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<regulation prefix="Regulation" num=".08" citation="COMAR 10.09.80.08" title_num="10" subtitle_num="09" chapter_num="80" heading="Payment Procedures.">
  <paragraph num="A.">
    <text>General policies governing payment procedures that are applicable to all providers are set forth in COMAR 10.09.36.04.</text>
  </paragraph>
  <paragraph num="B.">
    <text>Billing time limitations for claims submitted under this chapter are set forth in COMAR 10.09.36.06.</text>
  </paragraph>
  <paragraph num="C.">
    <text>Unless the care is free to other patients, a provider shall bill the Program their usual and customary charge to the general public.</text>
  </paragraph>
  <paragraph num="D.">
    <text>For dates of service July 1, 2023 through December 31, 2023, rates for the services outlined in this chapter shall be as follows:</text>
    <paragraph num="(1)">
      <text>For services outlined in this regulation, as delivered through a BHA licensed substance use disorder treatment provider:</text>
      <paragraph num="(a)">
        <text>Comprehensive substance use disorder assessment — $198.35;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Level 1 group substance use disorder counseling — $54.49 per session;</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Level 1 individual substance use disorder counseling — $27.93 per 15-minute increment with a maximum of six 15-minute increments per day;</text>
      </paragraph>
      <paragraph num="(d)">
        <text>Level 2.1 Intensive Outpatient treatment — $174.60 per diem;</text>
      </paragraph>
      <paragraph num="(e)">
        <text>Level 2.5 Partial Hospitalization half day session — $181.58 per diem;</text>
      </paragraph>
      <paragraph num="(f)">
        <text>Level 2.5 Partial Hospitalization full day session — $293.31 per diem;</text>
      </paragraph>
      <paragraph num="(g)">
        <text>Ambulatory Withdrawal Management —$97.78 per diem;</text>
      </paragraph>
      <paragraph num="(h)">
        <text>Individual peer support services — $16.87 per 15-minute increment;</text>
      </paragraph>
      <paragraph num="(i)">
        <text>Group peer support services — $4.69 per 15-minute increment;</text>
      </paragraph>
      <paragraph num="(j)">
        <text>Point of care presumptive drug test read with direct optical observation only — $10.02 per test;</text>
      </paragraph>
      <paragraph num="(k)">
        <text>Point of care presumptive drug test read with instrument-assisted direct optical observation — $10.02 per test;</text>
      </paragraph>
      <paragraph num="(l)">
        <text>Point of care presumptive drug test read with instrumented chemistry analyzers — $49.40 per test; and</text>
      </paragraph>
      <paragraph num="(m)">
        <text>Periodic medication management through office-based evaluation and management visits, according to COMAR 10.09.02.07D.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(2)">
      <text>For services outlined in this regulation as delivered through an opioid treatment program:</text>
      <paragraph num="(a)">
        <text>Comprehensive substance use disorder assessment — $198.35;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Level 1 group substance use disorder counseling — $54.49 per session;</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Level 1 individual substance use disorder counseling — $27.93 per 15-minute increment with a maximum of six 15-minute increments per day;</text>
      </paragraph>
      <paragraph num="(d)">
        <text>Opioid Maintenance Therapy — $86.27 per participant per week;</text>
      </paragraph>
      <paragraph num="(e)">
        <text>Medication Assisted Treatment Induction — $279.36 per participant per week;</text>
      </paragraph>
      <paragraph num="(f)">
        <text>Buprenorphine Maintenance Therapy — $76.69 per participant per week;</text>
      </paragraph>
      <paragraph num="(g)">
        <text>Individual peer support services — $16.87 per 15-minute increment;</text>
      </paragraph>
      <paragraph num="(h)">
        <text>Group peer support services — $4.69 per 15-minute increment; and</text>
      </paragraph>
      <paragraph num="(i)">
        <text>Periodic medication management through office-based evaluation and management visits, according to COMAR 10.09.02.07D.</text>
      </paragraph>
    </paragraph>
  </paragraph>
  <paragraph num="E.">
    <text>For dates of service January 1, 2024, through June 30, 2024, rates for the services outlined in this chapter shall be as follows:</text>
    <paragraph num="(1)">
      <text>For services outlined in this chapter, as delivered through a BHA licensed substance use disorder treatment provider:</text>
      <paragraph num="(a)">
        <text>Comprehensive substance use disorder assessment — $214.22;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Level 1 group substance use disorder counseling — $58.85 per session;</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Level 1 individual substance use disorder counseling — $30.16 per 15-minute increment with a maximum of six 15-minute increments per day;</text>
      </paragraph>
      <paragraph num="(d)">
        <text>Level 2.1 Intensive Outpatient treatment — $188.57 per diem;</text>
      </paragraph>
      <paragraph num="(e)">
        <text>Level 2.5 Partial Hospitalization half day session — $196.11 per diem;</text>
      </paragraph>
      <paragraph num="(f)">
        <text>Level 2.5 Partial Hospitalization full day session — $316.77 per diem;</text>
      </paragraph>
      <paragraph num="(g)">
        <text>Ambulatory Withdrawal Management —$105.60 per diem;</text>
      </paragraph>
      <paragraph num="(h)">
        <text>Individual peer support services — $18.22 per 15-minute increment;</text>
      </paragraph>
      <paragraph num="(i)">
        <text>Group peer support services — $5.07 per 15-minute increment;</text>
      </paragraph>
      <paragraph num="(j)">
