13A.11.01.16

.16 Payment for Rehabilitation Services.

A. Preauthorization of Providers.

(1) The Division may pay a provider only if the provider has been preauthorized by the Division.

(2) Individual providers who are subject to State licensure or certification shall provide evidence of a current, valid license or certification, except in the area of specialized tutoring services for which a provider may present alternate qualifications as specified by the Division.

(3) Institutions of post-secondary education shall provide evidence of current, valid accreditation by an appropriate state or national accrediting organization.

(4) Private career schools shall provide evidence of a current, valid certificate of approval by the Maryland Higher Education Commission or, in the case of out-of-State private schools, by that state's equivalent certification entity.

B. Payment Procedures.

(1) Payment may be made only for services that have been preauthorized and approved by the Division through a signed purchase order or the use of the Division's purchasing card.

(2) For purchases initiated by purchase order, the provider shall submit an invoice for services rendered, along with any required reports, according to procedures established by the Division.

(3) The Division may return to the provider, before payment, all invoices not properly signed, completed, and accompanied by required reports.

(4) A provider may not charge or accept payment from the individual, the individual's family, or a third party for the authorized services unless, before providing the service, the amount of the individual's responsibility has been:

(a) Preauthorized by the Division; and

(b) Agreed to by the individual in writing.

C. Rate of Payment. The Division shall pay for authorized services at a rate equal to the lower of:

(1) The provider's customary charge;

(2) The maximum rate established in the "Division of Rehabilitation Services Fee Schedule"; or

(3) 120 percent of the Medicare Program rate established by 42 CFR 414 and 415, for medical or surgical procedures not identified in the Division's fee schedule.

D. Exceptions to Rate of Payment. The Division's payment may exceed the maximum rate established in the "Division of Rehabilitation Services Fee Schedule" only when the Director of Field Services or the Director of the Office for Blindness and Vision Services authorizes the exception:

(1) Because the client is at extreme medical risk, as evidenced by documentation submitted by a licensed medical professional; or

(2) For reasons related to the disability or services included on an approved Individualized Plan for Employment.