Md. Code Regs. 10.22.17.12

Current through Register Vol. 51, No. 20, October 4, 2024

Section 10.22.17.12 - Contract

A. If the Department preauthorizes a professional service, the Administration shall reimburse the provider for professional services according to the rate schedule in Regulation .08J(4) of this chapter except that the Administration may procure services to be reimbursed at a higher rate if:

(1) The provider submits documentation that it cannot find a professional to render services at this rate;

(2) The usual and customary rate charged by the professional for the service is above the rate in Regulation .08J(4) of this chapter; and

(3) The rate that the Maryland Medical Assistance Program reimburses the professional for this service is higher than the rate established by Regulation .08J(4) of this chapter.

B. The Administration may procure services needed by an individual as documented in the IP and preauthorized but not covered by rates or supplemental services in accordance with the State's requirements.

Md. Code Regs. 10.22.17.12