Chapter 52. Service Coordination for Children with an IEP or Enrolled in the Autism Waiver
Regulation .01 Definitions.LinkCopy Citation
A.
In this chapter, the following terms have the meanings indicated.
B.
Terms Defined.
(1)
“Autism” has the meaning stated in COMAR 10.09.56.01C.
(2)
“Autism Waiver” or “Waiver” means the Home and Community-Based Services Waiver for Children with Autism Spectrum Disorder.
(3)
“Autism Waiver Service Coordination” means the coordination of waiver services covered under this chapter.
(4)
“Autism Waiver Service Coordinator” means an individual who meets the requirements specified in Regulation .03-1 of this chapter and provides the autism waiver services specified in Regulations .04-1—04.2 of this chapter to a waiver participant.
(5)
“Department” has the meaning stated in COMAR 10.09.36.01.
(6)
“Home and Community-Based Services Waiver for Children with Autism Spectrum Disorder” means the program implemented under COMAR 10.09.56 in accordance with the document and any amendments to it submitted by the Department to, and approved by, the Secretary of the U. S. Department of Health and Human Services, which authorizes the waiver, pursuant to Section 1915(c) of Title XIX of the Social Security Act, of certain specified statutory requirements limiting coverage for home and community-based services under the Medical Assistance Program.
(7)
“IEP service coordination” means the coordination of services which assists a participant in gaining access to the services recommended in the participant’s IEP.
(8)
“IEP service coordinator” means an individual who meets the requirements in Regulation .03C of this chapter.
(9)
“Individualized Education Program (IEP)” means a written, individualized plan of care for a participant, that:
(a)
Is developed by an IEP team on a form approved by MSDE;
(b)
Recommends the special education and related services to meet a participant's needs; and
(c)
Conforms with the requirements in COMAR 13A.05.01 and 34 CFR §§300.320—300-324.
(10)
“Individualized education program (IEP) team” means the multidisciplinary team convened by a provider in accordance with COMAR 13A.05.01 to review a participant’s needs, develop the participant’s IEP, and determine the placement of the participant in the least restrictive environment.
(11)
“Individualized family service plan (IFSP)” means a written, individualized plan for providing early intervention and other services for an infant, toddler, or preschool-age child, in accordance with COMAR 13A.13.01.
(12)
“Local lead agency” means the agency designated by the local governing authority in each jurisdiction to administer the interagency system of early intervention services under the direction of the Maryland State Department of Education.
(13)
“Local school system (LSS)” means any public school system in Maryland responsible for providing public elementary or secondary education.
(14)
“Maryland Medicaid Managed Care Program” has the meaning stated in COMAR 10.67.01.01.
(15)
“Maryland State Department of Education (MSDE)” is the agency responsible for ensuring that all children with disabilities residing in the State are identified, assessed, and provided with a free, appropriate public education consistent with State and federal laws.
(16)
“Medically necessary” has the meaning stated in COMAR 10.09.36.01.
(17)
“Parent” has the meaning stated in COMAR 13A.13.01.03.
(18)
“Participant” means an individual who meets the qualifications for participation in the services covered under this chapter, as specified in Regulation .02 of this chapter.
(19)
“Program” has the meaning stated in COMAR 10.09.36.01.
(20)
“Provider” means an agency which meets the conditions for participation, as specified in Regulation .03 of this chapter.
(21)
“Qualified diagnostician” means an individual whose license or certification permits diagnosis of Autism Spectrum Disorder.
(22)
“Rare and expensive case management (REM)” has the meaning stated in COMAR 10.09.69.02.
(23)
“Telehealth” has the meaning as stated in COMAR 10.09.49.02.
(24)
“Waiver eligible person” means an individual who meets the qualifications, as specified in COMAR 10.09.56, for participation in the Autism Waiver.
(25)
“Waiver multidisciplinary team” means the team, consistent with the Individuals with Disabilities Education Act (IDEA), which is convened for a waiver applicant or waiver participant.
