Md. Code Regs. 10.09.81.39

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

Section 10.09.81.39 - Limitations

A. Reimbursement may be made by the Maryland Medical Assistance Program only if the requirements of this chapter are met.

B. The total reimbursement by the Maryland Medical Assistance Program for environmental accessibility adaptations and assistive technology combined is limited to the amount specified at Regulation .40C(4)(f)(ii) or (h)(ii) of this chapter during the participant's annual plan of service period, with exceptions allowed at the Department's discretion in the following circumstances:

(1) The amount exceeds the limit, but will allow the individual to return home from a nursing facility or avoid immediate placement in a nursing facility, and does not exceed the participant's cost neutrality under Regulation .38E of this chapter; or

(2) Expenditures in excess of the annual limit will reduce the participant's ongoing Medicaid cost of care significantly without exceeding the participant's cost neutrality.

C. Reimbursement for services or equipment estimated to cost more than the amount specified in Regulation .40C(4)(g)(ii) of this chapter shall be preapproved by the Department based on at least two cost estimates obtained from prospective vendors.

D. Reimbursement by the Maryland Medical Assistance Program for environmental accessibility adaptations covered under Regulation .27 of this chapter is limited to modifying two residences of the participant every 3 consecutive years.

E. Excluded from coverage under Regulation .27 of this chapter are adaptations or improvements to the home which:

(1) Are of general utility, such as carpeting, roof repair, and central air conditioning;

(2) Are not of direct medical or remedial benefit to the participant; or

(3) Add to the home's total square footage.

F. Reimbursement by the Maryland Medical Assistance Program for personal emergency response systems covered under Regulation .28 of this chapter may only be allowed for participants who:

(1) Are alone for significant parts of the day;

(2) Have no regular caregiver for extended parts of the day; and

(3) Would otherwise require extensive routine supervision to ensure the participant's health and safety.

G. The Maryland Medical Assistance Program may not reimburse for attendant care services provided under this chapter if:

(1) On the same date of service, a participant also received personal care services under COMAR 10.09.20; or

(2) Rendered for more than 23 hours for a participant on the same date of service.

H. Reimbursement for the following services shall be limited to 8 hours per service per date of service:

(1) Family training;

(2) Participant training; or

(3) Nursing supervision.

I. The total amount of reimbursement by the Maryland Medical Assistance Program for transition services is limited to a one-time expense of $3,000 per participant, with exceptions allowed at the Department's discretion.

Md. Code Regs. 10.09.81.39