        <text>Point of care presumptive drug test read with direct optical observation only — $10.02 per test;</text>
      </paragraph>
      <paragraph num="(k)">
        <text>Point of care presumptive drug test read with instrument-assisted direct optical observation — $10.02 per test;</text>
      </paragraph>
      <paragraph num="(l)">
        <text>Point of care presumptive drug test read with instrumented chemistry analyzers — $49.40 per test; and</text>
      </paragraph>
      <paragraph num="(m)">
        <text>Periodic medication management through office-based evaluation and management visits, according to COMAR 10.09.02.07D.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(2)">
      <text>For services outlined in this chapter as delivered through an opioid treatment program:</text>
      <paragraph num="(a)">
        <text>Comprehensive substance use disorder assessment — $214.22;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Level 1 group substance use disorder counseling — $58.85 per session;</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Level 1 individual substance use disorder counseling — $30.16 per 15-minute increment with a maximum of six 15-minute increments per day;</text>
      </paragraph>
      <paragraph num="(d)">
        <text>Opioid Maintenance Therapy — $93.17 per participant per week;</text>
      </paragraph>
      <paragraph num="(e)">
        <text>Medication Assisted Treatment Induction — $301.71 per participant per week;</text>
      </paragraph>
      <paragraph num="(f)">
        <text>Buprenorphine Maintenance Therapy — $82.83 per participant per week;</text>
      </paragraph>
      <paragraph num="(g)">
        <text>Individual peer support services — $18.22 per 15-minute increment;</text>
      </paragraph>
      <paragraph num="(h)">
        <text>Group peer support services — $5.07 per 15-minute increment; and</text>
      </paragraph>
      <paragraph num="(i)">
        <text>Periodic medication management through office-based evaluation and management visits, according to COMAR 10.09.02.07D.</text>
      </paragraph>
    </paragraph>
  </paragraph>
  <paragraph num="F.">
    <text>Effective July 1, 2024, rates for the services outlined in this chapter shall be as follows:</text>
    <paragraph num="(1)">
      <text>For services outlined in this chapter, as delivered through a BHA licensed substance use disorder treatment provider:</text>
      <paragraph num="(a)">
        <text>Comprehensive substance use disorder assessment — $220.65;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Level 1 group substance use disorder counseling — $60.62 per session;</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Level 1 individual substance use disorder counseling — $31.06 per 15-minute increment with a maximum of six 15-minute increments per day;</text>
      </paragraph>
      <paragraph num="(d)">
        <text>Level 2.1 Intensive Outpatient treatment — $194.23 per diem;</text>
      </paragraph>
      <paragraph num="(e)">
        <text>Level 2.5 Partial Hospitalization half day session — $201.99 per diem;</text>
      </paragraph>
      <paragraph num="(f)">
        <text>Level 2.5 Partial Hospitalization full day session — $326.27 per diem;</text>
      </paragraph>
      <paragraph num="(g)">
        <text>Ambulatory Withdrawal Management —$108.77 per diem;</text>
      </paragraph>
      <paragraph num="(h)">
        <text>Individual peer support services — $18.77 per 15-minute increment;</text>
      </paragraph>
      <paragraph num="(i)">
        <text>Group peer support services — $5.22 per 15-minute increment;</text>
      </paragraph>
      <paragraph num="(j)">
        <text>Point of care presumptive drug test read with direct optical observation only — $10.02 per test;</text>
      </paragraph>
      <paragraph num="(k)">
        <text>Point of care presumptive drug test read with instrument-assisted direct optical observation — $10.02 per test;</text>
      </paragraph>
      <paragraph num="(l)">
        <text>Point of care presumptive drug test read with instrumented chemistry analyzers — $49.40 per test; and</text>
      </paragraph>
      <paragraph num="(m)">
        <text>Periodic medication management through office-based evaluation and management visits, according to COMAR 10.09.02.07D.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(2)">
      <text>For services outlined in this chapter as delivered through an opioid treatment program:</text>
      <paragraph num="(a)">
        <text>Comprehensive substance use disorder assessment — $220.65;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Level 1 group substance use disorder counseling — $60.62 per session;</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Level 1 individual substance use disorder counseling — $31.06 per 15-minute increment with a maximum of six 15-minute increments per day;</text>
      </paragraph>
      <paragraph num="(d)">
        <text>Opioid Maintenance Therapy — $95.97 per participant per week;</text>
      </paragraph>
      <paragraph num="(e)">
        <text>Medication Assisted Treatment Induction — $310.76 per participant per week;</text>
      </paragraph>
      <paragraph num="(f)">
        <text>Buprenorphine Maintenance Therapy — $85.31 per participant per week;</text>
      </paragraph>
      <paragraph num="(g)">
        <text>Individual peer support services — $18.77 per 15-minute increment;</text>
      </paragraph>
      <paragraph num="(h)">
        <text>Group peer support services — $5.22 per 15-minute increment; and</text>
      </paragraph>
      <paragraph num="(i)">
        <text>Periodic medication management through office-based evaluation and management visits, according to COMAR 10.09.02.07D.</text>
      </paragraph>
    </paragraph>
  </paragraph>
  <paragraph num="G.">
    <text>The Program shall make no direct payment to participants.</text>
  </paragraph>
  <paragraph num="H.">
    <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="I.">
    <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>
</regulation>