Plain Text Law

Regulation .41 Payment Procedures — Rates.

Regulation .41 Payment Procedures — Rates.Copy Citation

A.
To receive payment as a provider of services covered under Regulations .23, .24, and .33—.37 of this chapter, a provider shall submit claims in accordance with procedures outlined in the Department's billing manual.
B.
Billing time limitations for the services covered under this chapter are set forth in COMAR 10.09.36.06.
C.
Payments.
(1)
Payments shall be made directly to a qualified provider.
(2)
A provider shall be paid the lesser of:
(a)
The provider's customary charge to the general public unless the service is free to individuals not covered by Medicaid; or
(b)
The rates established in §D of this regulation.
D.
Rates.
(1)
For dates of service beginning July 1, 2024, fees per unit of service shall be as follows:
(a)
Assisted Living Level II, No Medical Day Care—reimbursed at the maximum rate of $90.74 per day;
(b)
Assisted Living Level III, No Medical Day Care—reimbursed at the maximum rate of $114.51 per day;
(c)
Assisted Living Level II, Medical Day Care—reimbursed at the maximum rate of $68.09 per day;
(d)
Assisted Living Level III, Medical Day Care—reimbursed at the maximum rate of $85.86 per day;
(e)
Behavioral Consultation—reimbursed at the maximum rate of $99.25 per hour;
(f)
Case Management—Administrative—reimbursed at the maximum rate of $93.06 per hour or $23.2645 per 15-minute unit;
(g)
Case Management—Comprehensive—reimbursed at the maximum rate of $93.06 per hour or $23.2645 per 15-minute unit;
(h)
Case Management—Ongoing—reimbursed at the maximum rate of $93.06 per hour or $23.2645 per 15-minute unit;
(i)
Dietitian and Nutritionist Services—reimbursed at the maximum rate of $99.25 per hour;
(j)
Family 1/1 Training—reimbursed at the maximum rate of $99.25 per hour;
(k)
Medical Day Care Services—reimbursed at the maximum rate of $116.59 per day; and
(l)
Senior Center Plus—reimbursed at the maximum rate of $72.19 per day.
(2)
The ICS Program’s rates for covered services under Regulations .23, .24, and .33—.37 of this chapter shall be adjusted subject to the limitations of the State budget.