<?xml version='1.0' encoding='utf-8'?>
<regulation prefix="Regulation" num=".13" citation="COMAR 10.09.89.13" title_num="10" subtitle_num="09" chapter_num="89" heading="Limitations.">
  <paragraph num="A.">
    <text>Reimbursement shall be made by the Program only when all of the requirements of this chapter are met.</text>
  </paragraph>
  <paragraph num="B.">
    <text>The Program may not reimburse for:</text>
    <paragraph num="(1)">
      <text>Services that are:</text>
      <paragraph num="(a)">
        <text>Provided by a member of the recipient’s immediate family or an individual who resides in the recipient’s home;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Not preauthorized by the Department;</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Not medically necessary;</text>
      </paragraph>
      <paragraph num="(d)">
        <text>Beyond the provider’s scope of practice;</text>
      </paragraph>
      <paragraph num="(e)">
        <text>Not appropriately documented;</text>
      </paragraph>
      <paragraph num="(f)">
        <text>Part of another service paid for by the State; or</text>
      </paragraph>
      <paragraph num="(g)">
        <text>Provided without a valid required license or appropriate credentials as specified in this chapter;</text>
      </paragraph>
    </paragraph>
    <paragraph num="(2)">
      <text>Completion of forms or reports;</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Broken or missed appointments;</text>
    </paragraph>
    <paragraph num="(4)">
      <text>Time spent in travel by the provider to and from site of service, except when with the participant or the participant’s family; or</text>
    </paragraph>
    <paragraph num="(5)">
      <text>Costs of travel by the provider to and from the site of service.</text>
    </paragraph>
  </paragraph>
  <paragraph num="C.">
    <text>The Program may not reimburse more than the following:</text>
    <paragraph num="(1)">
      <text>1 session per day for out-of-home respite;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>6 hours per day of community-based respite;</text>
    </paragraph>
    <paragraph num="(3)">
      <text>24 overnight units of respite annually;</text>
    </paragraph>
    <paragraph num="(4)">
      <text>2 types per day of expressive and experiential behavioral services; or</text>
    </paragraph>
    <paragraph num="(5)">
      <text>1 MCRS assessment for the development of the initial crisis plan.</text>
    </paragraph>
  </paragraph>
  <paragraph num="D.">
    <text>Intensive in-home services may not be reimbursed for the same day of service or on the same day of service as:</text>
    <paragraph num="(1)">
      <text>Partial hospitalization/day treatment;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Mobile crisis response services; or</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Other family therapies.</text>
    </paragraph>
  </paragraph>
  <paragraph num="E.">
    <text>Out-of-home respite and community-based respite services may not be reimbursed for the same day of service or on the same day of service as:</text>
    <paragraph num="(1)">
      <text>Residential rehabilitation;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Therapeutic behavioral services; or</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Any other public mental health system respite services.</text>
    </paragraph>
  </paragraph>
  <paragraph num="F.">
    <text>Out-of-home respite and community-based respite services do not include on-going day care or before or after school programs.</text>
  </paragraph>
  <paragraph num="G.">
    <text>Out-of-home respite and community based respite services may not be delivered to youth residing in Treatment Foster Care.</text>
  </paragraph>
  <paragraph num="H.">
    <text>No more than 25 percent of the family support organization’s claims in a 30-day period for family peer support may be telephonic for a participant or the participant’s family.</text>
  </paragraph>
</regulation>