Sec. 10.09.84.24. Payment Procedures

A. Request for Payment - Personal Assistance. To receive payment as a personal assistance provider agency under Regulation .14 of this chapter, a provider and its workers shall use the telephonic timekeeping system approved by the Department to:

(1) Document time; and

(2) Submit claims.

B. Request for Payment - All Other Covered Services. To receive payment as a provider of services covered under Regulations .15-.21 of this chapter, a provider shall submit claims in accordance with procedures outlined in the Department’s billing manual.

C. Billing time limitations are set forth in COMAR 10.09.36.06.

D. Payments.

(1) Payments for services rendered to a participant shall be made directly to a qualified provider.

(2) A provider shall be paid the lesser of:

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

(b) The rate established according to the fee schedule published by the Department.

E. Effective May 1, 2017, for personal assistance services up to 12 hours per day, payment will be made in 15-minute units of service. For individuals who are determined to need more than 12 hours of personal assistance per day, a daily rate for the service will be paid.

F. Rates.

(1) The Department shall publish a fee schedule for services covered under this chapter which shall be publicly available and updated at least annually or upon any changes made by the Department.

(2) Effective July 1, 2018, the Program’s rates for covered services under Regulations .14-.16, .18D, .19, and .20 of this chapter shall increase on July 1 of each year by 3 percent, subject to the limitations of the State budget.