(26)
“Waiver participant” means a waiver eligible person who is enrolled in the Autism Waiver.
(27)
“Waiver plan of care” means the written, individualized treatment plan which preauthorizes the specific Autism Waiver services to be provided to a waiver participant, as covered under COMAR 10.09.56.
Regulation .02 Participant Eligibility.LinkCopy Citation
A participant is eligible for Service Coordination if:
A.
The individual is enrolled as a waiver participant in accordance with the requirements of COMAR 10.09.56 and this chapter; or
B.
The following requirements are met:
(1)
The participant, for whom free and appropriate education is provided under the Individuals with Disabilities Education Act, is aged 3 through 20 years old;
(2)
An IEP team determines that the participant is a child with disabilities who:
(a)
Is eligible for special education and related services, and
(b)
Needs an IEP;
(3)
The participant elects, or the participant’s parent elects on the participant’s behalf, to receive the services available under this chapter; and
(4)
The participant is not a resident of any of the facilities that receive Medicaid reimbursement for residential services.
Regulation .03 Conditions for Participation for IEP Service Coordination Providers.LinkCopy Citation
A.
General requirements for participation in the Program are that a provider shall:
(1)
Meet all the conditions for participation as set forth in COMAR 10.09.36; and
(2)
If delivering services via telehealth, comply with COMAR 10.09.49 and any subregulatory guidance issued by the Department.
B.
IEP service coordination providers shall:
(1)
Be an agency within the State that:
(a)
Operates programs with special education and related services for children with disabilities, in accordance with COMAR 13A.05.01; and
(b)
Is eligible to receive, through MSDE, funding from Assistance to States for the Education of Children with Disabilities under Part B of the Individuals with Disabilities Education Act;
(2)
Convene or participate on an IEP team or teams, in accordance with COMAR 13A.05.01;
(3)
Designate specific, qualified individuals as service coordinators, and verify their credentials for providing the services covered under this chapter;
(4)
Be knowledgeable of the eligibility requirements and application procedures of federal, State, and local government assistance programs which are applicable to participants;
(5)
Maintain a file on each participant which meets the Program’s requirements which shall include:
(a)
Copies of the participant's IEP with any revisions;
(b)
Written parental consent to initiate services covered under this chapter;
(c)
Written parental consent prior to accessing the student’s public benefits or insurance the first time, and annually thereafter, in accordance with 34 CFR §300.154(d)(2);
(d)
Approval from a participant’s parent of the participant’s IEP before implementation of the IEP service coordination; and
(e)
A record of IEP service coordination encounters including:
(i)
A brief description of the service;
(ii)
The location;
(iii)
The name of the contact (parent/guardian or student);
(iv)
The date of the service; and
(v)
The IEP service coordinator’s printed name and signature; and
(6)
Employ or have under contract qualified personnel who convene or participate on IEP teams, convene or participate on multidisciplinary teams as necessary, and develop participants’ IEPs.
C.
IEP Service Coordinator Requirements.
(1)
An IEP service coordinator shall:
(a)
Be employed by or under contract with a provider;
(b)
Be identified by the IEP team ;
(c)
Participate with the IEP team in the development or revision of a participant’s IEP and in the IEP review;
(d)
Assist the participant in gaining access to the services recommended in the IEP; and
(e)
Collect and synthesize evaluation reports and other relevant information about a participant that might be needed by an IEP team.
(2)
An IEP service coordinator shall have the following qualifications and be a:
(a)
Professional who has a current license or certification, in accordance with §C(3) of this regulation, in the profession most immediately relevant to a participant's needs; or
(b)
Nonprofessional who meets the requirements in §C(4) of this regulation.
