<?xml version='1.0' encoding='utf-8'?>
<regulation prefix="Regulation" num=".40" citation="COMAR 10.09.81.40" title_num="10" subtitle_num="09" chapter_num="81" heading="Payment Procedures — General.">
  <paragraph num="A.">
    <text>Request for Payment.</text>
    <paragraph num="(1)">
      <text>An approved provider shall:</text>
      <paragraph num="(a)">
        <text>Submit a request for payment for the services covered under this chapter according to procedures set forth in COMAR 10.09.36.04; and</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Include the following information on the request:</text>
        <paragraph num="(i)">
          <text>Date or dates of service;</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>Participant's name and Medical Assistance number;</text>
        </paragraph>
        <paragraph num="(iii)">
          <text>Provider's name, location, and identification number;</text>
        </paragraph>
        <paragraph num="(iv)">
          <text>Nature, procedure code or codes, and unit or units of the covered services provided; and</text>
        </paragraph>
        <paragraph num="(v)">
          <text>Amount of reimbursement requested.</text>
        </paragraph>
      </paragraph>
    </paragraph>
    <paragraph num="(2)">
      <text>The provider shall submit a request for payment in a manner approved by the Maryland Medical Assistance Program.</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Participant-employed attendants shall submit a request for payment to a designated fiscal intermediary who shall:</text>
      <paragraph num="(a)">
        <text>Submit bills to the Department;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Withhold appropriate taxes; and</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Remit reimbursement to the provider for services rendered.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(4)">
      <text>A request for payment shall include all units of service rendered, as defined in Regulations .22 — .37 of this chapter, during a given time period for a participant.</text>
    </paragraph>
    <paragraph num="(5)">
      <text>Except as specified in §A(3) of this regulation, the provider shall bill the Department, or its authorized agent, in accordance with the payment methodology specified in Regulation .41 of this chapter for services approved by the Department.</text>
    </paragraph>
  </paragraph>
  <paragraph num="B.">
    <text>Billing time limitations for the services covered under this chapter are set forth in COMAR 10.09.36.06.</text>
  </paragraph>
  <paragraph num="C.">
    <text>Payments.</text>
    <paragraph num="(1)">
      <text>Payments for services rendered to a participant shall be made:</text>
      <paragraph num="(a)">
        <text>Directly to a qualified provider; or</text>
      </paragraph>
      <paragraph num="(b)">
        <text>To a designated fiscal intermediary for distribution to participant-employed attendants.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(2)">
      <text>A provider 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 in Regulation .41 of this chapter.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(3)">
      <text>Payment by the Department for the services covered under this chapter:</text>
      <paragraph num="(a)">
        <text>Shall be considered as payment in full; and</text>
      </paragraph>
      <paragraph num="(b)">
        <text>May not supplement or be supplemented by payment from other sources, such as the participant, family, a public program, or private agency.</text>
      </paragraph>
    </paragraph>
  </paragraph>
  <paragraph num="D.">
    <text>The ICS Program’s rates as specified in Regulation .41A — C, E, I — M, O, and P of this chapter shall increase on July 1 of each year beginning July 1, 2012, subject to the limitations of the State budget, by the lesser of:</text>
    <paragraph num="(1)">
      <text>2.5 percent; or</text>
    </paragraph>
    <paragraph num="(2)">
      <text>The change from March to March in the medical care component of the Consumer Price Index for all urban consumers (CPI-U) for the Washington-Baltimore area.</text>
    </paragraph>
  </paragraph>
</regulation>