<?xml version='1.0' encoding='utf-8'?>
<regulation prefix="Regulation" num=".22" citation="COMAR 10.09.56.22" title_num="10" subtitle_num="09" chapter_num="56" 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 the procedures set forth in COMAR 10.09.36.04 or otherwise established by the Program.</text>
    </paragraph>
    <paragraph num="(2)">
      <text>The provider shall:</text>
      <paragraph num="(a)">
        <text>Bill the Program in accordance with the payment methodology specified in §§D and E 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 for these services; and</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Submit a request for payment in a manner approved by the Program, which includes the:</text>
        <paragraph num="(i)">
          <text>Date or dates of service;</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>Participant's name and Medicaid number;</text>
        </paragraph>
        <paragraph num="(iii)">
          <text>Provider's name, location, and Program identification number;</text>
        </paragraph>
        <paragraph num="(iv)">
          <text>Type, procedure code or codes, and unit or units of covered services provided; and</text>
        </paragraph>
        <paragraph num="(v)">
          <text>Amount of reimbursement requested.</text>
        </paragraph>
      </paragraph>
    </paragraph>
  </paragraph>
  <paragraph num="B.">
    <text>Documentation Required.</text>
    <paragraph num="(1)">
      <text>Payments by the Program or its designee may be withheld if the provider fails to submit requested evidence of services provided, staff qualifications, corrective action plans, or other types of documentation related to ensuring the health and safety of a participant.</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Payments shall be released upon receipt and approval by the Program or its designee of the requested documentation.</text>
    </paragraph>
    <paragraph num="(3)">
      <text>An appeal by the provider under COMAR 10.01.03 does not stay the withholding of payments.</text>
    </paragraph>
  </paragraph>
  <paragraph num="C.">
    <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="D.">
    <text>Payments.</text>
    <paragraph num="(1)">
      <text>Payments shall be made only to a qualified provider for services covered under this chapter which are rendered to a participant.</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Providers 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 rate established according to the fee schedule published by the Department.</text>
      </paragraph>
    </paragraph>
  </paragraph>
  <paragraph num="E.">
    <text>Rates.</text>
    <paragraph num="(1)">
      <text>The Department shall publish a fee schedule for services covered under this chapter that shall be publicly available and updated at least annually or upon any changes made by the Department.</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Subject to the limitations of the State budget, the Program’s rates as specified in this regulation shall increase by 4 percent each year through Fiscal Year 2026.</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Effective July 1, 2022, the Program shall pay according to the following fee-for-service schedule:</text>
      <paragraph num="(a)">
        <text>Residential habilitation services and retainer payments reimbursed at one of the following all-inclusive, maximum rates for a participant:</text>
        <paragraph num="(i)">
          <text>$283.69 per unit for the regular level of service; or</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>$567.45 per unit for the intensive level of service.</text>
        </paragraph>
      </paragraph>
      <paragraph num="(b)">
        <text>Therapeutic integration services reimbursed at the maximum rate of $17.19 per unit.</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Intensive therapeutic integration services reimbursed at the maximum rate of $21.49 per unit.</text>
      </paragraph>
      <paragraph num="(d)">
        <text>Intensive individual support services reimbursed at the maximum rate of $21.49 per unit.</text>
      </paragraph>
      <paragraph num="(e)">
        <text>Respite care reimbursed at the maximum rate of $16.80 per unit.</text>
      </paragraph>
      <paragraph num="(f)">
        <text>Family consultation reimbursed at the maximum rates of $70.55 per unit.</text>
      </paragraph>
      <paragraph num="(g)">
        <text>Adult life planning services reimbursed at the maximum rate of $70.55 per unit.</text>
      </paragraph>
      <paragraph num="(h)">
        <text>Environmental accessibility adaptations reimbursed at the maximum rate of $2,104 per 36-month period amount billed by the provider, which shall be the lesser of the:</text>
        <paragraph num="(i)">
          <text>Amount authorized by the State Department of Education; or</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>Actual cost of the job.</text>
        </paragraph>
      </paragraph>
    </paragraph>
    <paragraph num="(4)">
      <text>Effective July 1, 2023, the Program shall pay according to the following fee-for-service schedule:</text>
      <paragraph num="(a)">
        <text>Residential habilitation services and retainer payments reimbursed at one of the following all-inclusive, maximum rates for a participant:</text>
        <paragraph num="(i)">
          <text>$283.69 per unit for the regular level of service; or</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>$567.45 per unit for the intensive level of service.</text>
        </paragraph>
      </paragraph>
      <paragraph num="(b)">
        <text>Therapeutic integration services reimbursed at the maximum rate of $8.5950 per unit.</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Intensive therapeutic integration services reimbursed at the maximum rate of $10.7450 per unit.</text>
      </paragraph>
      <paragraph num="(d)">
        <text>Intensive individual support services reimbursed at the maximum rate of $10.7450 per unit.</text>
      </paragraph>
      <paragraph num="(e)">
        <text>Respite care reimbursed at the maximum rate of $8.4000 per unit.</text>
      </paragraph>
      <paragraph num="(f)">
        <text>Family consultation reimbursed at the maximum rate of $35.2750 per unit.</text>
      </paragraph>
      <paragraph num="(g)">
        <text>Adult life planning services reimbursed at the maximum rate of $35.2750 per unit.</text>
      </paragraph>
      <paragraph num="(h)">
        <text>Environmental accessibility adaptions reimbursed at the maximum rate of $2,104 per 36-month period amount billed by the provider, which shall be the lesser of the:</text>
        <paragraph num="(i)">
          <text>Amount authorized by the State Department of Education; or</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>Actual cost of the job.</text>
        </paragraph>
      </paragraph>
    </paragraph>
  </paragraph>
</regulation>