Md. Code Regs. 10.09.54.22

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

Section 10.09.54.22 - Payment Procedures

A. Request for Payment. To receive payment as a provider of services covered under Regulations .13-.19 of this chapter, a provider shall submit claims in accordance with procedures outlined in the Department's billing manual.

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

C. 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 in §D of this regulation.

D. Rates.

(1) For dates of service beginning July 1, 2022, fees per unit of service shall be as follows:

(a) Assisted Living Level II, No Medical Day Care: reimbursed at the maximum rate of $81.57 per day;

(b) Assisted Living Level III, No Medical Day Care: reimbursed at the maximum rate of $102.94 per day;

(c) Assisted Living Level II, Medical Day Care: reimbursed at the maximum rate of $61.21 per day;

(d) Assisted Living Level III, Medical Day Care: reimbursed at the maximum rate of $77.18 per day;

(e) Behavioral Consultation: reimbursed at the maximum rate of $89.22 per hour;

(f) Case Management-Administrative: reimbursed at the maximum rate of $83.66 per hour or $20.9138 per 15-minute unit;

(g) Case Management-Comprehensive: reimbursed at the maximum rate of $83.66 per hour or $20.9138 per 15-minute unit;

(h) Case Management-Ongoing: reimbursed at the maximum rate of $83.66 per hour or $20.9138 per 15-minute unit;

(i) Dietitian and Nutritionist Services: reimbursed at the maximum rate of $89.22 per hour;

(j) Family I/I Training: reimbursed at the maximum rate of $89.22 per hour;

(k) Medical Day Care Services: reimbursed at the maximum rate of $104.81 per day; and

(l) Senior Center Plus: reimbursed at the maximum rate of $64.90 per day.

(2) The Program's rates as specified in the Department's fee schedule shall increase by 4 percent on July 1 of each year through Fiscal Year 2026, subject to the limitations of the State budget.

Md. Code Regs. 10.09.54.22

Regulations .22 adopted effective 41:8 Md. R. 471, eff.4/28/2014 ; amended effective 43:13 Md. R. 713, eff. 7/4/2016; amended effective 44:2 Md. R. 84, eff. 1/30/2017; amended effective 46:10 Md. R. 485, eff. 5/20/2019; amended effective 50:23 Md. R. 1004, eff. 11/27/2023