Md. Code Regs. 10.09.76.06

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

Section 10.09.76.06 - Reimbursement Methodology

A. The provider shall charge the Program the provider's customary charge to the general public for similar services and charge the provider's acquisition cost for injectable drugs or dispensed medical supplies.

B. 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 §B of this regulation; and

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

C. Local health department clinics, general clinics, physicians, and nurse practitioners shall be paid the lesser of:

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

(2) The maximum rates according to COMAR 10.09.02.07.

D. The Department shall reimburse an SBHC, sponsored by an LHD or general clinic, for dental services in accordance with COMAR 10.09.05.07.

E. The Department shall reimburse an SBHC, sponsored by an LHD, general clinic, nurse practitioner, or physician, for specialty behavioral health services in accordance with COMAR 10.21.25 and 10.09.80.08.

F. The Department shall reimburse an SBHC, sponsored by an FQHC, for services in accordance with COMAR 10.09.08.08.

Md. Code Regs. 10.09.76.06

Regulations .06 adopted as an emergency provision effective July 1, 2006 (33:15 Md. R. 1274); adopted permanently effective September 25, 2006 (33:19 Md. R. 1560)
Regulation .06B amended effective October 5, 2009 (36:20 Md. R. 1528)
Regulations .06 repealed effective 41:13 Md. R. 752, eff.7/7/2014 ; adopted effective 44:7 Md. R. 355, eff. 4/10/2017; amended effective 48:12 Md. R. 473, eff. 6/14/2021