<?xml version='1.0' encoding='utf-8'?>
<regulation prefix="Regulation" num=".14" citation="COMAR 10.09.89.14" title_num="10" subtitle_num="09" chapter_num="89" heading="Payment Procedures.">
  <paragraph num="A.">
    <text>Request for Payment.</text>
    <paragraph num="(1)">
      <text>An approved provider shall submit requests for payment for the services covered under this chapter according to the procedures set forth in COMAR 10.09.36.04.</text>
    </paragraph>
    <paragraph num="(2)">
      <text>The provider shall:</text>
      <paragraph num="(a)">
        <text>Bill the ASO in accordance with the payment methodology specified in this chapter;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Accept payment from the ASO as payment in full for the covered services rendered, and make no additional charge to the participant or any other party for these services; and</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Submit a request for payment in a manner approved by the Program, which includes a certification of the:</text>
        <paragraph num="(i)">
          <text>Date or dates of service;</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>Participant's name and Medicaid number;</text>
        </paragraph>
        <paragraph num="(iii)">
          <text>Provider's name, location, and provider identification number;</text>
        </paragraph>
        <paragraph num="(iv)">
          <text>Type, procedure code or codes, and unit or units of covered services provided; and</text>
        </paragraph>
        <paragraph num="(v)">
          <text>Amount of reimbursement requested.</text>
        </paragraph>
      </paragraph>
    </paragraph>
  </paragraph>
  <paragraph num="B.">
    <text>Documentation Required.</text>
    <paragraph num="(1)">
      <text>Payments by the Program or its designee may be withheld or recovered if the provider fails to submit:</text>
      <paragraph num="(a)">
        <text>Requested evidence of services provided;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Staff qualifications;</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Corrective action plans; or</text>
      </paragraph>
      <paragraph num="(d)">
        <text>Any other types of documentation related to ensuring the health and safety of a participant.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(2)">
      <text>Payments shall be released upon receipt and approval by the Program or its designee of the requested documentation.</text>
    </paragraph>
    <paragraph num="(3)">
      <text>An appeal by the provider under COMAR 10.01.03 does not stay the withholding of payments.</text>
    </paragraph>
  </paragraph>
  <paragraph num="C.">
    <text>Billing time limitations for the services covered under this chapter are the same as those set forth in COMAR 10.09.36.06.</text>
  </paragraph>
  <paragraph num="D.">
    <text>Payments.</text>
    <paragraph num="(1)">
      <text>Payments shall be made only for services rendered by a 1915(i) provider approved by the Department and enrolled as a Medicaid provider.</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Services will only be paid when delivered in accordance with the POC that has been authorized by the Department.</text>
    </paragraph>
    <paragraph num="(3)">
      <text>The Program shall pay according to the fee-for-service schedule for each of the covered services, as set forth in this regulation.</text>
    </paragraph>
  </paragraph>
  <paragraph num="E.">
    <text>Family peer support services as described in Regulation .09 of this chapter shall be reimbursed at the following rates:</text>
    <paragraph num="(1)">
      <text>For dates of service from July 1, 2022 through June 30, 2023:</text>
      <paragraph num="(a)">
        <text>$21.65 per 15-minute unit for face-to-face services; or</text>
      </paragraph>
      <paragraph num="(b)">
        <text>$10.82 per 15-minute unit for telephonic or other non-face-to-face activities.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(2)">
      <text>Effective July 1, 2023:</text>
      <paragraph num="(a)">
        <text>$22.30 per 15-minute unit for face-to-face services; or</text>
      </paragraph>
      <paragraph num="(b)">
        <text>$11.84 per 15-minute unit for telephonic or other non-face-to-face activities.</text>
      </paragraph>
    </paragraph>
  </paragraph>
  <paragraph num="F.">
    <text>Respite services as described in Regulation .10 of this chapter shall be reimbursed at the following rates:</text>
    <paragraph num="(1)">
      <text>July 1, 2022 through June 30, 2023:</text>
      <paragraph num="(a)">
