Sec. 10.09.81.38. Conditions for Reimbursement

The Maryland Medical Assistance Program shall reimburse for the services specified in Regulations .22-.37 of this chapter, if the service:

A. Is recommended in the applicant’s or participant's plan of service as necessary in order to:

(1) Prevent admission to a nursing facility;

(2) Safely deinstitutionalize the individual from a nursing facility into the community; or

(3) Assure the participant’s health and safety in the community;

B. Has been preapproved by the Department in the participant's plan of service;

C. Is provided to an enrolled participant who meets the qualifications for eligibility specified in Regulation .03 of this chapter;

D. Is appropriate, relative to other community-based services;

E. Is cost-neutral for the ICS Program after receipt of the monthly assessment fee and by calculating, on an annualized basis, the cost of services covered under this chapter and other State Plan services that are not covered for nursing facility residents; and

F. Is provided by a Medicaid provider of ICS Program services who meets the appropriate conditions for participation under this chapter.