Md. Code Regs. 10.22.18.04

Current through Register Vol. 52, No. 1, January 10, 2025

Section 10.22.18.04 - Rates

A. The Department shall reimburse the licensee:

(1) For new individuals served after June 30, 2000, according to the rates set forth in this regulation; and

(2) For individuals receiving existing services, by converting those contracts to the Community Supported Living Arrangements Payment System if appropriate between:

(a) July 1, 2000, and December 31, 2000, if the individuals are living in their own residences, and

(b) January 1, 2001, and June 30, 2001, if the individuals are living with their families.

B. The Administration determines the rate based on the number of preauthorized hours of service each individual needs each week as documented by the individual's IP.

C. If an individual does not need the same amount of services each week, the rate is determined by the number of preauthorized hours of service in a 4-week period divided by 4, and is at least 1 hour each week.

D. The Department shall pay a daily amount per individual calculated by multiplying the number of hours of service each week approved for the individual by the hourly rate and dividing by seven.

E. The basic rates for CSLA services are set forth in §I of this regulation. These rates do not include professional services.

F. Under the rates, the Department may pay for up to 82 hours of service each week.

G. If awake-overnight or one-to-one services are indicated in the individual's IP, and are not included in the 82 hours of base rate service, the Administration may:

(1) Preauthorize and approve additional hours of service beyond 82 hours after reviewing the IP and any additional documentation the Administration requests; and

(2) Reimburse the licensee as set forth in §J of this regulation for these services.

H. Professional Services.

(1) The Administration may preauthorize and approve professional services if:

(a) The individual's IP, and any additional documentation the administration requires indicates the service is necessary; and

(b) The provider submits documentation that:

(i) The individual is not eligible for medical assistance,

(ii) For individuals who are Medicaid eligible, the service sought is not a service covered by the Maryland Medical Assistance Program, or

(iii) If the individual is Medicaid eligible and the service is covered by the Maryland Medical Assistance Program, the provider submits documentation that the Maryland Medical Assistance Program has denied coverage, and the agency is pursuing an appeal.

(2) If the Administration approves and preauthorizes a professional service, the Administration shall reimburse the provider for professional services according to the rate schedule in §K of this regulation except that the Administration may procure services to be reimbursed at a higher rate if:

(a) The provider submits documentation that it cannot find a professional to render services at this rate;

(b) The usual and customary rate charged by the professional for the service is above the rate of this regulation; and

(c) The rate that the Maryland Medical Assistance Program reimburses the professional for this service is higher than the rate established by §K of this regulation.

I. Fiscal Year 2020 Tables for CSLA's Personal Supports Hourly Rates.

(1) State Fiscal Year 2020 CSLA's Personal Supports Rates: Table for One Individual in a Dwelling Receiving CSLA Services.

	Hourly Rate per Individual
Hours of Service per Week	Baltimore City and Allegany, Anne Arundel, Baltimore, Caroline, Carroll, Dorchester, Garrett, Harford, Howard, Kent, Queen Anne's, St. Mary's, Somerset, Talbot, Washington, Wicomico, and Worcester Counties	Cecil County	Calvert, Charles, Frederick, Montgomery, and Prince George's Counties
1-19	$32.14	$33.27	$33.55
20-22	$30.73	$31.81	$32.08
23-24	$29.70	$30.74	$31.01
25	$28.75	$29.76	$30.01
26	$27.84	$28.81	$29.06
27	$27.01	$27.96	$28.20
28-82	$26.62	$27.55	$27.79

(2) State Fiscal Year 2020 CSLA's Personal Supports Rates: Table for Two Individuals in a Dwelling Receiving CSLA Services.

	Hourly Rate per Individual
Hours of Service per Week	Baltimore City and Allegany, Anne Arundel, Baltimore, Caroline, Carroll, Dorchester, Garrett, Harford, Howard, Kent, Queen Anne's, St. Mary's, Somerset, Talbot, Washington, Wicomico, and Worcester Counties	Cecil County	Calvert, Charles, Frederick, Montgomery, and Prince George's Counties
1-19	$29.90	$30.95	$31.22
20-22	$28.81	$29.82	$30.08
23-24	$27.84	$28.81	$29.06
25	$26.94	$27.88	$28.13
26	$26.09	$27.00	$27.24
27	$25.32	$26.21	$26.43
28-82	$24.95	$25.82	$26.05

(3) State Fiscal Year 2020 CSLA's Personal Supports Rates: Table for Three Individuals in a Dwelling Receiving CSLA Services.

