Code of Maryland Regulations
Title 10 - MARYLAND DEPARTMENT OF HEALTH
Part 2
Subtitle 09 - MEDICAL CARE PROGRAMS
Chapter 10.09.06 - Adult Residential Substance Use Disorder Services
Section 10.09.06.09 - Payment Procedures
Universal Citation: MD Code Reg 10.09.06.09
Current through Register Vol. 51, No. 19, September 20, 2024
A. General policies governing 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. For dates of services from January 1, 2021 through June 30, 2022, rates for the services outlined in this chapter shall be as follows:
(1) For ASAM Level 3.1, the provider shall
receive $94.70 per diem;
(2) For
ASAM Level 3.3, the provider shall receive $211.05 per diem;
(3) For ASAM Level 3.5, the provider shall
receive $211.05 per diem;
(4) For
ASAM Level 3.7, the provider shall receive $324.92 per diem; and
(5) For ASAM Level 3.7-WM, the provider shall
receive $395.12 per diem.
D. Effective July 1, 2022, rates for the services outlined in this chapter shall be as follows:
(1) For ASAM Level 3.1, the provider shall
receive $101.57 per diem;
(2) For
ASAM Level 3.3, the provider shall receive $226.35 per diem;
(3) For ASAM Level 3.5, the provider shall
receive $226.35 per diem;
(4) For
ASAM Level 3.7, the provider shall receive $348.48 per diem; and
(5) For ASAM Level 3.7-WM, the provider shall
receive $423.77 per diem.
E. Administrative Days. The Department shall pay at the daily rate based on the patient's ASAM level of care when:
(1) The participant's required level of care
has changed, and the following conditions are met:
(a) The provider has implemented a
predischarge planning program and initiated placement activities for the
participant at the earliest appropriate time;
(b) The provider has actively pursued
placement of the participant at the required level of care in an appropriate
facility during the entire period of administrative days;
(c) The provider has submitted documentation
to the Department or its designee that it has complied with the requirements of
§E(1)(a)-(b) of this regulation for the entire period of the
administrative stay claimed for reimbursement; and
(d) The participant is transferred promptly
to the first available appropriate facility licensed and certified for the
required level of care; and
(2) The participant is at an inappropriate
level of care but cannot be moved, and the following conditions are met:
(a) The attending physician has declared
that, because of physical or emotional problems, the participant is unable to
be moved; and
(b) The reason the
participant cannot be moved is adequately documented by the attending physician
in the participant's record.
Disclaimer: These regulations may not be the most recent version. Maryland may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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