Sec. 10.22.17.10. Payment for Services Reimbursed by Rates

A. The Department shall pay the provider the rate set forth under this chapter.

B. The rate is the sum of the individual component, the provider component, and any add-on component.

C. Reimbursement for Attendance Days of Day Habilitation, Vocational Services, and Supported Employment with Fewer than the Hours as Defined in Regulation .02 of this Chapter.

(1) The Administration may:

(a) Not approve reimbursement for an attendance day if the individual receives fewer than 4 hours of service;

(b) Approve reimbursement for fewer hours than the normal attendance day if the IP:

(i) Documents that the individual is not able to engage in the program activities for the normal attendance day; and

(ii) Includes a plan for enabling the individual to be engaged in a normal attendance day; and

(c) Approve reimbursement for an attendance day of supported employment when the individual receives fewer than 4 hours of supported employment services if the:

(i) IP documents that the individual is not able to engage in supported employment activities for 4 hours a day;

(ii) IP includes a plan for enabling the individual to be engaged in supported employment for at least 4 hours with the goal being a normal attendance day; and

(iii) Individual is engaged in at least 4 hours of activity that may include day habilitation and vocational services, with the majority of time spent in supported employment.

(2) The Administration's approval of electronic or paper attendance documentation as specified by the Administration and submitted by the provider shall constitute approval of an attendance day of fewer than 6 to 8 hours if the approved individual plan indicates this lower level of service is necessary.

D. Conversion of Existing Supported Employment Services from a Contract to the Rate System.

(1) There is a presumption that the cost of care for existing supported employment services reimbursed by the Administration under the rate system will be the same as under the contract.

(2) The Administration shall reimburse the provider at least the same amount for cost of care for existing supported employment services as the Administration reimbursed the provider under the contract.

(3) The Administration shall convert the contract reimbursement for individuals into a base rate together, if appropriate, with add-on components.

(4) If a utilization review audit indicates that add-on components were not required for the individual, the Administration may recover unnecessary expenditures.

(5) A provider may request additional services as set forth in Regulation .08F of this chapter.

(6) The Administration shall review any add-on components for existing services every 3 years unless the Administration documents a need for more frequent review.

(7) The Department shall reimburse providers of existing supported employment services by converting those contracts to reimbursement under this chapter between June 30, 2001, and July 1, 2002.

E. For add-on components, the Department shall reimburse providers of existing augmentation services by converting those contracts to reimbursement under this chapter between June 30, 2001, and July 1, 2003.

F. For a single calendar day, the Administration may not reimburse a provider for two or more attendance days of any combination of:

(1) Residential services under this chapter, community supported living arrangements under COMAR 10.22.18, and personal care services under COMAR 10.09.20; or

(2) Day habilitation services under this chapter, supported employment services under this chapter, vocational services under this chapter, and medical day care services under COMAR 10.09.07.

G. Absences and Vacancies.

(1) As of July 1, 2011 the Department shall only reimburse providers for 33 days of absences or vacancies per year per individual when the individual is unable to be in residential services due to illness, vacation, home visits, medical appointments, or other circumstances.

(2) As of July 1, 2003, the Department may claim federal financial participation for residential absence days as permitted by the Centers for Medicare and Medicaid Services under the Home and Community-Based Waiver.

H. The Administration shall reimburse day and supported employment programs an additional $2,000 per year per individual for transportation to and from day habilitation and vocational programs or to and from supported employment for individuals who, because of their disabilities, must use wheelchairs or motorized scooters, if the payments are consistent with the requirements under COMAR 10.09.26 and 10.09.19.

I. For residential services only, the Administration shall subtract from the payment, as appropriate, SSI contributions by individuals or other copayments.

J. The provider shall:

(1) Assist the individual in obtaining SSI, if applicable; and

(2) Collect all applicable individual copayment obligations while assuring that the individual retains the personal needs allowance.

K. To be reimbursed under this chapter, the provider shall submit:

(1) Attendance data for individuals served; and

(2) Other information as required by the Administration.