Code of Maryland Regulations
Title 10 - MARYLAND DEPARTMENT OF HEALTH
Part 2
Subtitle 09 - MEDICAL CARE PROGRAMS
Chapter 10.09.46 - Home and Community-Based Services Waiver for Individuals with Brain Injury
Section 10.09.46.12 - Payment Procedures
Universal Citation: MD Code Reg 10.09.46.12
Current through Register Vol. 51, No. 19, September 20, 2024
A. Request for Payment.
(1) An approved provider, with the
exception of a medical day care provider, shall submit requests for payment to
BHA or its authorized representative for the services covered under this
chapter, according to procedures set forth in COMAR
10.09.36.04 or otherwise
established by the Department. Medical day care providers shall submit requests
for payment to the Department in accordance with COMAR 10.09.07.08.
(2) The provider shall:
(a) Bill the Department in accordance with
the payment methodology specified in §C of this regulation;
(b) Accept payment from the Department as
payment in full for the services covered under this chapter and make no
additional charge for the covered services to the participant or any other
party; and
(c) Submit a request for
payment in a manner approved by the Department, which includes the:
(i) Date or dates of service;
(ii) Participant's name and Medicaid
number;
(iii) Provider's name,
location, and Program identification number;
(iv) Type, procedure code or codes, and unit
or units of covered services provided; and
(v) Amount of reimbursement
requested.
B. Billing time limitations for the services covered under this chapter are the same as those set forth in COMAR 10.09.36.06D.
C. Payments.
(1) Payments shall be made only to a
qualified provider for services covered under this chapter which are rendered
to a participant.
(2) The Program
shall pay according to the following fee-for-service schedule:
(a) Residential habilitation reimbursed at:
(i) $276.59 from July 1, 2022 to September
30, 2022, then effective October 1, 2022 at $266.64 per day for Level
1;
(ii) $366.22 from July 1, 2022
to September 30, 2022, then effective October 1, 2022 at $353.06 per day for
Level 2; and
(iii) $506.64 from
July 1, 2022 to September 30, 2022, then effective October 1, 2022 at $488.43
per day for Level 3;
(b)
Day habilitation reimbursed at:
(i) $71.41
from July 1, 2022 to September 30, 2022, then effective October 1, 2022 at
$68.84 per day for Level 1;
(ii)
$124.57 from July 1, 2022 to September 30, 2022, then effective October 1, 2022
at $120.09 per day for Level 2; and
(iii) $175.24 from July 1, 2022 to September
30, 2022, then effective October 1, 2022 at $168.84 per day for Level
3;
(c) Supported
employment reimbursed at:
(i) $42.36 from July
1, 2022 to September 30, 2022, then effective October 1, 2022 at $40.84 per day
for Level 1;
(ii) $71.41 from July
1, 2022 to September 30, 2022, then effective October 1, 2022 at $68.84 per day
for Level 2; and
(iii) $175.24 from
July 1, 2022 to September 30, 2022, then effective October 1, 2022 at $168.84
per day for Level 3; and
(d) Individual support services (ISS):
reimbursed at the maximum rate of $8.6553 per 15 minutes from July 1, 2022 to
September 30, 2022, then effective October 1, 2022 at $8.3440 per 15
minutes.
(3) The Program
shall pay for medical day care services in accordance with COMAR 10.09.07 and
the participant's approved plan of care.
(4) Program rates specified in this
regulation shall increase each fiscal year through FY 2026, subject to the
limitations of the State budget.
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