Md. Code Regs. 10.09.81.41

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

Section 10.09.81.41 - Payment Procedures - Rates

A. Participant Training. A qualified provider shall bill the Department an all-inclusive rate not to exceed $39.11 for each hour of covered service.

B. Family Training. A qualified provider shall bill the Department a rate for each hour of covered services not to exceed:

(1) Self-employed - $25.90 per hour for family training services rendered by an appropriately licensed professional; and

(2) Agency-employed - $37.75 per hour for family training services rendered by an appropriately licensed professional.

C. Case Management Services. A qualified provider shall bill the Department not more than $13.12 for each unit of service, as defined in Regulation .24 of this chapter.

D. Transition Services.

(1) A qualified provider shall bill the Department the lesser of the amount approved by the Department or the provider's customary charge to the general public for the service provided, including the cost of installation, if appropriate.

(2) Payment shall be in accordance with Regulation .391 of this chapter.

(3) If the service is free to individuals not covered by Medicaid:

(a) The provider:

(i) May charge the Program; and

(ii) Shall be reimbursed in accordance with §D(1) and (2) of this regulation; and

(b) The provider's reimbursement is not limited to the provider's customary charge.

E. Environmental Assessment.

(1) A qualified environmental assessment provider shall bill the Department the lesser of $383.80 or the provider's customary charge to the general public for the services rendered, minus any payments by other third party payers such as Medicare.

(2) If the environmental assessment is rendered to more than one participant, the total charge, not to exceed $383.80, shall be divided equally on invoices submitted for multiple participants.

(3) If the service is free to individuals not covered by Medicaid:

(a) The provider:

(i) May charge the Program; and

(ii) Shall be reimbursed in accordance with §E(1) and (2) of this regulation; and

(b) The provider's reimbursement is not limited to the provider's customary charge.

F. Environmental Accessibility Adaptations.

(1) A qualified provider shall bill the Department the lesser of the amount approved by the Department or the provider's customary charge to the general public for the service provided, including the cost of installation, if appropriate.

(2) Payment may not be more than $6,500 during the participant's annual plan of service period, subject to the limitations and exceptions specified at Regulation .39B of this chapter.

(3) The provider shall submit documentation to the Department from the seller of the assistive technology as to the actual purchase price.

(4) If the service is free to individuals not covered by Medicaid:

(a) The provider:

(i) May charge the Program; and

(ii) Shall be reimbursed in accordance with §F(1)-(3) of this regulation; and

(b) The provider's reimbursement is not limited to the provider's customary charge.

G. Personal Emergency Response Systems. A qualified provider shall:

(1) Bill the Department:

(a) The lesser of the amount approved by the Department or the actual purchase price for the service provided, including the cost of installation, if appropriate; and

(b) Not more than:

(i) $1,000 per unit of service, unless preapproved under Regulation .28C of this chapter; and

(ii) $45 per month for maintenance and monitoring; and

(2) Submit documentation to the Department from the seller of the personal emergency response system as to the actual purchase price.

H. Assistive Technology. A qualified provider shall:

(1) Bill the Department:

(a) The lesser of the amount approved by the Department or the actual purchase price for the service provided, including the cost of installation, if appropriate; and

(b) Not more than $6,500 during the participant's annual plan of service period, subject to the limitations and exceptions specified at Regulation .39B of this chapter; and

(2) Submit documentation to the Department from the seller of the assistive technology as to the actual purchase price.

I. Attendant Care Services. The Department shall reimburse a qualified provider a rate for each hour of covered service not to exceed:

(1) $12.93 per hour for attendant services rendered by a qualified participant-employed provider; and

(2) $16.52 per hour for attendant services rendered by a qualified agency-employed provider.

J. Nursing Supervision of Attendants. A qualified provider shall bill the Department a rate for each hour of covered services not to exceed:

(1) $25.90 per hour for nursing supervision services rendered by a self-employed licensed provider; and

(2) $37.75 per hour for nursing supervision services rendered by an agency-employed, licensed provider.

K. Home-Delivered Meals. A qualified provider shall bill the Department an all-inclusive rate not to exceed $5.48 for each delivered meal.

L. Dietitian and Nutritionist Services. A qualified provider shall bill the Department a rate not to exceed $60.32 for each hour of covered services.

M. Behavior Consultation Services. A qualified provider shall bill the Program an all-inclusive rate not to exceed $60.32 for each hour of a home visit by an individual qualified to render services.

N. Medical Day Care. A qualified provider shall bill the Department for the number of days each participant attends the medical day care center in accordance with rates established under COMAR 10.09.07.

O. Senior Center Plus. A qualified provider shall bill the Program a daily per capita rate, negotiated with the Maryland Department of Aging, not to exceed $43.87, for each day that a participant attended the center for at least 4 hours, not including transportation to and from the center.

P. Assisted Living Services.

(1) The assisted living services provider shall be paid for assisted living services the lesser of:

(a) The provider's customary charge to the general public for the services covered under COMAR 10.07.14, excluding room and board; or

(b) The rates established at §P(4) of this regulation.

(2) The provider's claim may not include any days that the participant was not residing in the assisted living facility according to Regulation .37A of this chapter or not eligible pursuant to Regulation .03 of this chapter.

(3) The provider's payment may not include the following amounts which the provider is expected to collect from the participant:

(a) The provider's customary charge for room and board, not to exceed $420 per month; or

(b) Any assessed amount of client contribution for the cost of care, established according to Regulation .03E(7) of this chapter.

(4) Payments for assisted living services as covered under Regulation .20 of this chapter are:

(a) $55.15 per day for Level 2 assisted living services;

(b) $41.38 per day for Level 2 assisted living services on a day that the participant also received medical day care services;

(c) $69.59 per day for Level 3 assisted living services; or

(d) $52.17 per day for Level 3 assisted living services on a day that the participant also received medical day care services.

(5) If the service is free to individuals not covered by Medicaid:

(a) The provider:

(i) May charge the Program; and

(ii) Shall be reimbursed in accordance with §P(1)-(4) of this regulation; and

(b) The provider's reimbursement is not limited to the provider's customary charge.

Md. Code Regs. 10.09.81.41

Regulations .41 amended effective 43:13 Md. R. 713, eff. 7/4/2016