<?xml version='1.0' encoding='utf-8'?>
<regulation prefix="Regulation" num=".09" citation="COMAR 10.09.59.09" title_num="10" subtitle_num="09" chapter_num="59" heading="Payment Procedures.">
  <paragraph num="A.">
    <text>Payment procedures shall be followed as specified in COMAR 10.09.36.04.</text>
  </paragraph>
  <paragraph num="B.">
    <text>A provider shall deliver and document services in accordance with Department regulations in order to receive reimbursement.</text>
  </paragraph>
  <paragraph num="C.">
    <text>Unless the care is free to other patients, a provider shall bill the Program its usual and customary charge to the general public.</text>
  </paragraph>
  <paragraph num="D.">
    <text>The Department shall authorize supplemental payment on Medicare claims only if:</text>
    <paragraph num="(1)">
      <text>The provider accepts Medicare assignments;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Medicare makes direct payment to the provider;</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Medicare has determined that the services are medically necessary;</text>
    </paragraph>
    <paragraph num="(4)">
      <text>The services are covered by the Program; and</text>
    </paragraph>
    <paragraph num="(5)">
      <text>Initial billing is made directly to Medicare according to Medicare guidelines.</text>
    </paragraph>
  </paragraph>
  <paragraph num="E.">
    <text>The Department shall make payment on Medicare claims subject to the following provisions:</text>
    <paragraph num="(1)">
      <text>Deductible and coinsurance shall be paid in full for services designated as mental health services by Medicare; and</text>
    </paragraph>
    <paragraph num="(2)">
      <text>The Program shall reimburse services not covered by Medicare, but considered medically necessary by the Program, according to the limitations of this chapter.</text>
    </paragraph>
  </paragraph>
  <paragraph num="F.">
    <text>A provider may not bill the Program for:</text>
    <paragraph num="(1)">
      <text>Completion of forms and reports;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Broken or missed appointments;</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Professional services rendered by mail or telehealth, unless the services are provided in compliance with COMAR 10.09.49; or</text>
    </paragraph>
    <paragraph num="(4)">
      <text>Services not authorized consistent with Regulation .08 of this chapter.</text>
    </paragraph>
  </paragraph>
  <paragraph num="G.">
    <text>Billing time limitations for claims submitted under this chapter are set forth in COMAR 10.09.36.06.</text>
  </paragraph>
  <paragraph num="H.">
    <text>The Department shall reimburse providers according to the fee schedule in COMAR 10.21.25.</text>
  </paragraph>
  <paragraph num="I.">
    <text>Psychiatric rehabilitation programs shall identify the mental health professional who referred the individual to psychiatric rehabilitation services by recording the individual practitioner’s National Provider Identifier (NPI) number on the claim.</text>
  </paragraph>
</regulation>