Md. Code Regs. 10.09.80.08

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

Section 10.09.80.08 - Payment Procedures

A. General policies for payment procedures that are applicable to all providers are set forth in COMAR 10.09.36.04.

B. Billing time limitations for claims submitted under this chapter are set forth in COMAR 10.09.36.06.

C. Unless the care is free to other patients, a provider shall bill the Program their usual and customary charge to the general public.

D. For dates of service from July 1, 2022, through June 30, 2023, rates for the services outlined in this regulation shall be as follows:

(1) For services outlined in this regulation, as delivered through a BHA licensed substance use disorder treatment provider:

(a) Comprehensive substance use disorder assessment - $192.57;

(b) Level 1 group substance use disorder counseling - $52.90 per session;

(c) Level 1 individual substance use disorder counseling - $27.12 per 15-minute increment with a maximum of six 15-minute increments per day;

(d) Level 2.1 Intensive Outpatient treatment - $169.51 per diem;

(e) Level 2.5 Partial Hospitalization half day session - $176.29 per diem;

(f) Level 2.5 Partial Hospitalization full day session - $284.77 per diem;

(g) Ambulatory Withdrawal Management -$94.93 per diem;

(h) Point of care presumptive drug test read with direct optical observation only - $10.02 per test;

(i) Point of care presumptive drug test read with instrument-assisted direct optical observation - $10.02 per test;

(j) Point of care presumptive drug test read with instrumented chemistry analyzers - $49.40 per test; and

(k) Periodic medication management through office-based evaluation and management visits, according to COMAR 10.09.02.07D.

(2) For services outlined in this regulation as delivered through an opioid treatment program:

(a) Comprehensive substance use disorder assessment - $192.57;

(b) Level 1 group substance use disorder counseling - $52.90 per session;

(c) Level 1 individual substance use disorder counseling - $27.12 per 15-minute increment with a maximum of six 15-minute increments per day;

(d) Opioid Maintenance Therapy - $83.76 per participant per week;

(e) Medication Assisted Treatment Induction - $271.22 per participant per week;

(f) Buprenorphine Maintenance Therapy - $74.46 per participant per week; and

(g) Periodic medication management through office-based evaluation and management visits, according to COMAR 10.09.02.07D.

E. For dates of service from March 1, 2023, through June 30, 2023, peer support services as outlined in Regulation .05 of this chapter as delivered a BHA licensed substance use disorder treatment provider or an opioid treatment program:

(1) Individual peer support services - $16.38 per 15-minute increment; and

(2) Group peer support services - $4.55 per 15-minute increment;

F. Effective July 1, 2023, rates for the services outlined in this regulation shall be as follows:

(1) For services outlined in this regulation, as delivered through a BHA licensed substance use disorder treatment provider:

(a) Comprehensive substance use disorder assessment - $198.35;

(b) Level 1 group substance use disorder counseling - $54.49 per session;

(c) Level 1 individual substance use disorder counseling - $27.93 per 15-minute increment with a maximum of six 15-minute increments per day;

(d) Level 2.1 Intensive Outpatient treatment - $174.60 per diem;

(e) Level 2.5 Partial Hospitalization half day session - $181.58 per diem;

(f) Level 2.5 Partial Hospitalization full day session - $293.31 per diem;

(g) Ambulatory Withdrawal Management - $97.78 per diem;

(h) Individual peer support services - $16.87 per 15-minute increment;

(i) Group peer support services - $4.69 per 15-minute increment;

(j) Point of care presumptive drug test read with direct optical observation only - $10.02 per test;

(k) Point of care presumptive drug test read with instrument-assisted direct optical observation - $10.02 per test;

(l) Point of care presumptive drug test read with instrumented chemistry analyzers - $49.40 per test; and

(m) Periodic medication management through office-based evaluation and management visits, according to COMAR 10.09.02.07D.

(2) For services outlined in this regulation as delivered through an opioid treatment program:

(a) Comprehensive substance use disorder assessment - $198.35;

(b) Level 1 group substance use disorder counseling - $54.49 per session;

(c) Level 1 individual substance use disorder counseling - $27.93 per 15-minute increment with a maximum of six 15-minute increments per day;

(d) Opioid Maintenance Therapy - $86.27 per participant per week;

(e) Medication Assisted Treatment Induction - $279.36 per participant per week;

(f) Buprenorphine Maintenance Therapy - $76.69 per participant per week;

(g) Individual peer support services - $16.87 per 15-minute increment;

(h) Group peer support services - $4.69 per 15-minute increment; and

(i) Periodic medication management through office-based evaluation and management visits, according to COMAR 10.09.02.07D.

G. The Program shall make no direct payment to participants.

H. The Department shall authorize supplemental payment on Medicare claims only if:

(1) The provider accepts Medicare assignments;

(2) Medicare makes direct payment to the provider;

(3) Medicare has determined that the services are medically necessary;

(4) The services are covered by the Program; and

(5) Initial billing is made directly to Medicare according to Medicare guidelines.

I. The Department shall make payment on Medicare claims subject to the following provisions:

(1) Deductible and coinsurance shall be paid in full for services designated as mental health services by Medicare; and

(2) The Program shall reimburse services not covered by Medicare, but considered medically necessary by the Program, according to the limitations of this chapter.

Md. Code Regs. 10.09.80.08

Regulations .08 adopted as an emergency provision effective January 1, 2010 (37:6 Md. R. 474); adopted permanently effective May 31, 2010 (37:11 Md. R. 765)
Regulation .08 amended effective 42:21 Md. R. 1302, eff.10/26/2015; amended effective 43:21 Md. R. 1166, eff. 10/24/2016; amended effective 44:7 Md. R. 356, eff. 4/10/2017; amended effective 44:26 Md. R. 1215, eff. 1/1/2018; amended effective 46:26 Md. R. 1164, eff. 12/30/2019; amended effective 49:23 Md. R. 996, eff. 11/14/2022; amended effective 50:9 Md. R. 379, eff. 5/15/2023; amended effective 51:15 Md. R. 708, eff. 8/5/2024.