Md. Code Regs. 10.09.06.09

Current through Register Vol. 51, No. 22, November 1, 2024

Section 10.09.06.09 - Payment Procedures

A. General policies governing payment procedures that are applicable to all providers are set forth in COMAR 10.09.36.04.

B. Billing time limitations for claims submitted under this chapter are set forth in COMAR 10.09.36.06.

C. For dates of service from July 1, 2022, through June 30, 2023, rates for the services outlined in this chapter shall be as follows:

(1) For ASAM Level 3.1, the provider shall receive $94.70 per diem;

(2) For ASAM Level 3.3, the provider shall receive $211.05 per diem;

(3) For ASAM Level 3.5, the provider shall receive $211.05 per diem;

(4) For ASAM Level 3.7, the provider shall receive $324.92 per diem; and

(5) For ASAM Level 3.7-WM, the provider shall receive $395.12 per diem.

D. Effective July 1, 2023, rates for the services outlined in this chapter shall be as follows:

(1) For ASAM Level 3.1, the provider shall receive $104.62 per diem;

(2) For ASAM Level 3.3, the provider shall receive $233.14 per diem;

(3) For ASAM Level 3.5, the provider shall receive $233.14 per diem;

(4) For ASAM Level 3.7, the provider shall receive $358.93 per diem; and

(5) For ASAM Level 3.7-WM, the provider shall receive $436.38 per diem.

E. Administrative Days. The Department shall pay at the daily rate based on the patient's ASAM level of care when:

(1) The participant's required level of care has changed, and the following conditions are met:

(a) The provider has implemented a predischarge planning program and initiated placement activities for the participant at the earliest appropriate time;

(b) The provider has actively pursued placement of the participant at the required level of care in an appropriate facility during the entire period of administrative days;

(c) The provider has submitted documentation to the Department or its designee that it has complied with the requirements of §E(1)(a)-(b) of this regulation for the entire period of the administrative stay claimed for reimbursement; and

(d) The participant is transferred promptly to the first available appropriate facility licensed and certified for the required level of care; and

(2) The participant is at an inappropriate level of care but cannot be moved, and the following conditions are met:

(a) The attending physician has declared that, because of physical or emotional problems, the participant is unable to be moved; and

(b) The reason the participant cannot be moved is adequately documented by the attending physician in the participant's record.

Md. Code Regs. 10.09.06.09

Regulation .09A, B amended effective August 17, 1981 (8:16 Md. R. 1365)
Regulations.09 adopted as an emergency provision effective December 1, 1988 (15:25 Md. R. 2881); emergency status extended at 16:7 Md. R. 802; adopted permanently effective May 1, 1989 (16:8 Md. R. 909)
Regulation .09 amended effective January 18, 1993 (20:1 Md. R. 27); June 3, 1996 (23:11 Md. R. 810)
Regulation .09A amended as an emergency provision effective July 1, 1990 (17:15 Md. R. 1850); adopted permanently effective October 29, 1990 (17:18 Md. R. 2201)
Regulation .09A amended as an emergency provision effective July 1, 1990 (17:15 Md. R. 1850); adopted permanently effective October 29, 1990 (17:21 Md. R. 2528)
Regulation .09A amended as an emergency provision effective November 1, 1990 (17:23 Md. R. 2731); adopted permanently effective March 1, 1991 (18:3 Md. R. 305)
Regulation .09A amended as an emergency provision effective July 16, 1991 (18:16 Md. R. 1809); emergency status extended at 18:26 Md. R. 2827 (December 27, 1991); emergency status expired February 16, 1992
Regulation .09A amended effective February 17, 1992 (19:3 Md. R. 303)
Regulation .09A amended as an emergency provision effective July 1, 2001 (29:3 Md. R. 213); emergency status extended at 29:9 Md. R. 743; superseded at 29:16 Md. R. 1284
Regulation .09A amended as an emergency provision effective July 1, 2002 (30:5 Md. R. 363); amended permanently effective April 14, 2003 (30:7 Md. R. 487)
Regulation .09A amended effective April 9, 2007 (34:7 Md. R. 698); August 8, 2011 (38:16 Md. R. 944); November 28, 2011 (38:24 Md. R. 1502);41:6 Md. R. 379, eff. 3/31/2014 ; repealed effective 44:7 Md. R. 354, eff. 4/10/2017; adopted effective 44:18 Md. R. 865, eff. 9/11/2017; amended effective 45:26 Md. R. 1242, eff. 12/31/2018; amended effective 46:26 Md. R. 1164, eff. 12/30/2019; amended effective 49:7 Md. R. 465, eff. 4/4/2022; amended effective 50:20 Md. R. 886, eff. 10/16/2023; amended effective 51:18 Md. R. 808, eff. 9/16/2024.