Sec. 10.09.46.11. Limitations

A. Reimbursement shall be made by the Program only if all of the requirements of this chapter are met.

B. Reimbursement may not be made by the Program for a waiver service furnished before:

(1) Enrollment of the participant in the waiver;

(2) Development of the participant's waiver plan of care; and

(3) Inclusion of the specific service in the participant's approved waiver plan of care.

C. The Program shall reimburse for a participant not more than:

(1) One unit of residential habilitation services for a date of service;

(2) One unit of day habilitation per day;

(3) One unit of supported employment per day;

(4) A combined maximum of seven units of supported employment and day habilitation per week; or

(5) 32 units of individual support services for a date of service.

D. The Program does not cover the following:

(1) Room and board for the participant;

(2) Room and board for an unrelated personal caregiver who lives with the participant;

(3) Direct payments to the participant's family;

(4) Respite care for a participant residing in an out-of-home facility;

(5) Activities or supervision reimbursed by a source other than Medicaid;

(6) Payment for day habilitation on the same date of service as medical day care under COMAR 10.09.07;

(7) Payment for day habilitation on the same date of services as on-site psychiatric rehabilitation as defined in COMAR 10.21.21 and COMAR 10.21.25;

(8) Payment for residential habilitation on the same date of service as personal care under COMAR 10.09.20;

(9) Payment for residential habilitation on the same date of service as residential rehabilitation services as defined in COMAR 10.21.22;

(10) Payment for supported employment on the same date of service as mental health vocational supported employment as defined in COMAR 10.21.28;

(11) Payment for individual support services on the same day as residential habilitation services as defined in Regulation .01B of this chapter; or

(12) Payment for individual support services on the same day as family and individual support services as defined in Regulation .01B of this chapter.