Sec. 10.09.07.08. Payment Procedures

A. Requests for Payment.

(1) All requests for payment of services rendered shall be submitted in accordance with COMAR 10.09.36.

(2) Billing time limitations for claims submitted pursuant to this chapter are set forth in COMAR 10.09.36.

B. Payment to a provider shall be limited to the number of days each participant attends the medical day care center, as authorized by a participant’s home and community based services waiver service plan.

C. Payment shall be made only to a qualified medical day care provider. Payment may not be made to a participant, or to individual nurses, physicians, social workers, activity coordinators, or aides for services rendered in connection with the provision of medical day care.

D. Per Diem Rate.

(1) Payment to a provider of medical day care services shall be on a per diem basis. The per diem rate is $82.24 effective July 1, 2019.

(2) The per diem rate shall increase on July 1 of each year by 4 percent, subject to the limitations of the State budget.

E. Payment to a provider of medical day care services may not exceed the lesser of the:

(1) Per diem rate established under §D of this regulation; or

(2) Provider's customary charge to the general public for services covered by the Program, unless the service is free to individuals not covered by Medicaid.

F. If the service is free to individuals not covered by Medicaid:

(1) The provider:

(a) May charge the Program; and

(b) Shall be reimbursed in accordance with §D of this regulation; and

(2) The provider’s reimbursement is not limited to the provider’s customary charge.