Current through Register Vol. 51, No. 19, September 20, 2024
A. The
Department shall pay the provider the rate set forth under this
chapter.
B. The rate is the sum of
the individual component, the provider component, and any add-on
component.
C. Reimbursement for
Attendance Days of Day Habilitation, Vocational Services, and Supported
Employment with Fewer than the Hours as Defined in Regulation .02 of this
Chapter.
(1) The Administration may:
(a) Not approve reimbursement for an
attendance day if the individual receives fewer than 4 hours of
service;
(b) Approve reimbursement
for fewer hours than the normal attendance day if the IP:
(i) Documents that the individual is not able
to engage in the program activities for the normal attendance day;
and
(ii) Includes a plan for
enabling the individual to be engaged in a normal attendance day; and
(c) Approve reimbursement for an
attendance day of supported employment when the individual receives fewer than
4 hours of supported employment services if the:
(i) IP documents that the individual is not
able to engage in supported employment activities for 4 hours a day;
(ii) IP includes a plan for enabling the
individual to be engaged in supported employment for at least 4 hours with the
goal being a normal attendance day; and
(iii) Individual is engaged in at least 4
hours of activity that may include day habilitation and vocational services,
with the majority of time spent in supported employment.
(2) The Administration's approval
of electronic or paper attendance documentation as specified by the
Administration and submitted by the provider shall constitute approval of an
attendance day of fewer than 6 to 8 hours if the approved individual plan
indicates this lower level of service is necessary.
D. Conversion of Existing Supported
Employment Services from a Contract to the Rate System.
(1) There is a presumption that the cost of
care for existing supported employment services reimbursed by the
Administration under the rate system will be the same as under the
contract.
(2) The Administration
shall reimburse the provider at least the same amount for cost of care for
existing supported employment services as the Administration reimbursed the
provider under the contract.
(3)
The Administration shall convert the contract reimbursement for individuals
into a base rate together, if appropriate, with add-on components.
(4) If a utilization review audit indicates
that add-on components were not required for the individual, the Administration
may recover unnecessary expenditures.
(5) A provider may request additional
services as set forth in Regulation .08F of this chapter.
(6) The Administration shall review any
add-on components for existing services every 3 years unless the Administration
documents a need for more frequent review.
(7) The Department shall reimburse providers
of existing supported employment services by converting those contracts to
reimbursement under this chapter between June 30, 2001, and July 1,
2002.
E. For add-on
components, the Department shall reimburse providers of existing augmentation
services by converting those contracts to reimbursement under this chapter
between June 30, 2001, and July 1, 2003.
F. For a single calendar day, the
Administration may not reimburse a provider for two or more attendance days of
any combination of:
(1) Residential services
under this chapter, community supported living arrangements under COMAR
10.22.18, and personal care services under COMAR 10.09.20; or
(2) Day habilitation services under this
chapter, supported employment services under this chapter, vocational services
under this chapter, and medical day care services under COMAR
10.09.07.
G. Absences
and Vacancies.
(1) As of July 1, 2011 the
Department shall only reimburse providers for 33 days of absences or vacancies
per year per individual when the individual is unable to be in residential
services due to illness, vacation, home visits, medical appointments, or other
circumstances.
(2) As of July 1,
2003, the Department may claim federal financial participation for residential
absence days as permitted by the Centers for Medicare and Medicaid Services
under the Home and Community-Based Waiver.
H. The Administration shall reimburse day and
supported employment programs an additional $2,000 per year per individual for
transportation to and from day habilitation and vocational programs or to and
from supported employment for individuals who, because of their disabilities,
must use wheelchairs or motorized scooters, if the payments are consistent with
the requirements under COMAR 10.09.26 and 10.09.19.
I. For residential services only, the
Administration shall subtract from the payment, as appropriate, SSI
contributions by individuals or other copayments.
J. The provider shall:
(1) Assist the individual in obtaining SSI,
if applicable; and
(2) Collect all
applicable individual copayment obligations while assuring that the individual
retains the personal needs allowance.
K. To be reimbursed under this chapter, the
provider shall submit:
(1) Attendance data for
individuals served; and
(2) Other
information as required by the Administration.
