Code of Maryland Regulations
Title 10 - MARYLAND DEPARTMENT OF HEALTH
Part 2
Subtitle 09 - MEDICAL CARE PROGRAMS
Chapter 10.09.81 - Increased Community Services (ICS) Program
Section 10.09.81.40 - Payment Procedures - General
Universal Citation: MD Code Reg 10.09.81.40
Current through Register Vol. 51, No. 19, September 20, 2024
A. Request for Payment.
(1) An approved provider shall:
(a) Submit a request for payment for the
services covered under this chapter according to procedures set forth in COMAR
10.09.36.04C;
and
(b) Include the following
information on the request:
(i) Date or dates
of service;
(ii) Participant's name
and Medical Assistance number;
(iii) Provider's name, location, and
identification number;
(iv) Nature,
procedure code or codes, and unit or units of the covered services provided;
and
(v) Amount of reimbursement
requested.
(2) The provider shall submit a request for
payment in a manner approved by the Maryland Medical Assistance
Program.
(3) Participant-employed
attendants shall submit a request for payment to a designated fiscal
intermediary who shall:
(a) Submit bills to
the Department;
(b) Withhold
appropriate taxes; and
(c) Remit
reimbursement to the provider for services rendered.
(4) A request for payment shall include all
units of service rendered, as defined in Regulations .22-.37 of this chapter,
during a given time period for a participant.
(5) Except as specified in §A(3) of this
regulation, the provider shall bill the Department, or its authorized agent, in
accordance with the payment methodology specified in Regulation .41 of this
chapter for services approved by the Department.
B. Billing time limitations for the services covered under this chapter are set forth in COMAR 10.09.36.06C.
C. Payments.
(1) Payments for services rendered to a
participant shall be made:
(a) Directly to a
qualified provider; or
(b) To a
designated fiscal intermediary for distribution to participant-employed
attendants.
(2) A
provider 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 in Regulation .41 of
this chapter.
(3)
Payment by the Department for the services covered under this chapter:
(a) Shall be considered as payment in full;
and
(b) May not supplement or be
supplemented by payment from other sources, such as the participant, family, a
public program, or private agency.
D. The ICS Program's rates as specified in Regulation .41A-C, E, I-M, O, and P of this chapter shall increase on July 1 of each year beginning July 1, 2012, subject to the limitations of the State budget, by the lesser of:
(1) 2.5 percent;
or
(2) 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.
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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