(3)
A professional who is chosen as a participant's service coordinator shall meet the following licensing or certification requirements, as appropriate, and be:
(a)
An audiologist licensed pursuant to COMAR 10.41.03.03 and certified pursuant to COMAR 13A.12.03.09;
(b)
A guidance counselor with at least a master's degree and certified pursuant to COMAR 13A.12.03.02;
(c)
A professional counselor licensed to practice in accordance with Health Occupations Article, Title 17, Annotated Code of Maryland;
(d)
A registered nurse licensed pursuant to Health Occupations Article, Title 8, Annotated Code of Maryland;
(e)
An occupational therapist licensed pursuant to Health Occupations Article, Title 10, Annotated Code of Maryland;
(f)
A physical therapist licensed pursuant to Health Occupations Article, Title 13, Annotated Code of Maryland;
(g)
A psychologist with at least a master's degree in psychology and certified pursuant to COMAR 13A.12.03.08;
(h)
A pupil personnel worker with at least a master's degree and certified pursuant to COMAR 13A.12.03.04;
(i)
A social worker licensed at the master's level as a licensed certified social worker or licensed graduate social worker, pursuant to Health Occupations Article, Title 19, Annotated Code of Maryland;
(j)
A speech-language pathologist:
(i)
With at least a master's degree in speech pathology; or
(ii)
Certified pursuant to COMAR 13A.12.03.09 or licensed pursuant to Health Occupations Article, Title 2, Annotated Code of Maryland;
(k)
An education professional who is:
(i)
Certified as a teacher pursuant to COMAR 13A.12.02; or
(ii)
Certified as an administrator or supervisor pursuant to COMAR 13A.12.04.
(4)
A nonprofessional who is chosen as a participant’s IEP service coordinator shall meet the following requirements:
(a)
Have at least a high school diploma or the equivalent;
(b)
Have demonstrated training or experience in providing IEP service coordination to students with disabilities; and
(c)
Participate in ongoing IEP service coordination training offerings as specified in the interagency plan for special education services.
Regulation .03-1 Conditions for Participation for Autism Waiver Service Coordination Providers.LinkCopy Citation
A.
General requirements for participation in the Program are that a provider shall:
(1)
Meet all the conditions for participation as set forth in COMAR 10.09.36; and
(2)
If delivering services via telehealth, comply with COMAR 10.09.49 and any subregulatory guidance issued by the Department.
B.
Specific requirements for participation in the Program as a provider of Autism Waiver Service Coordination are that a provider shall:
(1)
Be an agency within the State that employs or has under contract qualified personnel who convene or participate on waiver multidisciplinary teams as necessary, develop participant’s waiver plans of care, and provide service coordination services for waiver participants;
(2)
Designate specific, qualified individuals as Autism Wavier service coordinators and verify their credentials for providing the services covered under this chapter;
(3)
Convene or participate on a waiver multidisciplinary team or teams for waiver participants, in accordance with the requirements of COMAR 10.09.56 and this chapter;
(4)
Be knowledgeable of the eligibility requirements and application procedures of federal, State, and local government assistance programs that are applicable to participants; and
(5)
Maintain a file on each participant that meets the Program’s requirements and includes the waiver participant’s:
(a)
Technical eligibility form approved by MSDE, reviewed and signed at least annually;
(b)
Determination of eligibility for level of care in an intermediate care facility for the intellectually disabled and persons with related conditions (ICF/IID) — initial determination and redetermination, at least annually;
(c)
Autism Waiver Risk Assessment pursuant to 10.09.56;
(d)
Consent Form for Autism Waiver Services, signed before Autism Waiver enrollment and annually thereafter;
(e)
Form for determination of Medicaid eligibility for Autism Waiver services — initial determination and redetermination, at least annually;
(f)
Initial waiver plan of care, reviewed at least annually, and any plan revisions;
(g)
Parental Rights and Responsibilities form reviewed and signed at least annually;
(h)
Preauthorization by MSDE of any environmental accessibility adaptations reimbursed through the Autism Waiver, if applicable;
(i)
Reportable Event forms concerning the waiver participant, if applicable;
(j)
Record of ongoing Autism Wavier service coordination encounters, including:
(i)
A description of the service;
(ii)
The location of the service;
(iii)
Date of contact and name of the parent/guardian or participant;
(iv)
Type of contact;
(v)
Supportive documentation of the service; and
(vi)
The Autism Wavier service coordinator’s printed name and signature;
(k)
Monthly tracking logs with Technical Eligibility Exemption Request Forms as applicable; and
(l)
A copy of the treatment plans for each applicable service provided or Reportable Event form, as applicable, if a treatment plan was not submitted.
