Sec. 10.22.17.08. Add-On Component

A. An add-on component is for:

(1) Residential programs;

(2) Day habilitation, vocational, and supported employment programs; and

(3) Professional services.

B. The Administration may preauthorize and approve one or more units of add-on components for additional support:

(1) Not to exceed 1 year for individuals whose need for additional support is the result of a temporary condition; or

(2) Exceeding 1 year for individuals whose need for additional support is on-going.

C. The per-unit amounts have been calculated to cover all costs incidental to providing the service.

D. In order to preauthorize and approve one or more units of add-on components for an individual, the Administration shall determine that the:

(1) Individual's particular circumstances warrant units of add-on components to implement the IP; and

(2) Individual requires more services than the provider can provide with the sum of the provider and individual components.

E. Circumstances that warrant units of add-on components include a need for:

(1) Additional support for an individual whose individual component is less than level 5 and for whom approval of an add-on component would be more cost effective than an increase in the individual component;

(2) Ongoing, intensive support, such as one-to-one support, for an individual whose individual component is level 5;

(3) Ongoing support in a residential program for an individual who does not attend day services;

(4) Awake-overnight support for an individual; and

(5) Professional services not covered by Medicaid or other payers.

F. Procedures for Requesting Authorization of Add-On Components.

(1) On forms approved by the Administration, the provider shall submit documentation that justifies the request for add-on components.

(2) For all requests for add-on components, the justification shall include:

(a) Recommendations from the individual's team and appropriate professionals;

(b) Services the provider can provide with existing resources; and

(c) Any other information required by the Administration.

(3) For requests for professional add-on components, additional justification shall include:

(a) The individual's IP and any additional documentation the administration requires indicating the service is necessary; and

(b) Documentation that:

(i) The individual is not eligible for Medical Assistance;

(ii) For individuals who are Medicaid eligible, the service sought is not a service covered by the Maryland Medical Assistance Program; or

(iii) If the individual is Medicaid eligible and the service is covered by the Maryland Medical Assistance Program, the Maryland Medical Assistance Program has denied coverage, and the agency is pursuing an appeal.

G. Administration Approval of Add-on Components.

(1) In deciding whether to preauthorize an add-on component, the Administration shall:

(a) Consider the documentation submitted by the provider in §F of this regulation that identifies the needs of the individual;

(b) Consider the proposed cost for the add-on component;

(c) Consider the existing funding levels for other individuals at the service site and the availability of State funds;

(d) If appropriate, visit the individual in the setting where the service is to be provided; and

(e) Review the provider's efforts to meet the individual's needs with existing resources available at the site such as staffing levels and revenue for all services provided at the site.

(2) When determining the number of units of add-on components to authorize, the Administration shall conduct the cost analysis described in §G(1) of this regulation. The Administration may authorize the number of units of add-on components necessary to fund the amount identified by the cost analysis.

H. Review of Add-on Components. Unless justification for a less frequent review is documented, the Administration shall review the appropriateness of the add-on component:

(1) For individuals receiving temporary additional support, quarterly for up to 1 year after which the Administration shall:

(a) Reassess the appropriateness of the individual component and increase the individual component if justified;

(b) Continue the temporary additional support for up to 1 year if the individual's prognosis indicates that the condition remains temporary; or

(c) Discontinue the temporary additional support; and

(2) For other individuals, quarterly during the first year and annually after that.

I. The add-on component is calculated by multiplying the number of units of service per week approved by the Administration by the per unit amount and dividing by seven for residential programs and by the number of approved days of service per week for day habilitation, vocational, and supported employment programs.

J. Reimbursement for Add-On Components.

(1) Unless the Administration preauthorizes an add-on component, the Administration may not reimburse the provider.

(2) Effective July 1, 2019, the amount per unit of service for residential programs is as follows:

(a) In Baltimore City and Allegany, Anne Arundel, Baltimore, Caroline, Carroll, Dorchester, Garrett, Harford, Howard, Kent, Queen Anne's, St. Mary's, Somerset, Talbot, Washington, Wicomico, and Worcester counties - $21.19;

(b) In Cecil County - $22.31; and

(c) In Calvert, Charles, Frederick, Montgomery, and Prince George's counties - $22.59.

(3) Effective July 1, 2019, the amount per unit of service for day habilitation and community learning services is as follows:

(a) In Baltimore City and Allegany, Anne Arundel, Baltimore, Caroline, Carroll, Dorchester, Garrett, Harford, Howard, Kent, Queen Anne's, St. Mary's, Somerset, Talbot, Washington, Wicomico, and Worcester counties - $23.68;

(b) In Cecil County - $24.80; and

(c) In Calvert, Charles, Frederick, Montgomery, and Prince George's counties - $25.09.

(4) Effective July 1, 2019, the amount per unit of service for supported employment and employment discovery and customization is as follows:

(a) In Baltimore City and Allegany, Anne Arundel, Baltimore, Caroline, Carroll, Dorchester, Garrett, Harford, Howard, Kent, Queen Anne's, St. Mary's, Somerset, Talbot, Washington, Wicomico, and Worcester counties - $23.68;

(b) In Cecil County - $24.80; and

(c) In Calvert, Charles, Frederick, Montgomery, and Prince George's counties - $25.09.

(5) Effective July 1, 2019, the amount per unit of service per individual for professional services is as follows:

(a) In Baltimore City and Allegany, Anne Arundel, Baltimore, Caroline, Carroll, Dorchester, Garrett, Harford, Howard, Kent, Queen Anne's, St. Mary's, Somerset, Talbot, Washington, Wicomico, and Worcester counties - $34.93;

(b) In Cecil County - $36.89; and

(c) In Calvert, Charles, Frederick, Montgomery, and Prince George's counties - $37.39.