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10.22.17.00.htm 10.22.17.00. Title 10 DEPARTMENT OF HEALTH AND MENTAL HYGIENE Subtitle 22 DEVELOPMENTAL DISABILITIES Chapter 17 Fee Payment System for Licensed Residential and Day Programs Authority: Health-General Article, §2-104(b) 7-306.1, 7-307, 7-910(c) 15-105, 15-107, and 16-201, Annotated Code of Maryland
10.22.17.01.htm 10.22.17.01. 01 Scope.. A. This chapter establishes the methodology that the Department shall use to reimburse:. 1) Licensed residential alternative living units, residential group homes, day habilitation programs, and vocational programs that provide services to individuals with disabilities after June 30, 1998;2) Supported employment provided by licensed providers of services to individuals after June 30, 2001;3) Add-on component services for individuals in these programs; and.
10.22.17.02.htm 10.22.17.02. 02 Definitions.. A. In this chapter, the following terms have the meanings indicated.. B. Terms Defined.. 1) "Add-on component" means one or more units of service, each one of which includes funding for direct service and other nondirect costs not covered by the sum of the provider and individual components.2) "Administration" means the Developmental Disabilities Administration.. 3) "Agreement" means a legal document setting forth the rights and responsibilities of the Administr
10.22.17.03.htm 10.22.17.03. 03 General.. A. The provider shall sign an agreement with the Administration.. B. The rights of the Administration include but are not limited to the following:. 1) Approving the individuals to be served;. 2) Performing a utilization review of individual indicator rating scales; and. 3) Auditing provider operations.. C. Personal Needs Allowance.. 1) On January 1, 2009, the Administration set the personal needs allowance at $299 per month for an individual.
10.22.17.04.htm 10.22.17.04. 04 Licensure Requirements.. To receive reimbursement under this chapter, a provider shall:. A. Be licensed in accordance with Health-General Article, Title 7, Annotated Code of Maryland, and COMAR 10.22.08 or 10.22.07; andB. Comply with COMAR 10.09.26 and all other applicable regulations under COMAR 10.09..
10.22.17.05.htm 10.22.17.05. 05 Reporting Requirements and Record Keeping.. A. The provider shall submit an annual cost report not later than 6 months after the end of the State fiscal year that:1) Documents the provider's actual expenditures for the fiscal year being reported;. 2) Is based on the provider's audited financial statement;. 3) Includes a worksheet reconciling the cost report to the financial statement; and. 4) Contains a certification by an independent certified public accountant,
10.22.17.06.htm 10.22.17.06. 06 Determination of Individual Component.. A. The individual component is for costs the provider incurs in providing direct services to the individual.B. The Administration shall establish an individual component for new and existing services that is based on the:1) Individual indicator rating scale; and. 2) Geographic region in which the service is provided.. C. Individuals who have been receiving services from a provider and who are transferring to a differ
10.22.17.07.htm 10.22.17.07. 07 Provider Components.. Effective July 1, 2016, the provider components for all regions are as follows:. A. The residential program provider component is $63.95; and. B. The day habilitation, vocational, supported employment, community learning services, and employment discovery and customization program provider component is $35.41.
10.22.17.08.htm 10.22.17.08. 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
10.22.17.09.htm 10.22.17.09. 09 Supplemental Services.. A. The Administration may preauthorize supplemental services.. B. Supplemental services do not include any services that are in the State Medical Assistance Plan and can be provided to an individual and reimbursed under the Medical Assistance Program, or any services covered by private insurance or federal and State funded health programs.C. Supplemental services include:. 1) Household furnishings and equipment, normally funded once per individual;.
10.22.17.10.htm 10.22.17.10. 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
10.22.17.11.htm 10.22.17.11. 11 Payment For Supplemental Services.. A. The Administration shall pay the lower of either:. 1) Reasonable customary and actual costs not to exceed the cost to the general public; or. 2) Medicaid-approved rates.. B. Reasonable customary and actual costs are determined and authorized by the Administration before the delivery of the service.C. The Department shall reimburse the providers for preauthorized supplemental services upon submission of an invoice.
10.22.17.12.htm 10.22.17.12. 12 Contract.. A. If the Department preauthorizes a professional service, the Administration shall reimburse the provider for professional services according to the rate schedule in Regulation .08J(4) of this chapter except that the Administration may procure services to be reimbursed at a higher rate if:1) The provider submits documentation that it cannot find a professional to render services at this rate;2) The usual and customary rate charged by the professional for the service
10.22.17.13.htm 10.22.17.13. 13 Rates for Self-Directed Services.. A. If there is an existing contract to buy vocational and supported employment services, the contract amount less the amount to be paid for fiscal management services shall be used in determining the amount of money available for purchasing supported employment services and support brokerage services in an individual's budget.B. If there is no existing contract to buy vocational and supported employment services, the support
10.22.17.14.htm 10.22.17.14. 14 Hearings.. If an individual is denied services, the individual may request a hearing in accordance with all applicable federal and State laws and regulations, including COMAR 10.09.24.
10.22.17.15.htm 10.22.17.15. 15 Phase-In of Provider Component.. A. The Administration shall phase in the provider component for existing services.. B. The Administration shall determine providers' increases and decreases as described in this regulation.C. The individual components and the day habilitation and vocational program provider component in Regulations .06 and .07 of this chapter include increases funded by allocations in the fiscal year 1999 budget. The Administration shall calculate the
10.22.17.9999.htm 10.22.17.9999. Administrative History Effective date: August 10, 1987 (14:16 Md. R. 1775). Regulations .01―03, .06, and .08 amended as an emergency provision effective October 16, 1995 (22:22 Md. R. 1654)Regulation .01B amended effective April 8, 1996 (23:7 Md. R. 552). Regulation .02A amended effective April 8, 1996 (23:7 Md. R. 552). Regulation .02F repealed effective June 21, 1993 (20:12 Md. R. 997). Regulation .03D amended effective April 8, 1996 (23:7 Md. R. 552).
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