	Hourly Rate per Individual
Hours of Service per Week	Baltimore City and Allegany, Anne Arundel, Baltimore, Caroline, Carroll, Dorchester, Garrett, Harford, Howard, Kent, Queen Anne's, St. Mary's, Somerset, Talbot, Washington, Wicomico, and Worcester Counties	Cecil County	Calvert, Charles, Frederick, Montgomery, and Prince George's Counties
1-19	$23.96	$24.80	$25.01
20-22	$23.08	$23.89	$24.10
23-24	$22.29	$23.07	$23.27
25	$21.59	$22.35	$22.54
26	$20.92	$21.65	$21.84
27	$20.28	$20.99	$21.17
28-82	$20.00	$20.70	$20.88

J. State Fiscal Year 2020 CSLA's Personal Supports Rates: Table for 1:1 Support or Not More than 8 Hours of Awake-Overnight Support per Residence for Individuals Receiving CSLA Services Regardless of the Number of Individuals in a Dwelling.

Hourly Rate per Individual

Hours of Service per Week

Baltimore City and Allegany, Anne Arundel, Baltimore, Caroline,

Carroll, Dorchester, Garrett, Harford, Howard, Kent, Queen Anne's, St.

Mary's, Somerset, Talbot, Washington, Wicomico, and Worcester

Counties

Cecil County

Calvert, Charles, Frederick,

Montgomery,

and Prince George's Counties

Hours in Excess of 82

$20.00

$20.70

$20.88

K. State Fiscal Year 2020 CSLA's Personal Supports Rates: Table for Professional Services for Individuals Receiving CSLA Servi Regardless of the Number of Individuals in a Dwelling.

Hourly Rate per Individual

Hours of Service per Week

Baltimore City and Allegany, Anne Arundel, Baltimore, Caroline, Carroll,

Dorchester, Garrett, Harford, Howard, Kent, Queen Anne's, St. Mary's,

Somerset, Talbot, Washington, Wicomico, and Worcester Counties

Cecil County

Calvert, Charles, Frederick,

Montgomery,

and Prince George's

Counties

As Preauthorized and Approved

$34.93

$36.15

$36.47

Md. Code Regs. 10.22.18.04

Regulations .04 adopted as an emergency provision effective July 1, 2000 (27:15 Md. R. 1397); adopted permanently effective October 30, 2000 (27:21 Md. R. 1976)
Regulation .04 amended as an emergency provision effective July 1, 2001 (28:15 Md. R. 1395); amended permanently effective October 1, 2001 (28:19 Md. R. 1684)
Regulation .04 amended as an emergency provision effective July 1, 2002 (29:15 Md. R. 1139); amended permanently effective October 14, 2002 (29:20 Md. R. 1588)
Regulation .04 amended as an emergency provision effective July 1, 2003 (30:14 Md. R. 934); amended permanently effective September 29, 2003 (30:19 Md. R. 1333)
Regulation .04I, J, K amended effective December 20, 2004 (31:25 Md. R. 1790); March 13, 2006 (33:5 Md. R. 520); December 7, 2006 (33:24 Md. R. 1906); December 31, 2007 (34:26 Md. R. 2263); March 23, 2009 (36:6 Md. R. 491); October 4, 2010 (37:20 Md. R. 1394); April 15, 2013 (40:7 Md. R. 611); July 7, 2014 (41:13 Md. R. 752)
Regulation .04 amended effective 42:20 Md. R. 1265, eff.10/12/2015; amended effective 44:5 Md. R. 293, eff. 3/13/2017; amended effective 45:7 Md. R. 345, eff. 4/9/2018; amended effective 46:10 Md. R. 485, eff. 5/20/2019; amended effective 47:20 Md. R. 875, eff. 10/5/2020