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10.22.18.00.htm 10.22.18.00. Title 10 DEPARTMENT OF HEALTH AND MENTAL HYGIENE Subtitle 22 DEVELOPMENTAL DISABILITIES Chapter 18 Community Supported Living Arrangements Payment System Authority: Health-General Article, §2-104(b) 7-306.1, 7-307, 7-714, 7-910(c) 15-105, 15-107, and 16-201, Annotated Code of Maryland; Chapter 102, Acts of 2001
10.22.18.01.htm 10.22.18.01. 01 Scope.. A. This chapter establishes the methodology by which the Department shall reimburse licensed Community Supported Living Arrangements providers for:1) Services, the provision of which begins after June 30, 2000; and. 2) Existing services provided under contract which the Department shall convert to this rate system.. B. The rates are based on the service needs of the individual and an allowance for indirect expenses incurred by licensees.
10.22.18.02.htm 10.22.18.02. 02 Definitions.. A. In this chapter, the following terms have the meanings indicated.. B. Terms Defined.. 1) "Actual costs" means all direct and indirect costs that the provider incurs for labor performed or goods delivered.2) "Administration" means the Developmental Disabilities Administration.. 3) "Base services" means services covered by the rate.. 4) "Community Supported Living Arrangements (CSLA) has the meaning stated in COMAR 10.22.01.01B(12).
10.22.18.03.htm 10.22.18.03. 03 General Requirements.. A. To provide CSLA services and seek reimbursement from the Administration, a licensee shall:. 1) Be licensed in accordance with Health-General Article, Title 7, Annotated Code of Maryland, and COMAR 10.22.02;2) Comply with:. a) COMAR 10.22.08; and. b) COMAR 10.09.26;. 3) Execute an agreement with the Administration;. 4) Comply with the Administration's reporting and record-keeping requirements, including:. a) Submitting an annual cost report on a form appr
10.22.18.04.htm 10.22.18.04. 04 Rates.. A. The Department shall reimburse the licensee:. 1) For new individuals served after June 30, 2000, according to the rates set forth in this regulation; and2) For individuals receiving existing services, by converting those contracts to the Community Supported Living Arrangements Payment System if appropriate between:a) July 1, 2000, and December 31, 2000, if the individuals are living in their own residences, and.
10.22.18.05.htm 10.22.18.05. 05 Supplemental Services.. A. Supplemental services do not include any services that are in the Maryland Medical Assistance Program and can be provided to an individual and reimbursed under the Medical Assistance Program, or any services covered by private insurance, including Medicare.B. Supplemental services include:. 1) Respite;. 2) Expenses related to the operation and maintenance of the individual's vehicle;. 3) Medical equipment;.
10.22.18.06.htm 10.22.18.06. 06 Requests For and Approval of Supplemental Services.. A. In order for the Administration to reimburse a licensee for supplemental services, the Administration shall preauthorize the service and approve the cost.B. To be approved for reimbursement of supplemental services, except housing, the licensee shall:. 1) Submit a written request to the Administration justifying the request, including:. a) Recommendations from the individual's team,.
10.22.18.07.htm 10.22.18.07. 07 Payment for Base Services.. The licensee shall submit invoices or electronic claims in the form determined by the Administration.
10.22.18.08.htm 10.22.18.08. 08 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 licensee for preauthorized supplemental services upon submission of an invoice.
10.22.18.09.htm 10.22.18.09. 09 Contract.. The Administration shall contract for services needed by an individual as documented in the IP and preauthorized but not covered by rates or supplemental services in accordance with the State's procurement requirements.
10.22.18.10.htm 10.22.18.10. 10 Rates for Self-Directed Services.. A. If there is an existing contract for family support services or individual support 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 support services and support brokerage services in an individual's budget.B. If there is no existing contract for family support services or individual support services, the CSLA rates less the amoun
10.22.18.9999.htm 10.22.18.9999. Administrative History Effective date:. Regulations .01―09 adopted as an emergency provision effective July 1, 2000 (27:15 Md. R. 1397) adopted permanently effective October 30, 2000 (27:21 Md. R. 1976)Regulation .02B amended effective March 13, 2006 (33:5 Md. R. 520). Regulation .03 amended as an emergency provision effective July 1, 2001 (28:15 Md. R. 1395) amended permanently effective October 1, 2001 (28:19 Md. R. 1684)Regulation .03 amended as an emergency provision e
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