Md. Code Regs. 10.09.48.08

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

Section 10.09.48.08 - Payment Procedures

A. Request for Payment.

(1) Requests for payment for the services covered under this chapter shall be submitted by a provider according to procedures set forth in COMAR 10.09.36.04.

(2) Billing time limitations for services covered under this chapter are the same as those set forth in COMAR 10.09.36.06.

B. Payment Rates.

(1) The Department shall publish a fee schedule for services covered under this chapter, which shall be publicly available and updated at least annually or upon any changes made by the Department.

(2) The Department's rates set forth in its fee schedule will apply to services covered under this chapter that are provided under either the traditional services delivery model or the self-directed services delivery model.

(3) The Program's rates for covered services under this chapter shall increase on July 1 of each year, subject to the limitations of the State budget.

(4) Providers shall be reimbursed within 45 days of approved invoice for services rendered based on the rates set forth in §C(1) and (2) of this regulation.

(5) For a comprehensive assessment, providers shall be reimbursed $450 per assessment.

(6) For all other services rendered to Maryland Medicaid participants residing in counties other than those listed in §B(7) of this regulation, providers shall be reimbursed:

(a) For dates of service July 1, 2022 through September 30, 2022, $24.56 per unit of service;

(b) For dates of service October 1, 2022 through December 31, 2022, $27.02 per unit;

(c) For dates of service January 1, 2023 through June 30, 2023, $24.56 per unit; and

(d) For dates of service July 1, 2023 through June 30, 2024, $25.54 per unit.

(7) Providers rendering services to Maryland Medicaid participants residing in Calvert, Charles, Frederick, Montgomery, and Prince George's counties shall be reimbursed:

(a) For dates of service July 1, 2022 through September 30, 2022, $25.86 per unit;

(b) For dates of service October 1, 2022 through December 31, 2022, $28.45 per unit;

(c) For dates of service January 1, 2023 through June 30, 2023, $25.86 per unit; and

(d) For dates of service July 1, 2023 through June 30, 2024, $26.89 per unit.

C. Changes in Rates.

(1) The rates are subject to the limitations of the State budget.

(2) Unless otherwise authorized, the rates may be changed on July 1 of each year beginning July 1, 2015, based on legislative action, and subject to limitations of the State budget.

D. Payment Limitations.

(1) Payment shall be made only to one provider for covered services rendered to a participant on a particular date of service.

(2) Payment for the services covered under this chapter:

(a) Shall be considered as payment in full; and

(b) May not supplement or be supplemented by payment from other sources, such as the participant, family, a public program, or private agency.

(3) For a comprehensive assessment, only one assessment may be reimbursed per participant, unless otherwise authorized by DDA.

(4) Ongoing coordination of community services shall be billed on a scheduled determined by the Department.

E. Units of Services and Limitations.

(1) All coordination of community services other than the initial comprehensive assessment shall be billed to DDA in units of service.

(2) DDA shall provide payment for only those coordination of community services that were authorized by DDA before the provision of the service.

(3) Each fiscal year, the coordinator of community services shall complete the core services for each participant.

Md. Code Regs. 10.09.48.08

Regulations .08 adopted as an emergency provision effective June 23, 1992 (19:14 Md. R. 1276); adopted permanently effective October 12, 1992 (19:20 Md. R. 1815)
Regulations .08 under Case Management for Individuals with Developmental Disability repealed and new Regulations .08 under Targeted Case Management for People with Intellectual and Developmental Disabilities adopted effective July 8, 2013 (40:13 Md. R. 1074)
Regulation .08 amended effective 42:11 Md. R. 723, eff.6/8/2015; amended effective 43:12 Md. R. 666, eff.6/20/2016; amended effective 44:16 Md. R. 809, eff. 8/14/2017; amended effective 45:3 Md. R. 156, eff. 2/12/2018; amended effective 45:26 Md. R. 1243, eff. 12/31/2018; amended effective 46:26 Md. R. 1164, eff. 12/30/2019; amended effective 48:26 Md. R.1111, eff. 12/27/2021; amended effective 50:16 Md. R. 726, eff. 8/21/2023; amended effective 51:18 Md. R. 809, eff. 9/16/2024.