<?xml version='1.0' encoding='utf-8'?>
<regulation prefix="Regulation" num=".14" citation="COMAR 10.09.69.14" title_num="10" subtitle_num="09" chapter_num="69" heading="Payment Procedures — Request for Payment.">
  <paragraph num="A.">
    <text>A provider shall submit a request for payment for the services covered under this chapter according to the procedures set forth in COMAR 10.09.36.</text>
  </paragraph>
  <paragraph num="B.">
    <text>Billing time limitations for the services covered under this chapter are the same as those set forth in COMAR 10.09.36.</text>
  </paragraph>
  <paragraph num="C.">
    <text>The Department shall pay for covered services at the lower of:</text>
    <paragraph num="(1)">
      <text>The lowest price, including negotiated contract prices, that is offered to any other purchaser for the same or similar service during the same time period, after extending to the Program all rebates, coupons, and negotiated discounts;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>The actual charge billed by the provider; or</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Any fee schedule developed for reimbursement of the same service provided under Medical Assistance.</text>
    </paragraph>
  </paragraph>
  <paragraph num="D.">
    <text>For dates of service from January 1, 2021, through June 30, 2022, the Department shall pay $445.86 for a case management assessment, as described in Regulation .05C of this chapter.</text>
  </paragraph>
  <paragraph num="E.">
    <text>For dates of service from January 1, 2021, through June 30, 2022, the Department shall make payments monthly for case management services at one of the rates specified below:</text>
    <paragraph num="(1)">
      <text>Level of Care 1: $329.22;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Level of Care 2: $196.22; or</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Level of Care 3: $103.56.</text>
    </paragraph>
  </paragraph>
  <paragraph num="F.">
    <text>Effective July 1, 2022, the Department shall pay $463.69 for a case management assessment, as described in Regulation .05C of this chapter.</text>
  </paragraph>
  <paragraph num="G.">
    <text>Effective July 1, 2022, the Department shall make payments monthly for case management services at one of the rates specified below:</text>
    <paragraph num="(1)">
      <text>Level of Care 1: $342.39;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Level of Care 2: $204.07; or</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Level of Care 3: $107.70.</text>
    </paragraph>
  </paragraph>
  <paragraph num="H.">
    <text>The rates found in §§E and G of this regulation are the monthly rates paid by the Department for a participant receiving case management as follows:</text>
    <paragraph num="(1)">
      <text>Level of Care 1 is intensive level of case management, assessment, and coordination of services for a participant who:</text>
      <paragraph num="(a)">
        <text>Is acutely ill;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Has an unstable clinical condition;</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Has an exacerbated chronic illness; or</text>
      </paragraph>
      <paragraph num="(d)">
        <text>Has a newly diagnosed condition;</text>
      </paragraph>
    </paragraph>
    <paragraph num="(2)">
      <text>Level of Care 2 is case management to a participant who has a history of exacerbations of medical issues requiring services on an ongoing basis to attain stable service or treatment plans; and</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Level of Care 3 is case management that is required on an ongoing basis to monitor a participant’s stability and treatment plans.</text>
    </paragraph>
  </paragraph>
</regulation>