C.
Autism Waiver Service Coordinator Requirements.
(1)
An Autism Waiver service coordinator shall:
(a)
Be employed by or under contract with a provider;
(b)
Be approved by the participant’s parent or parents;
(c)
Participate with the waiver multidisciplinary team in the development, or revision, of a participant’s waiver plan of care and in the waiver plan of care review;
(d)
Assist the participant in gaining access to the services recommended in the waiver plan of care; and
(2)
An Autism Waiver service coordinator who is chosen to provide services for a waiver participant shall have at least:
(a)
1 year of relevant training or experience; and
(b)
A bachelor’s degree.
(3)
An Autism Waiver service coordinator shall complete at least 5 hours of training on the Autism Waiver, offered by the Department and MSDE, prior to rendering Autism Waiver service coordination in accordance with Regulations .04-1 and .04-2 of this chapter.
(4)
Autism Waiver service coordinators shall attend one Statewide training for Autism Waiver service coordinators per fiscal year.
Regulation .04 Covered Services.LinkCopy Citation
A.
The Program shall reimburse for the services in §§B—D of this regulation when the services have been documented, pursuant to the requirements of this chapter, as medically necessary.
B.
Initial IEP.
(1)
Definition. “Unit of service” means:
(a)
A completed initial IEP, signed by all members of the IEP team; and
(b)
At least one contact by the participant’s service coordinator or IEP team in person or by telephone with the participant or the participant’s parent, on the participant’s behalf relating to development of the IEP.
(2)
The covered services include convening and conducting an IEP team to:
(a)
Perform a multidisciplinary assessment of the participant; and
(b)
Develop an initial IEP.
C.
Ongoing Service Coordination.
(1)
Ongoing service coordination is provided by a participant's service coordinator.
(2)
Definition. For purposes of this section, “unit of service” means:
(a)
At least one contact per month by the service coordinator in person, by telephone, or by written progress notes or log with the participant or the participant's parent, on the participant's behalf relating to the child's ongoing service coordination; and
(b)
The provision of all other necessary services covered under these regulations.
(3)
As necessary, the Program shall include as covered services the following:
(a)
Acting as a central point of contact relating to IEP services for a participant;
(b)
Maintaining contact with:
(i)
The child's direct service providers, as applicable, which may include, but not be limited to, the child's Maryland Medicaid Managed Care Program provider or the Rare and Expensive case management provider; and
(ii)
A participant and the participant's parent through home visits, office visits, written notes, school visits, telephone calls, and follow-up service as necessary;
(c)
Implementing the IEP by referring the participant to direct service providers, assisting the participant in gaining access to services specified in the IEP, and providing linkage to agreed-upon direct service providers of services;
(d)
Discussing with direct service providers the services needed and available for the participant, assessing the quality and quantity of services being provided, following up to identify any obstacles to a participant’s utilization of services, coordinating the service delivery, and performing ongoing monitoring to determine whether the services are being delivered in an integrated fashion as recommended in the IEP and meet the participant’s current needs;
(e)
Providing a participant and the participant’s parent with information and direction that will assist them in successfully accessing and using the services recommended in the IEP;
(f)
Informing a participant’s parent of the participant’s and the family’s rights and responsibilities in regard to specific programs and resources recommended in the IEP;
(g)
Conducting, with a participant’s parent at a meeting or by other means acceptable to the parent and the service coordinator, a periodic review of the participant’s IEP every 6 months, or more frequently if warranted or the parent requests a review; and
(h)
Reviewing at least annually at a meeting or by other means acceptable to the participant’s parent and others involved in the review process:
(i)
The degree of a participant’s progress toward achieving the goals established in the IEP; and
(ii)
Whether the goals or recommended services need to be revised.
