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<regulation prefix="Regulation" num=".21" citation="COMAR 10.09.56.21" title_num="10" subtitle_num="09" chapter_num="56" heading="Limitations.">
  <paragraph num="A.">
    <text>Reimbursement may be made by the Program only when all of the requirements of this chapter are met.</text>
  </paragraph>
  <paragraph num="B.">
    <text>Residential habilitation services may not be reimbursed for the same date of service as intensive individual support services, therapeutic integration services, intensive therapeutic integration services, or respite care.</text>
  </paragraph>
  <paragraph num="C.">
    <text>Therapeutic integration services, intensive therapeutic integration services, and intensive individual support services under this chapter and school health-related services under COMAR 10.09.50 may not be reimbursed for the same period of the same day.</text>
  </paragraph>
  <paragraph num="D.">
    <text>Therapeutic integration and intensive therapeutic integration services may not be rendered during the same week to a participant.</text>
  </paragraph>
  <paragraph num="E.">
    <text>Therapeutic integration and intensive therapeutic integration services may include transportation time when at least 2 units of service have been provided on-site, and the maximum units of service billed may not exceed 12 units.</text>
    <paragraph num="(1)">
      <text>For dates of service before July 1, 2023, 24 units; or</text>
    </paragraph>
    <paragraph num="(2)">
      <text>For dates of service on or after July 1, 2023, 12 units.</text>
    </paragraph>
  </paragraph>
  <paragraph num="F.">
    <text>Environmental accessibility adaptations may be reimbursed only if preauthorized by the State Department of Education.</text>
  </paragraph>
  <paragraph num="G.">
    <text>If an environmental accessibility adaptation is anticipated to cost over $500, at least two bids or prices shall be obtained, based on which the State Department of Education may approve the purchase.</text>
  </paragraph>
  <paragraph num="H.">
    <text>The Program may reimburse for a participant not more than:</text>
    <paragraph num="(1)">
      <text>For dates of service before July 1, 2023:</text>
      <paragraph num="(a)">
        <text>1 unit per date of service for residential habilitation services at either the regular or intensive level;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>40 units of therapeutic integration services per week;</text>
      </paragraph>
      <paragraph num="(c)">
        <text>30 units of intensive therapeutic integration services per week;</text>
      </paragraph>
      <paragraph num="(d)">
        <text>12 units or fewer than 2 units of therapeutic integration or intensive therapeutic integration services for a date of service;</text>
      </paragraph>
      <paragraph num="(e)">
        <text>50 units of intensive individual support services per week;</text>
      </paragraph>
      <paragraph num="(f)">
        <text>48 units of respite care for a date of service;</text>
      </paragraph>
      <paragraph num="(g)">
        <text>672 units of respite care per State fiscal year;</text>
      </paragraph>
      <paragraph num="(h)">
        <text>12 units of family consultation for a date of service;</text>
      </paragraph>
      <paragraph num="(i)">
        <text>80 units of family consultation per State fiscal year;</text>
      </paragraph>
      <paragraph num="(j)">
        <text>A total of $2,000 for environmental accessibility adaptations over a 36-month period;</text>
      </paragraph>
      <paragraph num="(k)">
        <text>16 units of intensive individual support services per day;</text>
      </paragraph>
      <paragraph num="(l)">
        <text>30 units of adult life planning services per State fiscal year, for participants 16 years old or older;</text>
      </paragraph>
      <paragraph num="(m)">
        <text>A lifetime maximum of 90 units of adult life planning services per participant, for participants 16 years old or older; and</text>
      </paragraph>
      <paragraph num="(n)">
        <text>15 units of retainer payment per calendar year at either the regular or intensive level when the participant is absent from the residential habilitation program for the purposes of family visitation, hospitalization, or other overnight stays; or</text>
      </paragraph>
    </paragraph>
    <paragraph num="(2)">
      <text>For dates of service on or after July 1, 2023:</text>
      <paragraph num="(a)">
        <text>1 unit per date of service for residential habilitation services at either the regular or the intensive level;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>80 units of therapeutic integration services per week;</text>
      </paragraph>
      <paragraph num="(c)">
        <text>60 units of intensive therapeutic integration services per week;</text>
      </paragraph>
      <paragraph num="(d)">
        <text>24 units or fewer than 2 units of therapeutic integration or intensive therapeutic integration services for a date of service;</text>
      </paragraph>
      <paragraph num="(e)">
        <text>160 units of intensive individual support services per week;</text>
      </paragraph>
      <paragraph num="(f)">
        <text>96 units of respite care for a date of service;</text>
      </paragraph>
      <paragraph num="(g)">
        <text>1344 units of respite care per State fiscal year;</text>
      </paragraph>
      <paragraph num="(h)">
        <text>24 units of family consultation for a date of service;</text>
      </paragraph>
      <paragraph num="(i)">
        <text>160 units of family consultation per State fiscal year;</text>
      </paragraph>
      <paragraph num="(j)">
        <text>A total of $2,104 for environmental accessibility adaptations over a 36-month period;</text>
      </paragraph>
      <paragraph num="(k)">
        <text>32 units of intensive individual support services per day;</text>
      </paragraph>
      <paragraph num="(l)">
        <text>80 units of adult life planning services per State fiscal year, for participants 14 years old or older;</text>
      </paragraph>
      <paragraph num="(m)">
        <text>16 units of adult life planning services per date of service, for participants 14 years old or older; and</text>
      </paragraph>
      <paragraph num="(n)">
        <text>15 units of retainer payment per calendar year at either the regular or intensive level when the participant is absent from the residential habilitation program for the purposes of family visitation, hospitalization, or other overnight stays.</text>
      </paragraph>
    </paragraph>
  </paragraph>
  <paragraph num="I.">
    <text>Respite services may not be reimbursed for the same period of the same day as:</text>
    <paragraph num="(1)">
      <text>Residential habilitation;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Intensive individual support services;</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Family consultation;</text>
    </paragraph>
    <paragraph num="(4)">
      <text>Therapeutic integration;</text>
    </paragraph>
    <paragraph num="(5)">
      <text>Intensive therapeutic integration; or</text>
    </paragraph>
    <paragraph num="(6)">
      <text>Adult life planning services.</text>
    </paragraph>
  </paragraph>
  <paragraph num="J.">
    <text>The Program does not reimburse transportation costs such as gas, maintenance, or other vehicle operating expenses.</text>
  </paragraph>
  <paragraph num="K.">
    <text>Adult life planning services under this chapter and school health-related services under COMAR 10.09.50 may not be reimbursed for the same period of the day.</text>
  </paragraph>
  <paragraph num="L.">
    <text>The Program does not reimburse for any autism waiver services for a participant whose residential placement in a 24-hour, 365-day residential program is funded with non-Medicaid federal, State, or local government funds.</text>
  </paragraph>
</regulation>