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<section article="ghg" article_name="Health - General" number="7-308" title_number="7" title_name="Developmental Disabilities Law" subtitle_number="3" subtitle_name="State Plan">
  <level label="a">
    <text>In this section, “pilot program” means the fee–for–service payment pilot program.</text>
  </level>
  <level label="b">
    <text>The Department shall establish a fee–for–service payment pilot program.</text>
  </level>
  <level label="c">
    <text>A provider that provides waiver program services to individuals with a developmental disability who are eligible for services under Subtitle 4 of this title may participate in the pilot program.</text>
  </level>
  <level label="d">
    <text>The Department shall:</text>
    <level label="1">
      <text>Determine and establish rates for waiver program services; and</text>
    </level>
    <level label="2">
      <text>Publish the rates for waiver program services, and any subsequent changes to those rates, in regulation.</text>
    </level>
  </level>
  <level label="e">
    <level label="1">
      <text>A provider participating in the pilot program shall submit a claim for payment to the Department on a form that the Department requires.</text>
    </level>
    <level label="2">
      <text>Payment for a claim is subject to the following limitations:</text>
      <level label="i">
        <text>Payment may not be made for a claim that is received by the Department more than 1 calendar year after the date the services were provided; and</text>
      </level>
      <level label="ii">
        <text>A claim that is not submitted within the time period required under item (i) of this paragraph may not be charged to the recipient of services.</text>
      </level>
    </level>
  </level>
  <level label="f">
    <text>A provider may not knowingly submit to the Department:</text>
    <level label="1">
      <text>A false or fraudulent claim for payment; or</text>
    </level>
    <level label="2">
      <text>Documentation supporting a claim that contains false information.</text>
    </level>
  </level>
  <level label="g">
    <level label="1">
      <text>A provider that participates in the pilot program must complete and submit to the Department each year financial statements for each fiscal year that were audited by an independent certified public accountant.</text>
    </level>
    <level label="2">
      <text>A provider participating in the pilot program shall submit information required by the Department, on a form approved by the Department, relating to wages and benefits paid to direct support professionals.</text>
    </level>
    <level label="3">
      <text>The Department may require a provider participating in the pilot program to submit information related to the provision of services to individuals with a developmental disability as it relates to the execution of the pilot program.</text>
    </level>
  </level>
  <level label="h">
    <text>The Department may:</text>
    <level label="1">
      <text>Conduct an audit of any records supporting a claim for payment of a provider participating in the pilot program; and</text>
    </level>
    <level label="2">
      <text>Recover overpayments from a provider.</text>
    </level>
  </level>
  <level label="i">
    <text>A provider participating in the pilot program shall comply with all applicable laws and regulations governing financial documentation, reporting, and other payment–related requirements for Medicaid providers.</text>
  </level>
</section>