(4)
Administrative, supervisory, and monitoring services associated with the ongoing service coordination, including coordinating with the child's primary care provider, are included as part of the service.
D.
IEP Review.
(1)
Definition. “Unit of service” means:
(a)
A completed initial 60-day, interim, or annual IEP review as evidenced by a signed revised IEP or, if a revised IEP was not done, IEP team records documenting a meeting in which there is participation by at least two different disciplines; and
(b)
At least one contact by the service coordinator or IEP team in person, by telephone, or by written progress notes or log with the participant or the participant's parent, on the participant's behalf.
(2)
The covered services include convening and conducting an IEP team to:
(a)
Perform a multidisciplinary reassessment of the participant's status and service needs; and
(b)
Review and revise, as necessary, the participant’s IEP.
Regulation .04-1 Covered Services — Autism Waiver Service Coordination — General Requirements.LinkCopy Citation
A.
Autism Waiver Service Coordination is intended to:
(1)
Assist a waiver participant in gaining access to the Autism Waiver services approved in the waiver participant's waiver plan of care;
(2)
Assure coordination of the waiver participant's Autism Waiver services with other services received by the waiver participant; and
(3)
Assure that the waiver participant's full range of needs are adequately met, so as to assure the individual's:
(a)
Appropriate placement in the community;
(b)
Health and safety;
(c)
Quality of care; and
(d)
Access to authorized, necessary services.
B.
Waiver Service Coordinator. A waiver service coordinator employed by a provider shall assist with meeting the provider’s responsibilities specified in this regulation and Regulation .04-2 of this chapter.
C.
Waiver Multidisciplinary Team. A waiver multidisciplinary team:
(1)
Shall be convened by the local lead agency or local school system to:
(a)
Assess or reassess a waiver applicant's or waiver participant's need and eligibility for Autism Waiver services; and
(b)
Develop or review the waiver participant's waiver plan of care; and
(2)
Shall include:
(a)
The waiver participant's service coordinator;
(b)
The waiver applicant's or waiver participant's parent or parents;
(c)
A chairman who is the official representative of the local lead agency or local school system; and
(d)
Other service providers and individuals, as appropriate.
D.
Waiver Plan of Care.
(1)
A waiver participant's waiver plan of care is:
(a)
Initially developed on admission to the Autism Waiver;
(b)
Reviewed at least every 12 months; and
(c)
Revised as necessary by a waiver multidisciplinary team convened by the waiver participant's service coordinator.
(2)
A waiver participant’s waiver plan of care shall be submitted to MSDE before implementation.
(3)
Any revisions or additions to a waiver participant’s waiver plan of care shall be submitted to MSDE before implementation.
(4)
A waiver participant’s Autism Waiver service coordinator may make minor changes to the waiver participant’s waiver plan of care without reconvening the waiver multidisciplinary team, if the change is approved by the waiver participant’s parent or parents, and MSDE is notified.
(5)
A waiver participant’s initial or revised waiver plan of care shall include the:
(a)
Identification of Autism Waiver service or services to be delivered;
(b)
Service start date;
(c)
Service stop date;
(d)
Approved amount of services to be delivered; and
(e)
Provider or providers.
E.
Three types of Autism Waiver Service Coordination shall be provided, at times concurrently;
(1)
Waiver initial assessment;
(2)
Waiver ongoing service coordination; and
(3)
Waiver reassessment.
Regulation .04-2 Covered Services — Autism Waiver Service Coordination — Specific Requirements.LinkCopy Citation
A.
