Md. Code Regs. 10.09.63.06

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

Section 10.09.63.06 - Payment Procedures

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

B. The provider shall charge the Program the provider's customary charge to the general public for similar services. If the service is free to individuals not covered by Medicaid:

(1) The provider:

(a) May charge the Program; and

(b) Shall be reimbursed in accordance with §G of this regulation; and

(2) The provider's reimbursement is not limited to the provider's customary charge.

C. The Program will reimburse a provider for covered services:

(1) The lesser of the provider's customary charge to the general public unless the service is free to individuals not covered by Medicaid; or

(2) In accordance with §G of this regulation.

D. The provider may not bill the Program or the participant for:

(1) Completion of forms and reports;

(2) Broken or missed appointments;

(3) Professional services rendered by mail; or

(4) Providing a copy of a program participant's medical record when requested by another provider on behalf of the participant.

E. Payments for services rendered to a Program participant shall be made directly to a qualified provider or program.

F. Billing time limitations for claims submitted pursuant to this chapter are set forth in COMAR 10.09.36.06.

G. Reimbursement.

(1) Payments shall be made in 30-minute units of service.

(2) Effective July 1, 2023, rates for the services outlined in this chapter shall be reimbursed at $32.76 per unit.

Md. Code Regs. 10.09.63.06

Regulations .06 adopted as an emergency provision effective November 8, 1996 (23:25 Md. R. 1730); adopted permanently effective March 10, 1997 (24:5 Md. R. 408)
Regulations .06F amended as an emergency provision effective July 1, 1997 (24:16 Md. R. 1151); emergency status expired December 31, 1997
Regulation .06 amended effective June 25, 2001 (28:12 Md. R. 1109); February 18, 2002 (29:3 Md. R. 220)
Regulation .06A amended as an emergency provision effective January 5, 2005 (32:6 Md. R. 634); amended permanently effective April 11, 2005 (32:7 Md. R. 679)
Regulation .06A, B amended effective November 6, 2006 (33:22 Md. R. 1732)
Regulation .06A, D amended effective June 30, 2008 (35:13 Md. R. 1180)
Regulation .06B amended effective February 6, 2012 (39:2 Md. R. 141); October 14, 2013 (40:20 Md. R. 1652)
Regulation .06B, F amended as an emergency provision effective January 1, 2001 (28:4 Md. R. 414)
Regulation .06B, F amended effective April 19, 2010 (37:8 Md. R. 615)
Regulation .06F amended effective February 9, 1998 (25:3 Md. R. 144)
Regulation .06F amended as an emergency provision effective July 1, 2002 (29:15 Md. R. 1139); amended permanently effective October 28, 2002 (29:21 Md. R. 1645)
Regulation .06F amended effective April 9, 2007 (34:7 Md. R. 698); February 16, 2015 (42:3 Md. R. 316)
Regulation .06G adopted effective June 30, 2008 (35:13 Md. R. 1180)
Regulation .06G amended effective April 28, 2014 (41:8 Md. R. 471); February 16, 2015 (42:3 Md. R. 316)
Regulation .06H adopted effective April 28, 2014 (41:8 Md. R. 471)
Regulation .06 amended effective 42:23 Md. R. 1434, eff.2/1/2016; amended effective 45:4 Md. R. 205, eff. 2/26/2018; amended effective 45:26 Md. R. 1244, eff. 12/31/2018; recodified to 10.67.02.06 effective 46:22 Md. R. 976, eff. 11/1/2019; adopted effective 50:22 Md. R. 974, eff. 11/13/2023