<?xml version='1.0' encoding='utf-8'?>
<regulation prefix="Regulation" num=".22" citation="COMAR 10.09.54.22" title_num="10" subtitle_num="09" chapter_num="54" heading="Payment Procedures.">
  <paragraph num="A.">
    <text>To receive payment as a provider of services covered under Regulations .13—.19 of this chapter, a provider shall submit claims in accordance with procedures outlined in the Department's billing manual.</text>
  </paragraph>
  <paragraph num="B.">
    <text>Billing time limitations for the services covered under this chapter are set forth in COMAR 10.09.36.06.</text>
  </paragraph>
  <paragraph num="C.">
    <text>Payments.</text>
    <paragraph num="(1)">
      <text>Payments shall be made directly to a qualified provider.</text>
    </paragraph>
    <paragraph num="(2)">
      <text>A provider shall be paid the lesser of:</text>
      <paragraph num="(a)">
        <text>The provider's customary charge to the general public unless the service is free to individuals not covered by Medicaid; or</text>
      </paragraph>
      <paragraph num="(b)">
        <text>The rates established in §D of this regulation.</text>
      </paragraph>
    </paragraph>
  </paragraph>
  <paragraph num="D.">
    <text>Rates.</text>
    <paragraph num="(1)">
      <text>For dates of service beginning July 1, 2022, through June 30, 2024, fees per unit of service shall be as follows:</text>
      <paragraph num="(a)">
        <text>Assisted Living Level II, No Medical Day Care: reimbursed at the maximum rate of $81.57 per day;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Assisted Living Level III, No Medical Day Care: reimbursed at the maximum rate of $102.94 per day;</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Assisted Living Level II, Medical Day Care: reimbursed at the maximum rate of $61.21 per day;</text>
      </paragraph>
      <paragraph num="(d)">
        <text>Assisted Living Level III, Medical Day Care: reimbursed at the maximum rate of $77.18 per day;</text>
      </paragraph>
      <paragraph num="(e)">
        <text>Behavioral Consultation: reimbursed at the maximum rate of $89.22 per hour;</text>
      </paragraph>
      <paragraph num="(f)">
        <text>Case Management — Administrative: reimbursed at the maximum rate of $83.66 per hour or $20.9138 per 15-minute unit;</text>
      </paragraph>
      <paragraph num="(g)">
        <text>Case Management — Comprehensive: reimbursed at the maximum rate of $83.66 per hour or $20.9138 per 15-minute unit;</text>
      </paragraph>
      <paragraph num="(h)">
        <text>Case Management — Ongoing: reimbursed at the maximum rate of $83.66 per hour or $20.9138 per 15-minute unit;</text>
      </paragraph>
      <paragraph num="(i)">
        <text>Dietitian and Nutritionist Services: reimbursed at the maximum rate of $89.22 per hour;</text>
      </paragraph>
      <paragraph num="(j)">
        <text>Family 1/1 Training: reimbursed at the maximum rate of $89.22 per hour;</text>
      </paragraph>
      <paragraph num="(k)">
        <text>Medical Day Care Services: reimbursed at the maximum rate of $104.81 per day; and</text>
      </paragraph>
      <paragraph num="(l)">
        <text>Senior Center Plus: reimbursed at the maximum rate of $64.90 per day.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(2)">
      <text>For dates of service beginning July 1, 2024, fees per unit of service shall be as follows:</text>
      <paragraph num="(a)">
        <text>Assisted Living Level II, No Medical Day Care: reimbursed at the maximum rate of $90.74 per day;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Assisted Living Level III, No Medical Day Care: reimbursed at the maximum rate of $114.51 per day;</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Assisted Living Level II, Medical Day Care: reimbursed at the maximum rate of $68.09 per day;</text>
      </paragraph>
      <paragraph num="(d)">
        <text>Assisted Living Level III, Medical Day Care: reimbursed at the maximum rate of $85.86 per day;</text>
      </paragraph>
      <paragraph num="(e)">
        <text>Behavioral Consultation: reimbursed at the maximum rate of $99.25 per hour;</text>
      </paragraph>
      <paragraph num="(f)">
        <text>Case Management — Administrative: reimbursed at the maximum rate of $93.06 per hour or $23.2645 per 15-minute unit;</text>
      </paragraph>
      <paragraph num="(g)">
        <text>Case Management — Comprehensive: reimbursed at the maximum rate of $93.06 per hour or $23.2645 per 15-minute unit;</text>
      </paragraph>
      <paragraph num="(h)">
        <text>Case Management — Ongoing: reimbursed at the maximum rate of $93.06 per hour or $23.2645 per 15-minute unit;</text>
      </paragraph>
      <paragraph num="(i)">
        <text>Dietitian and Nutritionist Services: reimbursed at the maximum rate of $99.25 per hour;</text>
      </paragraph>
      <paragraph num="(j)">
        <text>Family 1/1 Training: reimbursed at the maximum rate of $99.25 per hour;</text>
      </paragraph>
      <paragraph num="(k)">
        <text>Medical Day Care Services: reimbursed at the maximum rate of $116.59 per day; and</text>
      </paragraph>
      <paragraph num="(l)">
        <text>Senior Center Plus: reimbursed at the maximum rate of $72.19 per day.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(3)">
      <text>The Program’s rates for covered services under Regulations .13—.19 of this chapter shall be adjusted subject to the limitations of the State budget.</text>
    </paragraph>
  </paragraph>
</regulation>