Waiver Initial Assessment.
(1)
Definition. For the purposes of this section, “unit of service” means:
(a)
A completed initial waiver plan of care, submitted to MSDE and signed by the service coordinator, the waiver participant or the parent or parents of a minor child, and all other members of the waiver multidisciplinary team; or
(b)
The provision of all necessary services specified in §A(2) of this regulation.
(2)
The covered services shall include:
(a)
Convening, coordinating, and participating on the waiver multidisciplinary team to perform the initial assessment and develop the waiver participant's initial waiver plan of care;
(b)
Assisting the waiver participant or the parent or parents of a minor child with scheduling and attending the appointments required for the waiver initial assessment;
(c)
Referring the waiver participant to approved Autism Waiver providers specified in the waiver plan of care;
(d)
Assisting the waiver participant with gaining access to the Autism Waiver services preauthorized in the waiver plan of care;
(e)
Assisting waiver participants with the waiver enrollment process specified in COMAR 10.09.56; and
(f)
Assisting with completion of forms and coordinating with the Department for determination of the waiver participant's Medicaid financial and technical eligibility in a timely fashion.
B.
Waiver Ongoing Autism Waiver Service Coordination.
(1)
Definition. For the purposes of this section, a monthly “unit of service” means:
(a)
At least one documented monthly contact by the waiver participant’s service coordinator in person, by telephone, via telehealth, or through written progress notes with the waiver participant or parent;
(b)
A quarterly visit to the waiver participant’s residence, residential program, or day program conducted in person or via telehealth, including at least one in-person visit to the waiver participant’s residence every 12 months; and
(c)
The provision of all other necessary services specified in §B(2) of this regulation.
(2)
The covered services shall include, as necessary:
(a)
Acting as a central point of contact relating to a waiver participant;
(b)
Coordinating Autism Waiver Service Coordination with the Department and MSDE;
(c)
Referring the waiver participant to the Autism Waiver providers specified in the waiver plan of care;
(d)
Assisting the waiver participant with gaining access to the Autism Waiver services preauthorized in the waiver plan of care according to the type, level, amount, frequency, and duration;
(e)
Assisting with coordination of the Autism Waiver service delivery;
(f)
Providing the waiver participant and the parent or parents with information and direction to assist them with accessing and successfully utilizing the Autism Waiver services preauthorized in the waiver plan of care;
(g)
Maintaining contact with the waiver participant’s waiver and other service providers and with the waiver participant or parent through documented in-person visits, telehealth contact, telephone calls, mailings, and follow-up services as necessary;
(h)
Following up to identify any problems or obstacles to the waiver participant's appropriate receipt of the Autism Waiver services specified in the waiver plan of care;
(i)
Assisting to resolve any conflicts or crises in delivery of the waiver participant's Autism Waiver services which jeopardize the waiver participant's community placement or the health and safety of the waiver participant or another individual;
(j)
Making minor changes to the waiver participant’s waiver plan of care as necessary, without reconvening the waiver multidisciplinary team, if the change is approved by the waiver participant’s parent or parents and submitted to MSDE;
(k)
Assuring that the necessary documentation is maintained in the waiver participant’s file, as specified in Regulation .03-1B(5) of this chapter;
(l)
Providing MSDE with required information in the established time frame on waiver participants enrolled in the Autism Waiver; and
(m)
Monitoring on an ongoing basis:
(i)
The appropriateness of the type, amount, duration, and quality of the Autism Waiver services received by a waiver participant;
(ii)
Whether a waiver participant's Autism Waiver services are delivered in an integrated and coordinated fashion and adequately meet the waiver participant's current needs; and
(iii)
The impact of the Autism Waiver services on the waiver participant's health, safety, development, relationships with family members and other persons, home environment, educational program, quality of life, and life satisfaction.
C.
