Md. Code Regs. 10.09.10.07

Current through Register Vol. 51, No. 25, December 13, 2024

Section 10.09.10.07 - Prospective Rates

A. A provider shall be paid the prospective rate for nursing facility services as defined in Regulation .01B of this chapter plus the Nursing Facility Quality Assessment add-on identified in Regulation .11E of this chapter.

B. When necessary, each facility's per diem rate shall be reduced by the same percentage to maintain compliance with the Medicare upper payment limit requirement.

C. Power wheelchairs and bariatric beds are not included in the prospective rate, but may be preauthorized for payment in accordance with COMAR 10.09.12.

D. Support Surfaces.

(1) Support surfaces are not included in the prospective rate.

(2) A provider shall be paid a per diem rate for providing appropriate specialized support surfaces to patients with pressure ulcers or in recovery from myocutaneous flap or graft surgery for a pressure ulcer.

(3) A Class A support surface is a mattress replacement which has been approved as a Group 2 Pressure Reducing Support Surface by the Medical Policy of the Medicare Durable Medical Equipment Regional Carrier. A Class A support surface shall be reimbursed per day at the Medicare Durable Medical Equipment Regional Carrier Maryland monthly fee cap, in effect at the beginning of the State fiscal year, for HCPCS Code E0277 multiplied by 12 and then divided by the number of days in the State fiscal year.

(4) A Class B support surface is an air fluidized bed which has been approved as a Group 3 Pressure Reducing Support Surface by the Medical Policy of the Medicare Durable Medical Equipment Regional Carrier. A Class B support surface shall be reimbursed per day at the Medicare Durable Medical Equipment Regional Carrier Maryland monthly fee cap, in effect at the beginning of the State fiscal year, for HCPCS Code E0194 multiplied by 12 and then divided by the number of days in the State fiscal year.

E. Negative pressure wound therapy is not included in the prospective rate, but is reimbursed in accordance with rates established under COMAR 10.09.12. Reimbursement shall include the cost of pumps, dressings, and containers associated with this procedure.

F. Nursing facilities that are owned and operated by the State are not paid in accordance with the provisions of §A of this regulation, but are reimbursed reasonable costs based upon Medicare principles of reasonable costs as described at 42 CFR Part 413 . Aggregate payments for these facilities may not exceed Medicare upper payment limits as specified at 42 CFR § 447.272. If the Medicare upper payment limit is above aggregate costs for this ownership class, the State may elect to make supplemental payments to increase payments up to the Medicare upper payment limit.

G. Final facility rates for the period July 1, 2023, through June 30, 2024, shall be each nursing facility's quarterly rate, exclusive of the amount identified in Regulation .13A(2) of this chapter, increased by the budget adjustment factor of 2.298 percent, plus the Nursing Facility Quality Assessment add-on identified in Regulation .11E of this chapter and the ventilator care add-on amount identified in Regulation .13A(2) of this chapter when applicable.

