13A.11.01.17

.17 Payment for Goods.

A. Payment Procedures.

(1) Preauthorization.

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

(b) A provider shall be licensed or certified consistent with Regulation .16A(2) of this chapter.

(2) For purchases initiated by purchase order, the provider shall submit the invoice for goods delivered 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 applicant or eligible individual, the individual's family, or a third party for the authorized goods unless, before providing the goods, the amount of the individual's responsibility has been:

(a) Preauthorized by the Division; and

(b) Agreed to by the individual in writing.

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

(1) Provider's customary charge;

(2) Rate established by the Department of General Services Purchasing Bureau;

(3) Rate established as the result of competitive bidding conducted by the Division in accordance with COMAR Title 21; or

(4) Maximum rate established in the "Division of Rehabilitation Services Fee Schedule", which is incorporated by reference in Regulation .03-1 of this chapter.

C. Purchase Limitations.

(1) Prescription goods may be purchased only after receipt of a current, valid prescription.

(2) Generic drugs shall be purchased unless the physician indicates that a particular brand is medically necessary.

(3) The Division may not pay for vehicles which require a license to operate, land, buildings, or the construction of or addition to a building.

(4) The purchase of goods and services for a self-employment enterprise will be made only after:

(a) The eligible individual has submitted a business plan which:

(i) Identifies a business enterprise which meets standards established by the Division for types of businesses which can be supported;

(ii) Meets generally accepted business standards;

(iii) Identifies multiple funding sources as the Division may not be the primary funder of a business;

(iv) Has been reviewed by an advisory entity established by the Division; and

(v) Has been approved by the Division; and

(b) Any required goods and services are:

(i) Included on the individualized plan for employment; and

(ii) Approved by the Division.

(5) The Division may establish other reasonable purchase limitations in order to manage agency resources and maximize the number of employment outcomes.

D. Ownership of Goods.

(1) The State shall retain legal title to tools, equipment, shelters, and supplies purchased as part of an eligible individual's rehabilitation program, except as provided in §D(3) of this regulation.

(2) An eligible individual shall return goods purchased by the Division when they are no longer needed for the individual's rehabilitation program, employment, or independent living.

(3) Title may be assigned to the eligible individual for the following:

(a) Medical appliances not transferable to or useable by another person;

(b) Goods provided as part of an approved business plan to be used as collateral to leverage funds for the business; and

(c) Other exceptional circumstances with approval of the Director or designee.