Md. Code Regs. 10.09.89.14

Current through Register Vol. 51, No. 22, November 1, 2024

Section 10.09.89.14 - Payment Procedures

A. Request for Payment.

(1) 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.

(2) The provider shall:

(a) Bill the ASO in accordance with the payment methodology specified in this chapter;

(b) 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

(c) Submit a request for payment in a manner approved by the Program, which includes a certification of the:

(i) Date or dates of service;

(ii) Participant's name and Medicaid number;

(iii) Provider's name, location, and provider identification number;

(iv) Type, procedure code or codes, and unit or units of covered services provided; and

(v) Amount of reimbursement requested.

B. Documentation Required.

(1) Payments by the Program or its designee may be withheld or recovered if the provider fails to submit:

(a) Requested evidence of services provided;

(b) Staff qualifications;

(c) Corrective action plans; or

(d) Any other types of documentation related to ensuring the health and safety of a participant.

(2) Payments shall be released upon receipt and approval by the Program or its designee of the requested documentation.

(3) An appeal by the provider under COMAR 10.01.03 does not stay the withholding of payments.

C. Billing time limitations for the services covered under this chapter are the same as those set forth in COMAR 10.09.36.06.

D. Payments.

(1) Payments shall be made only for services rendered by a 1915(i) provider approved by the Department and enrolled as a Medicaid provider.

(2) Services will only be paid when delivered in accordance with the POC that has been authorized by the Department.

(3) The Program shall pay according to the fee-for-service schedule for each of the covered services, as set forth in this regulation.

E. Family peer support services as described in Regulation .09 of this chapter shall be reimbursed at the following rates:

(1) For dates of service from July 1, 2022 through June 30, 2023:

(a) $21.65 per 15-minute unit for face-to-face services; or

(b) $10.82 per 15-minute unit for telephonic or other non-face-to-face activities.

(2) Effective July 1, 2023:

(a) $22.30 per 15-minute unit for face-to-face services; or

(b) $11.14 per 15-minute unit for telephonic or other non-face-to-face activities.

F. Respite services as described in Regulation .10 of this chapter shall be reimbursed at the following rates:

(1) For dates of service from July 1, 2022 through June 30, 2023:

(a) $34.12 per 1-hour unit of service for community-based respite services; or

(b) $270.46 per unit of out-of-home respite care.

(2) Effective July 1, 2023:

(a) $35.14 per 1-hour unit of service for community-based respite services; or

(b) $278.57 per unit of out-of-home respite care.

G. 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:

(1) For dates of service from July 1, 2022 through June 30, 2023:

(a) For individual therapy:

(i) $92.77 per 45-50-minute session; or

(ii) $121.55 per 75-80-minute session; and

(b) For group therapy:

(i) $36.87 per 45-60-minute session; or

(ii) $47.95 per prolonged (75-90-minute) session.

(2) Effective July 1, 2023:

(a) For individual therapy:

(i) $95.55 per 45-50-minute session; or

(ii) $125.20 per 75-80-minute session; and

(b) For group therapy:

(i) $37.98 per 45-60-minute session; or

(ii) $49.39 per prolonged (75-90-minute) session.

H. 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:

(1) For dates of service from July 1, 2022 through June 30, 2023:

(a) For individual therapy:

(i) $84.33 per 45-minute session; or

(ii) $109.64 per 75-80-minute session; and

(b) For group therapy:

(i) $32.78 per 45-60-minute session; or

(ii) $42.59 per prolonged (75-90-minute) session.

(2) Effective July 1, 2023:

(a) For individual therapy:

(i) $86.86 per 45-minute session; or

(ii) $112.93 per 75-80-minute session; and

(b) For group therapy:

(i) $33.76 per 45-60-minute session; or

(ii) $43.87 per prolonged (75-90-minute) session.

I. Intensive in-home services as described in Regulation .12 of this chapter shall be reimbursed at the following rates:

(1) For dates of service from July 1, 2022 through June 30, 2023:

(a) $337.54 per week of service for EBP-IIHS providers; or

(b) $267.78 per week of service for non-EBP IIHS providers.

(2) Effective July 1, 2023:

(a) $347.67 per week of service for EBP-IIHS providers; or

(b) $275.81 per week of service for non-EBP IIHS providers.

Md. Code Regs. 10.09.89.14

Regulations .14 adopted effective 41:19 Md. R. 1077, eff.10/1/2014 ; amended effective 43:21 Md. R. 1166, eff. 10/24/2016; amended effective 45:1 Md. R. 13, eff. 1/15/2018; recodified from .16 effective 46:17 Md. R. 725, eff. 8/26/2019; amended effective 50:22 Md. R. 974, eff. 11/13/2023; amended effective 51:18 Md. R. 809, eff. 9/16/2024.