Current through Register Vol. 51, No. 19, September 20, 2024
A.
Participant Training. A qualified provider shall bill the Department an
all-inclusive rate not to exceed $39.11 for each hour of covered
service.
B. Family Training. A
qualified provider shall bill the Department a rate for each hour of covered
services not to exceed:
(1) Self-employed -
$25.90 per hour for family training services rendered by an appropriately
licensed professional; and
(2)
Agency-employed - $37.75 per hour for family training services rendered by an
appropriately licensed professional.
C. Case Management Services. A qualified
provider shall bill the Department not more than $13.12 for each unit of
service, as defined in Regulation .24 of this chapter.
D. Transition Services.
(1) A qualified provider shall bill the
Department the lesser of the amount approved by the Department or the
provider's customary charge to the general public for the service provided,
including the cost of installation, if appropriate.
(2) Payment shall be in accordance with
Regulation .391 of this chapter.
(3) If the service is free to individuals not
covered by Medicaid:
(a) The provider:
(i) May charge the Program; and
(ii) Shall be reimbursed in accordance with
§D(1) and (2) of this regulation; and
(b) The provider's reimbursement is not
limited to the provider's customary charge.
E. Environmental Assessment.
(1) A qualified environmental assessment
provider shall bill the Department the lesser of $383.80 or the provider's
customary charge to the general public for the services rendered, minus any
payments by other third party payers such as Medicare.
(2) If the environmental assessment is
rendered to more than one participant, the total charge, not to exceed $383.80,
shall be divided equally on invoices submitted for multiple
participants.
(3) If the service is
free to individuals not covered by Medicaid:
(a) The provider:
(i) May charge the Program; and
(ii) Shall be reimbursed in accordance with
§E(1) and (2) of this regulation; and
(b) The provider's reimbursement is not
limited to the provider's customary charge.
F. Environmental Accessibility Adaptations.
(1) A qualified provider shall bill the
Department the lesser of the amount approved by the Department or the
provider's customary charge to the general public for the service provided,
including the cost of installation, if appropriate.
(2) Payment may not be more than $6,500
during the participant's annual plan of service period, subject to the
limitations and exceptions specified at Regulation .39B of this
chapter.
(3) The provider shall
submit documentation to the Department from the seller of the assistive
technology as to the actual purchase price.
(4) If the service is free to individuals not
covered by Medicaid:
(a) The provider:
(i) May charge the Program; and
(ii) Shall be reimbursed in accordance with
§F(1)-(3) of this regulation; and
(b) The provider's reimbursement is not
limited to the provider's customary charge.
G. Personal Emergency Response Systems. A
qualified provider shall:
(1) Bill the
Department:
(a) The lesser of the amount
approved by the Department or the actual purchase price for the service
provided, including the cost of installation, if appropriate; and
(b) Not more than:
(i) $1,000 per unit of service, unless
preapproved under Regulation .28C of this chapter; and
(ii) $45 per month for maintenance and
monitoring; and
(2) Submit documentation to the Department
from the seller of the personal emergency response system as to the actual
purchase price.
H.
Assistive Technology. A qualified provider shall:
(1) Bill the Department:
(a) The lesser of the amount approved by the
Department or the actual purchase price for the service provided, including the
cost of installation, if appropriate; and
(b) Not more than $6,500 during the
participant's annual plan of service period, subject to the limitations and
exceptions specified at Regulation .39B of this chapter; and
(2) Submit documentation to the
Department from the seller of the assistive technology as to the actual
purchase price.
I.
Attendant Care Services. The Department shall reimburse a qualified provider a
rate for each hour of covered service not to exceed:
(1) $12.93 per hour for attendant services
rendered by a qualified participant-employed provider; and
(2) $16.52 per hour for attendant services
rendered by a qualified agency-employed provider.
J. Nursing Supervision of Attendants. A
qualified provider shall bill the Department a rate for each hour of covered
services not to exceed:
(1) $25.90 per hour
for nursing supervision services rendered by a self-employed licensed provider;
and
(2) $37.75 per hour for nursing
supervision services rendered by an agency-employed, licensed
provider.
K.
Home-Delivered Meals. A qualified provider shall bill the Department an
all-inclusive rate not to exceed $5.48 for each delivered meal.
L. Dietitian and Nutritionist Services. A
qualified provider shall bill the Department a rate not to exceed $60.32 for
each hour of covered services.
M.
Behavior Consultation Services. A qualified provider shall bill the Program an
all-inclusive rate not to exceed $60.32 for each hour of a home visit by an
individual qualified to render services.
N. Medical Day Care. A qualified provider
shall bill the Department for the number of days each participant attends the
medical day care center in accordance with rates established under COMAR
10.09.07.
O. Senior Center Plus. A
qualified provider shall bill the Program a daily per capita rate, negotiated
with the Maryland Department of Aging, not to exceed $43.87, for each day that
a participant attended the center for at least 4 hours, not including
transportation to and from the center.
P. Assisted Living Services.
(1) The assisted living services provider
shall be paid for assisted living services the lesser of:
(a) The provider's customary charge to the
general public for the services covered under COMAR 10.07.14, excluding room
and board; or
(b) The rates
established at §P(4) of this regulation.
(2) The provider's claim may not include any
days that the participant was not residing in the assisted living facility
according to Regulation .37A of this chapter or not eligible pursuant to
Regulation .03 of this chapter.
(3)
The provider's payment may not include the following amounts which the provider
is expected to collect from the participant:
(a) The provider's customary charge for room
and board, not to exceed $420 per month; or
(b) Any assessed amount of client
contribution for the cost of care, established according to Regulation .03E(7)
of this chapter.
(4)
Payments for assisted living services as covered under Regulation .20 of this
chapter are:
(a) $55.15 per day for Level 2
assisted living services;
(b)
$41.38 per day for Level 2 assisted living services on a day that the
participant also received medical day care services;
(c) $69.59 per day for Level 3 assisted
living services; or
(d) $52.17 per
day for Level 3 assisted living services on a day that the participant also
received medical day care services.
(5) If the service is free to individuals not
covered by Medicaid:
(a) The provider:
(i) May charge the Program; and
(ii) Shall be reimbursed in accordance with
§P(1)-(4) of this regulation; and
(b) The provider's reimbursement is not
limited to the provider's customary charge.