Waiver Reassessment. For the purposes of this section, “unit of service” means:
(1)
A completed waiver plan of care review at least every 12 months, with revisions as necessary, which is submitted to MSDE and signed by the Autism Waiver service coordinator, the waiver participant or the parent or parents of a minor child, and all other members of the waiver multidisciplinary team;
(2)
Assisting waiver participants with the waiver’s eligibility redetermination process, as specified in COMAR 10.09.56;
(3)
Assisting families with making informed choices in selecting between a home and community-based waiver documented in the Autism Waiver Transitioning Youth Service Delivery Option Form or other documentation as required;
(4)
Assisting the waiver participant or the parent or parents of a minor child with completion and submission of the application forms and accompanying documentation for the Medicaid financial and technical eligibility redetermination, in coordination with the Department, before the deadline established by the Department;
(5)
Completing a risk assessment within 45 days of receiving notification of eligibility by the Department using the Autism Waiver Risk Assessment form;
(6)
Completing a risk assessment if the participant’s status changes, to ensure the applicant can be safely maintained in a home and community-based setting utilizing Autism Waiver services; or
(7)
Providing written notice to a MSDE representative of the participant’s ineligibility for the Autism Waiver.
Regulation .05 Limitations.LinkCopy Citation
A.
Service Coordination for Children with an IEP or enrolled in the Autism Waiver is advisory in nature except for Autism Waiver Service Coordination, covered under Regulations .03-1, .04-1, and .04-2 of this chapter.
B.
A restriction may not be placed on a qualified participant’s option to receive the services covered under this chapter except that Autism Waiver Service Coordination, as defined by Regulations .03-1, .04-1, and .04-2 of this chapter, is required for waiver eligible persons who choose to enroll in the Autism Waiver.
C.
The services covered under this chapter may not restrict or otherwise affect the:
(1)
Participant's eligibility for Title XIX benefits or other available benefits or programs except as limited by §E of this regulation;
(2)
Freedom of the participant's parent to select from all available services for which the participant is found to be eligible;
(3)
Participant's parent's free choice among qualified providers of services covered under this chapter, as well as among service providers of other services for which the participant qualifies; or
(4)
Provider's right to bill the Program for other covered Program services.
D.
Service Coordination for Children with an IEP or enrolled in the Autism Waiver may not be:
(1)
Provided as an integral and inseparable part of another covered Program service;
(2)
Provided as an administrative function necessary for the proper and efficient operation of the State's Medical Assistance plan; or
(3)
Delivered as part of institutional discharge planning.
E.
Reimbursement may not be made for the services covered under this chapter if the participant is receiving a similar case management service under another Program authority.
F.
Reimbursement may not be made to providers that participate on, but do not convene, an IEP team or teams, for ongoing service coordination for residential students who reside in facilities that receive Medical Assistance reimbursement for residential services.
G.
Only waiver participants may receive Autism Waiver Service Coordination, covered under Regulations .04-1 and .04-2 of this chapter.
Regulation .06 Payment Procedures.LinkCopy Citation
A.
Request for Payment.
(1)
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.
(2)
A provider shall:
(a)
Bill the Program for the appropriate fee or fees specified in §C of this regulation;
(b)
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
(c)
Submit a request for payment in the manner specified by the Program, that includes the:
(i)
Date or dates of service,
(ii)
Participant's name and Medical Assistance number,
(iii)
Provider’s name, location, and Medicaid provider number; and
(iv)
Nature, unit or units, and procedure code or codes of covered services provided.
(3)
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.
(4)
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.
B.
Billing time limitations for the services covered under this chapter are the same as those set forth in COMAR 10.09.36.06.
C.
