective September 24, 2007 (34:19 Md. R. 1650)
Regulation .07D amended as an emergency provision effective June 12, 2008 (35:14 Md. R. 1243); amended permanently effective December 1, 2008 (35:24 Md. R. 2077)
Regulation .07D amended effective March 22, 2010 (37:6 Md. R. 477)
Regulation .07E repealed effective March 10, 2008 (35:5 Md. R. 641); amended effective 43:21 Md. R. 1166, eff. 10/24/2016; amended effective 44:26 Md. R. 1214, eff. 1/1/2018; amended effective 46:10 Md. R. 485, eff. 5/20/2019; amended effective 49:23 Md. R. 995, eff. 11/14/2022; amended effective 50:16 Md. R. 726, eff. 8/21/2023