Md. Code Regs. 10.09.10.07

Regulation .07 amended effective August 17, 1977 (4:17 Md. R. 1298)
Regulation .07B amended as an emergency provision effective July 1, 1978 (5:14 Md. R. 1132); adopted permanently effective November 3, 1978 (5:22 Md. R. 1673)
Regulation .07B amended and .07H adopted as an emergency provision effective June 27, 1983 (10:14 Md. R. 1257); adopted permanently effective October 24, 1983 (10:21 Md. R. 1901)
Regulation .07B amended effective June 6, 1983 (10:11 Md. R. 975); August 10, 1987 (14:16 Md. R. 1773)
Regulation .07B and E amended effective July 1, 1984 (11:12 Md. R. 1063)
Regulation .07B, C, F, G amended and .07C-1 adopted as an emergency provision effective July 1, 1986 (13:15 Md. R. 1729); adopted permanently effective December 1, 1986 (13:22 Md. R. 2398)
Regulation .07C amended effective October 29, 1984 (11:21 Md. R. 1812)
Regulation .07D amended effective July 18, 1983 (10:14 Md. R. 1262); July 1, 1987 (14:13 Md. R. 1473); June 1, 1988 (15:11 Md. R. 1331); July 1, 1988 (15:13 Md. R. 1553)
Regulation .07D amended as an emergency provision effective January 26, 1988 (15:4 Md. R. 469); adopted permanently effective May 15, 1988 (15:8 Md. R. 1009)
Regulation .07E amended effective January 27, 1986 (13:2 Md. R. 137); July 1, 1988 (15:13 Md. R. 1533); September 5, 1988 (15:18 Md. R. 2147)
Regulation .07E amended as an emergency provision effective July 1, 1986 (13:14 Md. R. 1627); adopted permanently effective December 1, 1986 (13:21 Md. R. 2320)
Regulation .07G amended effective December 29, 1986 (13:26 Md. R. 2807)
Regulation .07H repealed effective August 10, 1987 (14:16 Md. R. 1773)
Regulations .07 amended as an emergency provision effective January 14, 1992 (19:3 Md. R. 299); emergency status expired June 30, 1992
Regulations .07 amended and new Regulation .09-1 adopted as an emergency provision effective October 1, 1999 (26:23 Md. R. 1775); adopted permanently effective January 9, 2000 (26:27 Md. R. 2015)
Regulations .07 amended as an emergency provision effective December 1, 2001 (29:1 Md. R. 17)
Regulations .07 amended as an emergency provision effective July 1, 1995 (22:15 Md. R. 1114); emergency status expired November 1, 1995; amended permanently effective November 6, 1995 (22:22 Md. R. 1658)
Regulation .07 amended effective July 8, 2002 (29:13 Md. R. 990)
Regulation .07 amended as an emergency provision effective July 1, 2003 (30:15 Md. R. 990); emergency status expired December 31, 2003
Regulation .07 amended effective February 16, 2004 (31:3 Md. R. 207)
Regulation .07 amended as an emergency provision effective July 16, 2009 (36:17 Md. R. 1310); amended permanently effective October 5, 2009 (36:20 Md. R. 1527)
Regulation .07 amended effective November 28, 2011 (38:24 Md. R. 1502); March 18, 2013 (40:5 Md. R. 411); December 12, 2013 (40:24 Md. R. 2016); December 11, 2014 (41:24 Md. R. 1427)
Regulation .07A amended effective June 25, 1990 (17:12 Md. R. 1494)
Regulation .07A-2 amended as an emergency provision effective July 1, 2007 (34:15 Md. R. 1345); emergency status extended at 35:3 Md. R. 286; emergency status expired June 24, 2008
Regulation .07A-2, C amended as an emergency provision effective April 1, 2008 (35:9 Md. R. 892); emergency status expired September 3, 2008
Regulation .07A-2, C amended effective September 22, 2008 (35:19 Md. R. 1716)
Regulation .07A-3 adopted effective September 22, 2008 (35:19 Md. R. 1716)
Regulation .07A-3 amended effective April 6, 2009 (36:7 Md. R. 523)
Regulation .07A-4 adopted effective April 6, 2009 (36:7 Md. R. 523)
Regulation .07B amended effective February 12, 2007 (34:3 Md. R. 297)
Regulation .07C amended effective March 19, 1990 (17:5 Md. R. 638)
Regulation .07C-1 amended effective April 5, 2010 (37:7 Md. R. 570)
Regulation .07C-2 and C-3 adopted effective April 5, 2010 (37:7 Md. R. 570)
Regulation .07C-4 adopted effective December 27, 2010 (37:26 Md. R. 1787)
Regulations .07 amended effective 42:7 Md. R. 567, eff.4/13/2015; amended and recodified from .07-2 effective 45:13 Md. R. 664, eff. 7/2/2018; amended effective 46:10 Md. R. 485, eff. 5/20/2019; amended effective 46:26 Md. R. 1164, eff. 12/30/2019; amended effective 48:12 Md. R. 472, eff. 6/14/2021; amended effective 49:23 Md. R. 995, eff. 11/14/2022; amended effective 50:15 Md. R. 681, eff. 8/7/2023; amended effective 51:18 Md. R. 808, eff. 9/16/2024.