Md. Code Regs. 10.09.56.21

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

Section 10.09.56.21 - Limitations

A. Reimbursemen may be made by the Program only when all of the requirements of this chapter are met.

B. Residential habilitation services may not be reimbursed for the same date of service as intensive individual support services, therapeutic integration services, intensive therapeutic integration services, or respite care.

C. Therapeutic integration services, intensive therapeutic integration services, and intensive individual support services under this chapter and school health-related services under COMAR 10.09.50 may not be reimbursed for the same period of the same day.

D. Therapeutic integration and intensive therapeutic integration services may not be rendered during the same week to a participant.

E. Therapeutic integration and intensive therapeutic integration services may include transportation time when at least 2 units of service have been provided on-site, and the maximum units of service billed may not exceed:

(1)For dates of service before July 1, 2023, 24 units; or

(2)For dates of service on or after July 1, 2023, 12 units.

F. Environmental accessibility adaptations may be reimbursed only if preauthorized by the State Department of Education.

G. If an environmental accessibility adaptation is anticipated to cost over $500, at least two bids or prices shall be obtained, based on which the State Department of Education may approve the purchase.

H. The Program may reimburse for a participant not more than:

(1)For dates of service before July 1, 2023:

(a) 1 unit per date of service for residential habilitation services at either the regular or intensive level;

(b) 40 units of therapeutic integration services per week;

(c) 30 units of intensive therapeutic integration services per week;

(d) 12 units or fewer than 2 units of therapeutic integration or intensive therapeutic integration services for a date of service;

(e) 50 units of intensive individual support services per week;

(f) 48 units of respite care for a date of service;

(g) 672 units of respite care per State fiscal year;

(h) 12 units of family consultation for a date of service;

(i) 80 units of family consultation per State fiscal year;

(j) A total of $2,000 for environmental accessibility adaptations over a 36-month period;

(k) 16 units of intensive individual support services per day;

(l) 30 units of adult life planning services per State fiscal year, for participants 16 years old or older;

(m) A lifetime maximum of 90 units of adult life planning services per participant, for participants 16 years old or older; and

(n) 15 units of retainer payment per calendar year at either the regular or intensive level when the participant is absent from the residential habilitation program for the purposes of family visitation, hospitalization, or other overnight stays; or

(2)For dates of service on or after July 1, 2023:

(a)1 unit per date of service for residential habilitation services at either the regular or the intensive level;

(b)80 units of therapeutic integration services per week;

(c)60 units of intensive therapeutic integration services per week;

(d)24 units or fewer than 2 units of therapeutic integration or intensive therapeutic integration services for a date of service;

(e)160 units of intensive individual support services per week;

(f)96 units of respite care for a date of service;

(g)1344 units of respite care per State fiscal year;

(h)24 units of family consultation for a date of service;

(i)160 units of family consultation per State fiscal year;

(j)A total of $2,104 for environmental accessibility adaptations over a 36-month period;

(k)32 units of intensive individual support services per day;

(l)80 units of adult life planning services per State fiscal year, for participants 14 years old or older;

(m)16 units of adult life planning services per date of service, for participants 14 years old or older; and

(n)15 units of retainer payment per calendar year at either the regular or intensive level when the participant is absent from the residential habilitation program for the purposes of family visitation, hospitalization, or other overnight stays.

I. Respite services may not be reimbursed for the same period of the same day as:

(1) Residential habilitation;

(2) Intensive individual support services;

(3) Family consultation;

(4) Therapeutic integration;

(5) Intensive therapeutic integration; or

(6) Adult life planning services.

J. The Program does not reimburse transportation costs such as gas, maintenance, or other vehicle operating expenses.

K. Adult life planning services under this chapter and school health-related services under COMAR 10.09.50 may not be reimbursed for the same period of the day.

L. The Program does not reimburse for any autism waiver services for a participant whose residential placement in a 24-hour, 365-day residential program is funded with non-Medicaid federal, State, or local government funds.

Md. Code Regs. 10.09.56.21

Regulations .21E as an emergency provision effective July 1, 2002 (29:17 Md. R. 1376); emergency status extended at 30:3 Md. R. 176 and 30:10 Md. R. 667; amended permanently effective April 14, 2003 (30:7 Md. R. 487)
Regulation .21F amended as an emergency provision effective October 1, 2004 (32:1 Md. R. 24); amended permanently effective April 25, 2005 (32:8 Md. R. 741)
Regulation .21J adopted effective April 16, 2012 (39:7 Md. R. 492); amended effective 43:7 Md. R. 449, eff.4/11/2016; amended effective 47:10 Md. R. 516, eff. 5/18/2020; amended effective 51:18 Md. R. 809, eff. 9/16/2024.