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:
(1)
Initial IEP: no more than one unit of service may be reimbursed per participant ... $500;
(2)
Ongoing IEP service coordination: no more than one unit of service per month may be reimbursed for a participant ... $150;
(3)
IEP review: at most, three units of service may be reimbursed for a participant in a 12-month period ... $275;
(4)
Waiver initial assessment: No more than one unit of service may be reimbursed per waiver participant ... $500;
(5)
Waiver ongoing service coordination: No more than one unit of service per month may be reimbursed for a waiver participant ... $150;
(6)
Waiver reassessment: At most, four units of service may be reimbursed for a waiver participant in a 12-month period ... $275.
D.
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:
(1)
An initial IEP service; or
(2)
An IEP review service.
E.
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.
F.
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.
G.
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.
H.
A provider shall be paid the lesser of:
(1)
The provider's usual and customary charge to the general public unless the service is free to individuals not covered by Medicaid; or
(2)
The rate established under §C of this regulation
Regulation .07 Recovery and Reimbursement.LinkCopy Citation
Recovery and reimbursement are as set forth in COMAR 10.09.36.07.
Regulation .08 Cause for Suspension or Removal and Imposition of Sanctions.LinkCopy Citation
Cause for suspension or removal and imposition of sanctions is as set forth in COMAR 10.09.36.08.
Regulation .09 Appeal Procedures.LinkCopy Citation
Appeal procedures are those set forth in COMAR 10.09.36.09.
Regulation .10 Interpretive Regulation.LinkCopy Citation
State regulations are interpreted in accordance with COMAR 10.09.36.10.
Chapter annotations
Authority: Health-General Article, §§2-104(b), 15-103, and 15-105, Annotated Code of Maryland
History: Effective date:
History: Regulations .01—.10 adopted as an emergency provision effective June 17, 1993 (20:14 Md. R. 1165); adopted permanently effective September 27, 1993 (20:19 Md. R. 1472)
History: Regulations .01—.06 amended as an emergency provision effective March 23, 1998 (25:8 Md. R. 595); amended permanently effective June 29, 1998 (25:13 Md. R. 993):
History: Regulations .01—.06 amended effective July 1, 2001(28:12 Md. R. 1107)
History: Regulation .01B amended effective August 27, 2007 (34:17 Md. R. 1507); March 28, 2016 (43:6 Md. R. 407): November 13, 2023 (50:22 Md. R. 973)
History: Regulation .02 amended effective November 13, 2023 (50:22 Md. R. 973)
History: Regulation .02B amended effective March 28, 2016 (43:6 Md. R. 407)
History: Regulation .03 amended as an emergency provision effective July 1, 2002 (30:1 Md. R. 23); amended permanently effective March 3, 2003 (30:4 Md. R. 316)
History: Regulation .03 amended effective November 13, 2023 (50:22 Md. R. 973)
History: Regulation .03B amended effective October 14, 2013 (40:20 Md. R. 1652)
History: Regulation .03B, C amended effective March 28, 2016 (43:6 Md. R. 407)
History: Regulation .03-1 adopted effective November 13, 2023 (50:22 Md. R. 973)
History: Regulation .04 amended effective March 28, 2016 (43:6 Md. R. 407); November 13, 2023 (50:22 Md. R. 973)
History: Regulation .04A amended effective August 27, 2007 (34:17 Md. R. 1507)
History: Regulations .04-1 and .04-2 adopted effective July 1, 2001(28:12 Md. R. 1107)
History: Regulations .04-1 amended effective November 13, 2023 (50:22 Md. R. 973)
History: Regulation .04-1D amended effective March 28, 2016 (43:6 Md. R. 407)
History: Regulation .04-2 amended effective March 28, 2016 (43:6 Md. R. 407); November 13, 2023 (50:22 Md. R. 973)
History: Regulation .04-2C amended effective December 31, 2018 (45:26 Md. R. 1243)
History: Regulation .05 amended effective November 13, 2023 (50:22 Md. R. 973)
History: Regulation .06 amended effective March 28, 2016 (43:6 Md. R. 407)
History: Regulation .06A, C amended effective November 13, 2023 (50:22 Md. R. 973)