<?xml version='1.0' encoding='utf-8'?>
<regulation prefix="Regulation" num=".07" citation="COMAR 10.09.04.07" title_num="10" subtitle_num="09" chapter_num="04" heading="Payment Procedures.">
  <paragraph num="A.">
    <text>The provider shall submit his request for payment on the form designated by the Department.</text>
  </paragraph>
  <paragraph num="B.">
    <text>To receive payment for services under Regulation .04 of this chapter, a provider and its workers shall use the Electronic Visit Verification method and data management system approved by the Department to document time and submit claims in accordance with COMAR 10.09.36.03-2.</text>
  </paragraph>
  <paragraph num="C.">
    <text>The provider shall submit requests for payment for supplies on the same invoice which requests payment for the visit during which the supplies were used.</text>
  </paragraph>
  <paragraph num="D.">
    <text>The Department reserves the right to return to the provider, before payment, all invoices not properly completed.</text>
  </paragraph>
  <paragraph num="E.">
    <text>Payment Rates.</text>
    <paragraph num="(1)">
      <text>The provider shall be paid the lesser of:</text>
      <paragraph num="(a)">
        <text>The provider's customary charge to the general public unless the service is free to individuals not covered by Medicaid; or</text>
      </paragraph>
      <paragraph num="(b)">
        <text>The rate in accordance with the Department's fee schedule.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(2)">
      <text>For out-of-State providers, rates shall be paid at the lower of the following:</text>
      <paragraph num="(a)">
        <text>The home state's Medicaid rate for the same service rendered by the same provider if the provider participates in its home state Medicaid Program; or</text>
      </paragraph>
      <paragraph num="(b)">
        <text>The rate paid for the same service rendered by a provider in the nearest Maryland county.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(3)">
      <text>The Department shall pay home health providers for medical and other supplies which are used during a covered home health visit as part of the treatment ordered by the participant's physician, physician assistant, certified nurse midwife, or certified nurse practitioner at a rate that is the lesser of the:</text>
      <paragraph num="(a)">
        <text>Provider's customary charge to the general public unless the service is free to individuals not covered by Medicaid; or</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Medicaid rate for the supply or pharmaceutical under COMAR 10.09.12 and 10.09.03.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(4)">
      <text>Subject to the limitations of the State budget, the fee schedule rates shall be adjusted annually by the same factor used by the Centers for Medicare and Medicaid Services in updating Medicare's prospective payment system rates. The annual fee schedule rate adjustment shall be limited to a maximum of 5 percent and be effective the date on which Medicare's rate changes are implemented.</text>
    </paragraph>
    <paragraph num="(5)">
      <text>The fee schedule effective January 1, 2025 is as follows:</text>
    </paragraph>
  </paragraph>
  <paragraph num="F.">
    <text>Billing time limitations for claims submitted pursuant to this chapter are set forth in COMAR 10.09.36.</text>
  </paragraph>
  <paragraph num="G.">
    <text>The Department shall reimburse for supervision of home health aide services by a registered nurse as part of the home health aide reimbursement.</text>
  </paragraph>
  <paragraph num="H.">
    <text>Payment to a provider of newborn early discharge services may not exceed the rate for one skilled nursing visit.</text>
  </paragraph>
  <paragraph num="I.">
    <text>The Department shall reimburse for preauthorized home health services upon verification that a face-to-face encounter with the participant was performed as described under Regulation .03C of this chapter.</text>
  </paragraph>
  <paragraph num="J.">
    <text>The home health provider shall identify the individual who ordered the home health services by recording the individual practitioner's National Provider Identifier (NPI) number on the claim.</text>
  </paragraph>
</regulation>