<?xml version='1.0' encoding='utf-8'?>
<regulation prefix="Regulation" num=".10" citation="COMAR 10.22.17.10" title_num="10" subtitle_num="22" chapter_num="17" heading="Payment for Services Reimbursed by Rates.">
  <paragraph num="A.">
    <text>The Department shall pay the provider the rate set forth under this chapter.</text>
  </paragraph>
  <paragraph num="B.">
    <text>The rate is the sum of the individual component, the provider component, and any add-on component.</text>
  </paragraph>
  <paragraph num="C.">
    <text>Reimbursement for Attendance Days of Day Habilitation, Vocational Services, and Supported Employment with Fewer than the Hours as Defined in Regulation .02 of this chapter.</text>
    <paragraph num="(1)">
      <text>The Administration may:</text>
      <paragraph num="(a)">
        <text>Not approve reimbursement for an attendance day if the individual receives fewer than 4 hours of service;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Approve reimbursement for fewer hours than the normal attendance day if the IP:</text>
        <paragraph num="(i)">
          <text>Documents that the individual is not able to engage in the program activities for the normal attendance day; and</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>Includes a plan for enabling the individual to be engaged in a normal attendance day; and</text>
        </paragraph>
      </paragraph>
      <paragraph num="(c)">
        <text>Approve reimbursement for an attendance day of supported employment when the individual receives fewer than 4 hours of supported employment services if the:</text>
        <paragraph num="(i)">
          <text>IP documents that the individual is not able to engage in supported employment activities for 4 hours a day;</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>IP includes a plan for enabling the individual to be engaged in supported employment for at least 4 hours with the goal being a normal attendance day; and</text>
        </paragraph>
        <paragraph num="(iii)">
          <text>Individual is engaged in at least 4 hours of activity that may include day habilitation and vocational services, with the majority of time spent in supported employment.</text>
        </paragraph>
      </paragraph>
    </paragraph>
    <paragraph num="(2)">
      <text>The Administration's approval of electronic or paper attendance documentation as specified by the Administration and submitted by the provider shall constitute approval of an attendance day of fewer than 6 to 8 hours if the approved individual plan indicates this lower level of service is necessary.</text>
    </paragraph>
  </paragraph>
  <paragraph num="D.">
    <text>Conversion of Existing Supported Employment Services from a Contract to the Rate System.</text>
    <paragraph num="(1)">
      <text>There is a presumption that the cost of care for existing supported employment services reimbursed by the Administration under the rate system will be the same as under the contract.</text>
    </paragraph>
    <paragraph num="(2)">
      <text>The Administration shall reimburse the provider at least the same amount for cost of care for existing supported employment services as the Administration reimbursed the provider under the contract.</text>
    </paragraph>
    <paragraph num="(3)">
      <text>The Administration shall convert the contract reimbursement for individuals into a base rate together, if appropriate, with add-on components.</text>
    </paragraph>
    <paragraph num="(4)">
      <text>If a utilization review audit indicates that add-on components were not required for the individual, the Administration may recover unnecessary expenditures.</text>
    </paragraph>
    <paragraph num="(5)">
      <text>A provider may request additional services as set forth in Regulation .08F of this chapter.</text>
    </paragraph>
    <paragraph num="(6)">
      <text>The Administration shall review any add-on components for existing services every 3 years unless the Administration documents a need for more frequent review.</text>
    </paragraph>
    <paragraph num="(7)">
      <text>The Department shall reimburse providers of existing supported employment services by converting those contracts to reimbursement under this chapter between June 30, 2001, and July 1, 2002.</text>
    </paragraph>
  </paragraph>
  <paragraph num="E.">
    <text>For add-on components, the Department shall reimburse providers of existing augmentation services by converting those contracts to reimbursement under this chapter between June 30, 2001, and July 1, 2003.</text>
  </paragraph>
  <paragraph num="F.">
    <text>For a single calendar day, the Administration may not reimburse a provider for two or more attendance days of any combination of:</text>
    <paragraph num="(1)">
      <text>Residential services under this chapter, community supported living arrangements under COMAR 10.22.18, and personal care services under COMAR 10.09.20; or</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Day habilitation services under this chapter, supported employment services under this chapter, vocational services under this chapter, and medical day care services under COMAR 10.09.07.</text>
    </paragraph>
  </paragraph>
  <paragraph num="G.">
    <text>Absences and Vacancies.</text>
    <paragraph num="(1)">
      <text>As of July 1, 2011, the Department shall only reimburse providers for 33 days of absences or vacancies per year per individual when the individual is unable to be in residential services due to illness, vacation, home visits, medical appointments, or other circumstances.</text>
    </paragraph>
    <paragraph num="(2)">
      <text>As of July 1, 2003, the Department may claim federal financial participation for residential absence days as permitted by the Centers for Medicare and Medicaid Services under the Home and Community-Based Waiver.</text>
    </paragraph>
  </paragraph>
  <paragraph num="H.">
    <text>The Administration shall reimburse day and supported employment programs an additional $2,000 per year per individual for transportation to and from day habilitation and vocational programs or to and from supported employment for individuals who, because of their disabilities, must use wheelchairs or motorized scooters, if the payments are consistent with the requirements under COMAR 10.09.26 and 10.09.19.</text>
  </paragraph>
  <paragraph num="I.">
    <text>For residential services only, the Administration shall subtract from the payment, as appropriate, SSI contributions by individuals or other copayments.</text>
  </paragraph>
  <paragraph num="J.">
    <text>The provider shall:</text>
    <paragraph num="(1)">
      <text>Assist the individual in obtaining SSI, if applicable; and</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Collect all applicable individual copayment obligations while assuring that the individual retains the personal needs allowance.</text>
    </paragraph>
  </paragraph>
  <paragraph num="K.">
    <text>To be reimbursed under this chapter, the provider shall submit:</text>
    <paragraph num="(1)">
      <text>Attendance data for individuals served; and</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Other information as required by the Administration.</text>
    </paragraph>
  </paragraph>
</regulation>