Sec. 10.09.76.06. Reimbursement Methodology

A. The provider shall charge the Program the provider’s customary charge to the general public for similar services and charge the provider’s acquisition cost for injectable drugs or dispensed medical supplies.

B. 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 §B of this regulation; and

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

C. Local health department clinics or general clinics shall be paid the lesser of:

(1) The provider’s customary charge to the general public unless the service is free to individuals not covered by Medicaid; or

(2) The maximum rates according to COMAR 10.09.02.07.

D. The Department shall reimburse an SBHC, sponsored by an FQHC, for services in accordance with COMAR 10.09.08.08.

E. The Department shall reimburse an SBHC, sponsored by an LHD or general clinic, for:

(1) Dental services in accordance with COMAR 10.09.05.07; and

(2) Specialty behavioral health services in accordance with COMAR 10.21.25 and 10.09.80.08.