<?xml version='1.0' encoding='utf-8'?>
<regulation prefix="Regulation" num=".04" citation="COMAR 10.22.18.04" title_num="10" subtitle_num="22" chapter_num="18" heading="Rates.">
  <paragraph num="A.">
    <text>The Department shall reimburse the licensee:</text>
    <paragraph num="(1)">
      <text>For new individuals served after June 30, 2000, according to the rates set forth in this regulation; and</text>
    </paragraph>
    <paragraph num="(2)">
      <text>For individuals receiving existing services, by converting those contracts to the Community Supported Living Arrangements Payment System if appropriate between:</text>
      <paragraph num="(a)">
        <text>July 1, 2000, and December 31, 2000, if the individuals are living in their own residences, and</text>
      </paragraph>
      <paragraph num="(b)">
        <text>January 1, 2001, and June 30, 2001, if the individuals are living with their families.</text>
      </paragraph>
    </paragraph>
  </paragraph>
  <paragraph num="B.">
    <text>The Administration determines the rate based on the number of preauthorized hours of service each individual needs each week as documented by the individual's IP.</text>
  </paragraph>
  <paragraph num="C.">
    <text>If an individual does not need the same amount of services each week, the rate is determined by the number of preauthorized hours of service in a 4-week period divided by 4, and is at least 1 hour each week.</text>
  </paragraph>
  <paragraph num="D.">
    <text>The Department shall pay a daily amount per individual calculated by multiplying the number of hours of service each week approved for the individual by the hourly rate and dividing by seven.</text>
  </paragraph>
  <paragraph num="E.">
    <text>The basic rates for CSLA services are set forth in §I of this regulation. These rates do not include professional services.</text>
  </paragraph>
  <paragraph num="F.">
    <text>Under the rates, the Department may pay for up to 82 hours of service each week.</text>
  </paragraph>
  <paragraph num="G.">
    <text>If awake-overnight or one-to-one services are indicated in the individual's IP, and are not included in the 82 hours of base rate service, the Administration may:</text>
    <paragraph num="(1)">
      <text>Preauthorize and approve additional hours of service beyond 82 hours after reviewing the IP and any additional documentation the Administration requests; and</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Reimburse the licensee as set forth in §J of this regulation for these services.</text>
    </paragraph>
  </paragraph>
  <paragraph num="H.">
    <text>Professional Services.</text>
    <paragraph num="(1)">
      <text>The Administration may preauthorize and approve professional services if:</text>
      <paragraph num="(a)">
        <text>The individual's IP, and any additional documentation the administration requires indicates the service is necessary; and</text>
      </paragraph>
      <paragraph num="(b)">
        <text>The provider submits documentation that:</text>
        <paragraph num="(i)">
          <text>The individual is not eligible for medical assistance,</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>For individuals who are Medicaid eligible, the service sought is not a service covered by the Maryland Medical Assistance Program, or</text>
        </paragraph>
        <paragraph num="(iii)">
          <text>If the individual is Medicaid eligible and the service is covered by the Maryland Medical Assistance Program, the provider submits documentation that the Maryland Medical Assistance Program has denied coverage, and the agency is pursuing an appeal.</text>
        </paragraph>
      </paragraph>
    </paragraph>
    <paragraph num="(2)">
      <text>If the Administration approves and preauthorizes a professional service, the Administration shall reimburse the provider for professional services according to the rate schedule in §K of this regulation except that the Administration may procure services to be reimbursed at a higher rate if:</text>
      <paragraph num="(a)">
        <text>The provider submits documentation that it cannot find a professional to render services at this rate;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>The usual and customary rate charged by the professional for the service is above the rate of this regulation; and</text>
      </paragraph>
      <paragraph num="(c)">
        <text>The rate that the Maryland Medical Assistance Program reimburses the professional for this service is higher than the rate established by §K of this regulation.</text>
      </paragraph>
    </paragraph>
  </paragraph>
  <paragraph num="I.">
    <text>Fiscal Year 2020 Tables for CSLA’s Personal Supports Hourly Rates.</text>
    <paragraph num="(1)">
      <text>State Fiscal Year 2019 CSLA’s Personal Supports Rates: Table for One Individual in a Dwelling Receiving CSLA Services.</text>
    </paragraph>
    <paragraph num="(2)">
      <text>State Fiscal Year 2020 CSLA’s Personal Supports Rates: Table for Two Individuals in a Dwelling Receiving CSLA Services.</text>
    </paragraph>
    <paragraph num="(3)">
      <text>State Fiscal Year 2020 CSLA’s Personal Supports Rates: Table for Three Individuals in a Dwelling Receiving CSLA Services.</text>
    </paragraph>
  </paragraph>
  <paragraph num="J.">
    <text>State Fiscal Year 2020 CSLA’s Personal Supports Rates: Table for 1:1 Support or Not More than 8 Hours of Awake-Overnight Support per Residence for Individuals Receiving CSLA Services Regardless of the Number of Individuals in a Dwelling.</text>
  </paragraph>
  <paragraph num="K.">
    <text>State Fiscal Year 2020 CSLA’s Personal Supports Rates: Table for Professional Services for Individuals Receiving CSLA Services Regardless of the Number of Individuals in a Dwelling.</text>
  </paragraph>
</regulation>