<?xml version='1.0' encoding='utf-8'?>
<regulation prefix="Regulation" num=".06" citation="COMAR 10.09.52.06" title_num="10" subtitle_num="09" chapter_num="52" heading="Payment Procedures.">
  <paragraph num="A.">
    <text>Request for Payment.</text>
    <paragraph num="(1)">
      <text>An approved provider shall submit requests for payment for the services covered under this chapter according to procedures established by the Program. The Program reserves the right to return to the provider, before payment, all requests not properly completed.</text>
    </paragraph>
    <paragraph num="(2)">
      <text>A provider shall:</text>
      <paragraph num="(a)">
        <text>Bill the Program for the appropriate fee or fees specified in §C of this regulation;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Accept payment from the Program as payment in full for the services covered under this chapter and make no additional charge to the participant or any other party; and</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Submit a request for payment in the manner specified by the Program, that includes the:</text>
        <paragraph num="(i)">
          <text>Date or dates of service,</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>Participant's name and Medical Assistance number,</text>
        </paragraph>
        <paragraph num="(iii)">
          <text>Provider’s name, location, and Medicaid provider number; and</text>
        </paragraph>
        <paragraph num="(iv)">
          <text>Nature, unit or units, and procedure code or codes of covered services provided.</text>
        </paragraph>
      </paragraph>
    </paragraph>
    <paragraph num="(3)">
      <text>Providers that convene or conduct an IEP team or teams in accordance with COMAR 13A.05.01 may bill the Program for all IEP-related services contained in this chapter.</text>
    </paragraph>
    <paragraph num="(4)">
      <text>Providers that participate on, but do not convene or conduct, an IEP team or teams, may only bill for ongoing service coordination, only for day students. These providers may not bill for ongoing service coordination for the residential students who reside in facilities that receive Medical Assistance reimbursement for residential services.</text>
    </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>The Program shall make payment only to one qualified provider for covered services rendered on a particular date of service to a participant and according to the following fee schedule covered under this chapter:</text>
    <paragraph num="(1)">
      <text>Initial IEP: no more than one unit of service may be reimbursed per participant ... $500;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Ongoing IEP service coordination: no more than one unit of service per month may be reimbursed for a participant ... $150;</text>
    </paragraph>
    <paragraph num="(3)">
      <text>IEP review: at most, three units of service may be reimbursed for a participant in a 12-month period ... $275;</text>
    </paragraph>
    <paragraph num="(4)">
      <text>Waiver initial assessment: No more than one unit of service may be reimbursed per waiver participant ... $500;</text>
    </paragraph>
    <paragraph num="(5)">
      <text>Waiver ongoing service coordination: No more than one unit of service per month may be reimbursed for a waiver participant ... $150;</text>
    </paragraph>
    <paragraph num="(6)">
      <text>Waiver reassessment: At most, four units of service may be reimbursed for a waiver participant in a 12-month period ... $275.</text>
    </paragraph>
  </paragraph>
  <paragraph num="D.">
    <text>The Program may not make payment for ongoing service coordination when, for the same month, payment is made to the provider for furnishing to the participant:</text>
    <paragraph num="(1)">
      <text>An initial IEP service; or</text>
    </paragraph>
    <paragraph num="(2)">
      <text>An IEP review service.</text>
    </paragraph>
  </paragraph>
  <paragraph num="E.">
    <text>The Program may not make payment for more than one IEP review in the same month, unless a subsequent review is documented as an emergency.</text>
  </paragraph>
  <paragraph num="F.">
    <text>The Program may not make payment for an initial IEP and an IEP review in the same month, unless a review is documented as an emergency.</text>
  </paragraph>
  <paragraph num="G.">
    <text>If an IEP review takes more than one meeting to complete, the Program shall only make payment for the meeting during which the review was signed.</text>
  </paragraph>
  <paragraph num="H.">
    <text>A provider shall be paid the lesser of:</text>
    <paragraph num="(1)">
      <text>The provider's usual and customary charge to the general public unless the service is free to individuals not covered by Medicaid; or</text>
    </paragraph>
    <paragraph num="(2)">
      <text>The rate established under §C of this regulation</text>
    </paragraph>
  </paragraph>
</regulation>