Regulation .06 Payment Procedures.
Regulation .06 Payment Procedures.LinkCopy Citation
A.
Payment procedures as set forth in COMAR 10.09.36 apply.
B.
Payments.
(1)
Payments shall be made directly to a qualified provider.
(2)
Providers 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 according to the fee schedule published by the Department.
C.
Rates.
(1)
The Department shall publish a fee schedule for services covered under this chapter that shall be publicly available and updated at least annually or upon any changes made by the Department.
(2)
Effective July 1, 2022, rates for services governed by this chapter are as follows:
(a)
For home health aide or certified nursing assistant services provided to one participant:
(i)
$5.0809 per 15 minutes of services; or
(ii)
If the services are rendered by a home health aide or certified nursing assistant who is also a certified medical technician, $6.1208 per 15 minutes of services;
(b)
For home health aide or certified nursing assistant services provided to two or more participants in the same residence:
(i)
$3.5044 per 15 minutes of services per participant; or
(ii)
If the services are rendered by a home health aide or certified nursing assistant who is also a certified medical technician, $4.2232 per 15 minutes of service per participant; and
(c)
Payments for home care case management services shall be made as follows:
(i)
Waiver enrollment process — $1,181.61;
(ii)
First month of home care case management — $1,181.61; and
(iii)
The second and any subsequent month of home care case management — $590.80.
(3)
Effective January 1, 2024 through June 30, 2024, rates for services governed by this chapter are as follows:
(a)
For home health aide or certified nursing assistant services provided to one participant:
(i)
$5.4874 per 15 minutes of services; or
(ii)
$6.6105 per 15 minutes of service if the services are rendered by a home health aide or certified nursing assistant who is also a certified medical technician;
(b)
For home health aide or certified nursing assistant services provided to two or more participants in the same residence:
(i)
$3.7848 per 15 minutes of services per participant; or
(ii)
$4.5611 per 15 minutes of service per participant if the services are rendered by a home health aide or certified nursing assistant who is also a certified medical technician; and
(c)
Payments for home care case management services shall be made as follows:
(i)
Waiver enrollment process — $1,276.14;
(ii)
First month of home care case management — $1,276.14; and
(iii)
The second and any subsequent month of home care case management — $638.06.
(4)
Effective July 1, 2024, rates for services governed by this chapter are as follows:
(a)
For home health aide or certified nursing assistant services provided to one participant:
(i)
$5.6520 per 15 minutes of services; or
(ii)
If the services are rendered by a home health aide or certified nursing assistant who is also a certified medical technician, $6.8088 per 15 minutes of services;
(b)
For home health aide or certified nursing assistant services provided to two or more participants in the same residence:
(i)
$3.8983 per 15 minutes of services per participant; or
(ii)
If the services are rendered by a home health aide or certified nursing assistant who is also a certified medical technician, $4.6979 per 15 minutes of service per participant; and
(c)
Payments for home care case management services shall be made as follows:
(i)
Waiver enrollment process — $1,314.42;
(ii)
First month of home care case management — $1,314.42; and
(iii)
The second and any subsequent month of home care case management — $657.21.
(5)
Subject to the limitations of the State budget, the Program’s rates as specified in this regulation shall increase by 4 percent each year through Fiscal Year 2026.