Md. Code Regs. 10.09.85.06

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

Section 10.09.85.06 - Payment Procedures

A. The Program will reimburse free-standing birth centers for:

(1) A facility fee of $2,000 for the care of the delivering mother and delivery of the newborn, if the delivery takes place at the facility; and

(2) A facility fee of $500 for the care of the newborn.

B. If the mother is transferred to a hospital prior to delivering the newborn, the Department will reimburse as follows:

(1) If the mother was at the birth center for less than 2 hours, before the delivery of the newborn, the reimbursement will be at 25 percent of the Medicaid rate;

(2) If the mother was at the birth center for 2 to 5 hours, before the delivery of the newborn, the reimbursement will be at 50 percent of the Medicaid rate;

(3) If the mother was at the birth center for 5 to 8 hours, before to the delivery of the newborn, the reimbursement will be at 70 percent of the Medicaid rate; and

(4) If the mother was at the birth center for more than 8 hours, before the delivery of the newborn, the reimbursement will be at the full Medicaid rate.

C. The Program shall pay for covered services at the lower of the:

(1) Provider's customary charge to the general public; or

(2) The Program's fee.

D. The provider shall submit a request for payment as set forth in COMAR 10.09.36.04A.

E. The Program reserves the right to return to the provider, before payment, all invoices that are not properly completed.

F. The Program may not make a direct payment to a recipient.

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

Md. Code Regs. 10.09.85.06

Effective date: 41:8 Md. R. 471, eff.5/1/2014