        <text>$34.12 per 1-hour unit of service for community-based respite services; or</text>
      </paragraph>
      <paragraph num="(b)">
        <text>$270.46 per unit of out-of-home respite care.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(2)">
      <text>Effective July 1, 2023:</text>
      <paragraph num="(a)">
        <text>$35.14 per 1-hour unit of service for community-based respite services; or</text>
      </paragraph>
      <paragraph num="(b)">
        <text>$278.57 per unit of out-of-home respite care.</text>
      </paragraph>
    </paragraph>
  </paragraph>
  <paragraph num="G.">
    <text>Expressive and experiential behavioral services as described in Regulation .11 of this chapter, when provided by a licensed mental health professional, shall be reimbursed at the following rates:</text>
    <paragraph num="(1)">
      <text>For dates of service from July 1, 2022 through June 30, 2023</text>
      <paragraph num="(a)">
        <text>For individual therapy:</text>
        <paragraph num="(i)">
          <text>$92.77 per 45—50-minute session; or</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>$121.55 per 75—80-minute session; and</text>
        </paragraph>
      </paragraph>
      <paragraph num="(b)">
        <text>For group therapy:</text>
        <paragraph num="(i)">
          <text>$36.87 per 45—60-minute session; or</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>$47.95 per prolonged (75—90-minute) session.</text>
        </paragraph>
      </paragraph>
    </paragraph>
    <paragraph num="(2)">
      <text>Effective July 1, 2023:</text>
      <paragraph num="(a)">
        <text>For individual therapy:</text>
        <paragraph num="(i)">
          <text>$95.55 per 45—50-minute session; or</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>$125.20 per 75—80-minute session; and</text>
        </paragraph>
      </paragraph>
      <paragraph num="(b)">
        <text>For group therapy:</text>
        <paragraph num="(i)">
          <text>$37.98 per 45—60-minute session; or</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>$49.39 per prolonged (75—90-minute) session.</text>
        </paragraph>
      </paragraph>
    </paragraph>
  </paragraph>
  <paragraph num="H.">
    <text>Expressive and experiential behavioral services as described in Regulation .11 of this chapter, when provided by a non-licensed mental health professional, shall be reimbursed at the following rates:</text>
    <paragraph num="(1)">
      <text>For dates of service from July 1, 2022 through June 30, 2023:</text>
      <paragraph num="(a)">
        <text>For individual therapy:</text>
        <paragraph num="(i)">
          <text>$84.33 per 45-minute session; or</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>$109.64 per 75—80-minute session; and</text>
        </paragraph>
      </paragraph>
      <paragraph num="(b)">
        <text>For group therapy:</text>
        <paragraph num="(i)">
          <text>$32.78 per 45—60-minute session; or</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>$42.59 per prolonged (75—90-minute) session.</text>
        </paragraph>
      </paragraph>
    </paragraph>
    <paragraph num="(2)">
      <text>Effective July 1, 2023:</text>
      <paragraph num="(a)">
        <text>For individual therapy:</text>
        <paragraph num="(i)">
          <text>$86.86 per 45-minute session; or</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>$112.93 per 75—80-minute session; and</text>
        </paragraph>
      </paragraph>
      <paragraph num="(b)">
        <text>For group therapy:</text>
        <paragraph num="(i)">
          <text>$33.76 per 45—60-minute session; or</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>$43.87 per prolonged (75—90-minute) session.</text>
        </paragraph>
      </paragraph>
    </paragraph>
  </paragraph>
  <paragraph num="I.">
    <text>Intensive in-home services as described in Regulation .12 of this chapter shall be reimbursed at the following rates:</text>
    <paragraph num="(1)">
      <text>For dates of service from July 1, 2022 through June 30, 2023:</text>
      <paragraph num="(a)">
        <text>$337.54 per week of service for EBP-IIHS providers; or</text>
      </paragraph>
      <paragraph num="(b)">
        <text>$267.78 per week of service for non-EBP IIHS providers.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(2)">
      <text>Effective July 1, 2023:</text>
      <paragraph num="(a)">
        <text>$347.67 per week of service for EBP-IIHS providers; or</text>
      </paragraph>
      <paragraph num="(b)">
        <text>$275.81 per week of service for non-EBP IIHS providers.</text>
      </paragraph>
    </paragraph>
  </paragraph>
</regulation>