Sec. 10.09.32.06. Payment Procedures

A. Request for Payment.

(1) Requests for payment of HIV-targeted case management services rendered shall be submitted by an approved provider according to procedures as set forth in COMAR 10.09.36.04.

(2) Requests for payment shall be submitted on the invoice form specified by the Department. The completed form shall indicate the:

(a) Date or dates of service;

(b) Participant's name and Medical Assistance number;

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

(d) Nature, procedure code or codes, and unit or units of covered service provided.

(3) Providers shall bill the Program for the appropriate fee specified in §C of this regulation.

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

C. Payments shall be made:

(1) Only to 1 provider for a specific type of HIV-targeted case management services rendered to a participant during a specified time period;

(2) To an HIV ongoing case management provider that shall be reimbursed in 15-minute increments, which is equal to 1 unit of service. Reimbursement for HIV ongoing case management may not exceed 96 units of service per year following the date of service for the HIV diagnostic evaluation services; and

(3) To a provider of HIV-targeted case management services that may not exceed the following fee schedule:

(a) For the completion of a bio-psychosocial assessment and development or revision of the plan of care performed by an HIV diagnostic evaluation services provider - $200;

(b) For the participation by the case manager in the completion of the bio-psychosocial assessment and development or revision of the plan of care, as specified in Regulation .04B of this chapter up to 6 units of service at a rate of $17.86 per unit of service

(c) For HIV ongoing case management, up to 96 units of service, at a rate of $17.86 per unit of service, may be reimbursed per year following completion of the bio-psychosocial assessment and development or revision of the plan of care by a qualified provider of HIV diagnostic evaluation services.