Md. Code Regs. 10.09.46.11

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

Section 10.09.46.11 - Limitations

A. Reimbursement shall be made by the Program only if all of the requirements of this chapter are met.

B. Reimbursement may not be made by the Program for a waiver service furnished before:

(1) Enrollment of the participant in the waiver;

(2) Development of the participant's waiver plan of care; and

(3) Inclusion of the specific service in the participant's approved waiver plan of care.

C. The Program shall reimburse for a participant not more than:

(1) One unit of residential habilitation services for a date of service;

(2) One unit of day habilitation per day;

(3) One unit of supported employment per day;

(4) A combined maximum of seven units of supported employment and day habilitation per week; or

(5) 32 units of individual support services for a date of service.

D. The Program does not cover the following:

(1) Room and board for the participant;

(2) Room and board for an unrelated personal caregiver who lives with the participant;

(3) Direct payments to the participant's family;

(4) Respite care for a participant residing in an out-of-home facility;

(5) Activities or supervision reimbursed by a source other than Medicaid;

(6) Payment for day habilitation on the same date of service as medical day care under COMAR 10.09.07;

(7) Payment for day habilitation on the same date of services as on-site psychiatric rehabilitation as defined in COMAR 10.21.21 and COMAR 10.21.25;

(8) Payment for residential habilitation on the same date of service as personal care under COMAR 10.09.20;

(9) Payment for residential habilitation on the same date of service as residential rehabilitation services as defined in COMAR 10.21.22;

(10) Payment for supported employment on the same date of service as mental health vocational supported employment as defined in COMAR 10.21.28;

(11) Payment for individual support services on the same day as residential habilitation services as defined in Regulation .01B of this chapter; or

(12) Payment for individual support services on the same day as family and individual support services as defined in Regulation .01B of this chapter.

Md. Code Regs. 10.09.46.11

Regulations .11 adopted as an emergency provision effective July 1, 2003 (30:14 Md. R. 933); adopted permanently effective December 11, 2003 (30:24 Md. R. 1740)
Regulation .11C, D amended effective April 9, 2007 (34:7 Md. R. 698); amended effective 47:10 Md. R. 516, eff. 5/18/2020