Md. Code Regs. 10.09.81.40

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

Section 10.09.81.40 - Payment Procedures - General

A. Request for Payment.

(1) An approved provider shall:

(a) Submit a request for payment for the services covered under this chapter according to procedures set forth in COMAR 10.09.36.04C; and

(b) Include the following information on the request:

(i) Date or dates of service;

(ii) Participant's name and Medical Assistance number;

(iii) Provider's name, location, and identification number;

(iv) Nature, procedure code or codes, and unit or units of the covered services provided; and

(v) Amount of reimbursement requested.

(2) The provider shall submit a request for payment in a manner approved by the Maryland Medical Assistance Program.

(3) Participant-employed attendants shall submit a request for payment to a designated fiscal intermediary who shall:

(a) Submit bills to the Department;

(b) Withhold appropriate taxes; and

(c) Remit reimbursement to the provider for services rendered.

(4) A request for payment shall include all units of service rendered, as defined in Regulations .22-.37 of this chapter, during a given time period for a participant.

(5) Except as specified in §A(3) of this regulation, the provider shall bill the Department, or its authorized agent, in accordance with the payment methodology specified in Regulation .41 of this chapter for services approved by the Department.

B. Billing time limitations for the services covered under this chapter are set forth in COMAR 10.09.36.06C.

C. Payments.

(1) Payments for services rendered to a participant shall be made:

(a) Directly to a qualified provider; or

(b) To a designated fiscal intermediary for distribution to participant-employed attendants.

(2) A provider shall be paid the lesser of:

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

(b) The rate established in Regulation .41 of this chapter.

(3) Payment by the Department 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.

D. The ICS Program's rates as specified in Regulation .41A-C, E, I-M, O, and P of this chapter shall increase on July 1 of each year beginning July 1, 2012, subject to the limitations of the State budget, by the lesser of:

(1) 2.5 percent; or

(2) The change from March to March in the medical care component of the Consumer Price Index for all urban consumers (CPI-U) for the Washington-Baltimore area.

Md. Code Regs. 10.09.81.40

Regulations .40 amended effective 43:13 Md. R. 713, eff. 7/4/2016