<?xml version='1.0' encoding='utf-8'?>
<regulation prefix="Regulation" num=".38" citation="COMAR 10.09.81.38" title_num="10" subtitle_num="09" chapter_num="81" heading="Conditions for Reimbursement.">
  <text>The Maryland Medical Assistance Program shall reimburse for the services specified in Regulations .22 — .37 of this chapter, if the service:</text>
  <paragraph num="A.">
    <text>Is recommended in the applicant’s or participant's plan of service as necessary in order to:</text>
    <paragraph num="(1)">
      <text>Prevent admission to a nursing facility;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Safely deinstitutionalize the individual from a nursing facility into the community; or</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Assure the participant’s health and safety in the community;</text>
    </paragraph>
  </paragraph>
  <paragraph num="B.">
    <text>Has been preapproved by the Department in the participant's plan of service;</text>
  </paragraph>
  <paragraph num="C.">
    <text>Is provided to an enrolled participant who meets the qualifications for eligibility specified in Regulation .03 of this chapter;</text>
  </paragraph>
  <paragraph num="D.">
    <text>Is appropriate, relative to other community-based services;</text>
  </paragraph>
  <paragraph num="E.">
    <text>Is cost-neutral for the ICS Program after receipt of the monthly assessment fee and by calculating, on an annualized basis, the cost of services covered under this chapter and other State Plan services that are not covered for nursing facility residents; and</text>
  </paragraph>
  <paragraph num="F.">
    <text>Is provided by a Medicaid provider of ICS Program services who meets the appropriate conditions for participation under this chapter.</text>
  </paragraph>
</regulation>