Md. Code Regs. 10.09.26.10

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

Section 10.09.26.10 - Limitations

A. These regulations do not cover the following services:

(1) Services available to waiver participants through programs funded under the Rehabilitation Act of 1973, § 110, Public Law 94-142, or Education of the Handicapped Act, § 602(16) and (17);

(2) Services which are not part of a waiver participant's plan of care as established by a:

(a) Licensed physician;

(b) Licensed physician's assistant or licensed nurse practitioner in accordance with applicable law; or

(c) Qualified developmental disabilities professional;

(3) Services which are not included in Regulations .04-.08-5 of this chapter; and

(4) Medical day care services which are not provided in accordance with COMAR 10.09.07.

B. Providers are not entitled to reimbursement from the Program unless the waiver participant served by that provider is certified for medical eligibility by the Department or its designee and for financial eligibility by the Department of Human Resources or its designee.

C. Providers of services coordination services pursuant to these regulations may not be providers of any other service covered under this chapter for waiver participants.

D. If the Program denies payment or requests repayment on the basis that an otherwise covered service was not programmatically necessary, the provider may not seek payment for that service from the recipient.

E. Payment may not be made for the same date of service for respite care, personal assistance, and residential habilitation services rendered to a waiver participant.

F. Payment may not be made for the same date of service to a residential habilitation services provider, a residential option services provider, and a personal care services provider under COMAR 10.09.20 for services rendered to a waiver participant. Qualified participants shall be given the option of residential habilitation or residential option services when they are determined to need residential services and qualify for both options.

G. Payment may not be made for the same date of service for day habilitation services, supported employment services, and medical day care services under COMAR 10.09.07 rendered to a waiver participant.

H. The following services shall be reimbursed only if preauthorized by DDA, or authorized by DDA after the fact in emergency situations:

(1) Environmental modifications as covered under Regulation .07 of this chapter;

(2) Assistive technology and adaptive equipment as covered under Regulation .08-3 of this chapter; and

(3) Nursing services as covered under Regulations .05 or .06 of this chapter.

Md. Code Regs. 10.09.26.10

Regulations .10 adopted as an emergency provision effective February 13, 1984 (11:5 Md. R. 455); emergency status extended at 11:7 Md. R. 621; adopted permanently effective August 12, 1984 (11:15 Md. R. 1330)
Regulations .10 amended effective February 28, 1994 (21:4 Md. R. 277)
Regulations .10 amended as an emergency provision effective June 8, 1992 (19:12 Md. R. 1130); emergency status extended at 19:19 Md. R. 1702; adopted permanently effective September 28, 1992 (19:19 Md. R. 1707)
Regulation .10A amended as an emergency provision effective July 1, 2008 (35:17 Md. R. 1480); emergency status extended at 36:2 Md. R. 96; emergency status extended at 36:17 Md. R. 1310; amended permanently effective October 19, 2009 (36:21 Md. R. 1591)