<?xml version='1.0' encoding='utf-8'?>
<regulation prefix="Regulation" num=".12" citation="COMAR 10.09.46.12" title_num="10" subtitle_num="09" chapter_num="46" heading="Payment Procedures.">
  <paragraph num="A.">
    <text>Request for Payment.</text>
    <paragraph num="(1)">
      <text>An approved provider, with the exception of a medical day care provider, shall submit requests for payment to BHA or its authorized representative for the services covered under this chapter, according to procedures set forth in COMAR 10.09.36.04 or otherwise established by the Department. Medical day care providers shall submit requests for payment to the Department in accordance with COMAR 10.09.07.08.</text>
    </paragraph>
    <paragraph num="(2)">
      <text>The provider shall:</text>
      <paragraph num="(a)">
        <text>Bill the Department in accordance with the payment methodology specified in §C of this regulation;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Accept payment from the Department as payment in full for the services covered under this chapter and make no additional charge for the covered services to the participant or any other party; and</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Submit a request for payment in a manner approved by the Department, which includes the:</text>
        <paragraph num="(i)">
          <text>Date or dates of service;</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>Participant's name and Medicaid number;</text>
        </paragraph>
        <paragraph num="(iii)">
          <text>Provider's name, location, and Program identification number;</text>
        </paragraph>
        <paragraph num="(iv)">
          <text>Type, procedure code or codes, and unit or units of covered services provided; and</text>
        </paragraph>
        <paragraph num="(v)">
          <text>Amount of reimbursement requested.</text>
        </paragraph>
      </paragraph>
    </paragraph>
  </paragraph>
  <paragraph num="B.">
    <text>Billing time limitations for the services covered under this chapter are the same as those set forth in COMAR 10.09.36.06.</text>
  </paragraph>
  <paragraph num="C.">
    <text>Payments.</text>
    <paragraph num="(1)">
      <text>Payments shall be made only to a qualified provider for services covered under this chapter which are rendered to a participant.</text>
    </paragraph>
    <paragraph num="(2)">
      <text>The Program shall pay according to the following fee-for-service schedule:</text>
      <paragraph num="(a)">
        <text>Residential habilitation reimbursed at:</text>
        <paragraph num="(i)">
          <text>$305.51 per day for Level 1 effective July 1, 2024;</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>$404.52 per day for Level 2 effective July 1, 2024; and</text>
        </paragraph>
        <paragraph num="(iii)">
          <text>$559.63 per day for Level 3 effective July 1, 2024;</text>
        </paragraph>
      </paragraph>
      <paragraph num="(b)">
        <text>Day habilitation reimbursed at:</text>
        <paragraph num="(i)">
          <text>$78.88 per day for Level 1 effective July 1, 2024;</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>$137.59 per day for Level 2 effective July 1, 2024; and</text>
        </paragraph>
        <paragraph num="(iii)">
          <text>$193.57 per day for Level 3 effective July 1, 2024;</text>
        </paragraph>
      </paragraph>
      <paragraph num="(c)">
        <text>Supported employment reimbursed at:</text>
        <paragraph num="(i)">
          <text>$46.80 per day for Level 1 effective July 1, 2024;</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>$78.88 per day for Level 2 effective July 1, 2024; and</text>
        </paragraph>
        <paragraph num="(iii)">
          <text>$193.57 per day for Level 3 effective July 1, 2024; and</text>
        </paragraph>
      </paragraph>
      <paragraph num="(d)">
        <text>Individual support services (ISS): reimbursed at the rate of $9.5666 per 15 minutes effective July 1, 2024; and</text>
      </paragraph>
      <paragraph num="(e)">
        <text>Individual support services—virtual: reimbursed at the rate of $9.5666 per 15 minutes effective July 1, 2024.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(3)">
      <text>The Program shall pay for medical day care services in accordance with COMAR 10.09.07 and the participant's approved plan of care.</text>
    </paragraph>
    <paragraph num="(4)">
      <text>Program rates specified in this regulation shall increase each fiscal year through FY 2026, subject to the limitations of the State budget.</text>
    </paragraph>
  </paragraph>
</regulation>