Regulation .07 Payment Procedures.
Regulation .07 Payment Procedures.LinkCopy Citation
A.
Payment procedures are as set forth in COMAR 10.09.36.04 and .06.
B.
Payments.
(1)
Payments shall be made directly to a qualified provider.
(2)
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.
(3)
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)
Effective July 1, 2022, through December 31, 2023, rates for the services outlined in this regulation shall be as follows:
(a)
$17.87 for 15 minutes of services provided by a registered nurse to one participant;
(b)
$12.32 for 15 minutes of services provided by a registered nurse to each of two or more participants in the same residence;
(c)
$11.58 for 15 minutes of services provided by a licensed practical nurse to one participant;
(d)
$7.99 for 15 minutes of services provided by a licensed practical nurse to each of two or more participants in the same residence;
(e)
$6.12 for 15 minutes of services provided by a CNA or HHA who is also certified as a CMT to one participant;
(f)
$4.22 for 15 minutes of services provided by a CNA or HHA who is also certified as a CMT to each of two or more participants in the same residence;
(g)
$5.08 for 15 minutes of services provided by a CNA or HHA to one participant;
(h)
$3.50 for 15 minutes of services provided by a CNA or HHA to two or more participants in the same residence; and
(i)
A flat rate of $71.41 per visit for a registered nurse supervisory visit of a nurse, CNA, or HHA.
(2)
Effective January 1, 2024 through June 30, 2024, rates for the services outlined in this regulation shall be as follows:
(a)
$19.2951 for 15 minutes of services provided by a registered nurse to one participant;
(b)
$13.3101 for 15 minutes of services provided by a registered nurse to each of two or more participants in the same residence;
(c)
$12.5061 for 15 minutes of services provided by a licensed practical nurse to one participant;
(d)
$8.6266 for 15 minutes of services provided by a licensed practical nurse to each of two or more participants in the same residence;
(e)
$6.6105 for 15 minutes of services provided by a CNA or HHA who is also certified as a CMT to one participant;
(f)
$4.5611 for 15 minutes of services provided by a CNA or HHA who is also certified as a CMT to each of two or more participants in the same residence;
(g)
$5.4874 for 15 minutes of services provided by a CNA or HHA to one participant;
(h)
$3.7848 for 15 minutes of services provided by a CNA or HHA to two or more participants in the same residence; and
(i)
A flat rate of $77.13 per visit for a registered nurse supervisory visit of a nurse, CNA, or HHA.
(3)
Effective July 1, 2024, rates for the services outlined in this regulation shall be as follows:
(a)
$19.8739 for 15 minutes of services provided by a registered nurse to one participant;
(b)
$13.7094 for 15 minutes of services provided by a registered nurse to each of two or more participants in the same residence;
(c)
$12.8813 for 15 minutes of services provided by a licensed practical nurse to one participant;
(d)
$8.8854 for 15 minutes of services provided by a licensed practical nurse to each of two or more participants in the same residence;
(e)
$6.8088 for 15 minutes of services provided by a CNA or HHA who is also certified as a CMT to one participant;
(f)
$4.6979 for 15 minutes of services provided by a CNA or HHA who is also certified as a CMT to each of two or more participants in the same residence;
(g)
$5.6520 for 15 minutes of services provided by a CNA or HHA to one participant;
(h)
$3.8983 for 15 minutes of services provided by a CNA or HHA to two or more participants in the same residence; and
(i)
A flat rate of $79.44 per visit for a registered nurse supervisory visit of a nurse, CNA, or HHA.
(4)
The Program’s rates as specified in this regulation shall adjust each year, subject to the limitations of the State budget.
D.
The nursing services provider shall identify the individual who ordered the nursing services by recording the individual practitioner’s National Provider Identifier (NPI) number on the claim.