Code of Maryland Regulations
Title 10 - MARYLAND DEPARTMENT OF HEALTH
Part 2
Subtitle 09 - MEDICAL CARE PROGRAMS
Chapter 10.09.56 - Home and Community-Based Services Waiver for Children with Autism Spectrum Disorder
Section 10.09.56.22 - Payment Procedures
Universal Citation: MD Code Reg 10.09.56.22
Current through Register Vol. 51, No. 19, September 20, 2024
A. Request for Payment.
(1) An approved provider shall submit
requests for payment for the services covered under this chapter according to
the procedures set forth in COMAR
10.09.36.04B or
otherwise established by the Program.
(2) The provider shall:
(a) Bill the Program in accordance with the
payment methodology specified in §§D and E of this
regulation;
(b) Accept payment from
the Program as payment in full for the services covered under this chapter and
make no additional charge to the participant or any other party for these
services; and
(c) Submit a request
for payment in a manner approved by the Program, 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. Documentation Required.
(1) Payments by the Program or its designee
may be withheld if the provider fails to submit requested evidence of services
provided, staff qualifications, corrective action plans, or other types of
documentation related to ensuring the health and safety of a
participant.
(2) Payments shall be
released upon receipt and approval by the Program or its designee of the
requested documentation.
(3) An
appeal by the provider under COMAR 10.01.03 does not stay the withholding of
payments.
C. Billing time limitations for the services covered under this chapter are the same as those set forth in COMAR 10.09.36.06B.
D. Payments.
(1) Payments shall be made only to a
qualified provider for services covered under this chapter which are rendered
to a participant.
(2) Providers
shall be paid the lesser of:
(a) The
provider's customary charge to the general public unless the service is free to
individuals not covered by Medicaid; or
(b) The rate established according to the fee
schedule published by the Department.
(3) The program shall only pay for services
at the lesser of:
(a) The fee for service
schedule; or
(b) The actual
cost.
(4) The Program's
rates as specified in §D(2)(a)-(g) of this regulation shall be effective
January 1, 2015 and shall increase on July 1 of each year, subject to the
limitations of the State budget, by the lesser of:
(a) 2.5 percent; or
(b) The change from March to March in the
medical care component of the Consumer Price Index for all urban consumers
(CPI-U) for the Washington-Baltimore area.
E. Rates.
(1) The Department shall publish a fee
schedule for services covered under this chapter that shall be publicly
available and updated at least annually or upon any changes made by the
Department.
(2) Subject to the
limitations of the State budget, the Program's rates as specified in this
regulation shall increase by 4 percent each year through Fiscal Year
2026.
(3) Effective July 1, 2022,
the Program shall pay according to the following fee-for-service schedule:
(a) Residential habilitation services and
retainer payments reimbursed at one of the following all-inclusive, maximum
rates for a participant:
(i) $283.69 per unit
for the regular level of service; or
(ii) $567.45 per unit for the intensive level
of service.
(b)
Therapeutic integration services reimbursed at the maximum rate of $17.19 per
unit.
(c) Intensive therapeutic
integration services reimbursed at the maximum rate of $21.49 per
unit.
(d) Intensive individual
support services reimbursed at the maximum rate of $21.49 per unit.
(e) Respite care reimbursed at the maximum
rate of $16.80 per unit.
(f) Family
consultation reimbursed at the maximum rates of $70.55 per unit.
(g) Adult life planning services reimbursed
at the maximum rate of $70.55 per unit.
(h) Environmental accessibility adaptations
reimbursed at the maximum rate of $2,104 per 36-month period amount billed by
the provider, which shall be the lesser of the:
(i) Amount authorized by the State Department
of Education; or
(ii) Actual cost
of the job.
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