Md. Code Regs. 10.09.46.12 – Payment Procedures.

A. Request for Payment.
1. (1) An approved provider, with the exception of a medical day care provider, shall submit requests for payment to BHA or its authorized representative for the services covered under this chapter, according to procedures set forth in COMAR 10.09.36.04 or otherwise established by the Department. Medical day care providers shall submit requests for payment to the Department in accordance with COMAR 10.09.07.08.
2. (2) The provider shall:
  1. (a) Bill the Department in accordance with the payment methodology specified in §C of this regulation;
  2. (b) Accept payment from the Department as payment in full for the services covered under this chapter and make no additional charge for the covered services to the participant or any other party; and
  3. (c) Submit a request for payment in a manner approved by the Department, which includes the:
    1. (i) Date or dates of service;
    2. (ii) Participant's name and Medicaid number;
    3. (iii) Provider's name, location, and Program identification number;
    4. (iv) Type, procedure code or codes, and unit or units of covered services provided; and
    5. (v) Amount of reimbursement requested.
B. Billing time limitations for the services covered under this chapter are the same as those set forth in COMAR 10.09.36.06.
C. Payments.
1. (1) Payments shall be made only to a qualified provider for services covered under this chapter which are rendered to a participant.
2. (2) The Program shall pay according to the following fee-for-service schedule:
  1. (a) Residential habilitation reimbursed at:
    1. (i) $305.51 per day for Level 1 effective July 1, 2024;
    2. (ii) $404.52 per day for Level 2 effective July 1, 2024; and
    3. (iii) $559.63 per day for Level 3 effective July 1, 2024;
  2. (b) Day habilitation reimbursed at:
    1. (i) $78.88 per day for Level 1 effective July 1, 2024;
    2. (ii) $137.59 per day for Level 2 effective July 1, 2024; and
    3. (iii) $193.57 per day for Level 3 effective July 1, 2024;
  3. (c) Supported employment reimbursed at:
    1. (i) $46.80 per day for Level 1 effective July 1, 2024;
    2. (ii) $78.88 per day for Level 2 effective July 1, 2024; and
    3. (iii) $193.57 per day for Level 3 effective July 1, 2024; and
  4. (d) Individual support services (ISS): reimbursed at the rate of $9.5666 per 15 minutes effective July 1, 2024; and
  5. (e) Individual support services—virtual: reimbursed at the rate of $9.5666 per 15 minutes effective July 1, 2024.
3. (3) The Program shall pay for medical day care services in accordance with COMAR 10.09.07 and the participant's approved plan of care.
4. (4) Program rates specified in this regulation shall increase each fiscal year through FY 2026, subject to the limitations of the State budget.

Authority: Health-General Article, §§2-104(b), 15-103, 15-105, and 15-141.2, Annotated Code of Maryland

Effective date:

Regulations .01—.16 adopted as an emergency provision effective July 1, 2003 (30:14 Md. R. 933); adopted permanently effective December 11, 2003 (30:24 Md. R. 1740)

Regulation .01B amended effective April 9, 2007 (34:7 Md. R. 698)

Regulation .01B amended as an emergency provision effective July 1, 2008 (35:17 Md. R. 1481); amended permanently effective October 6, 2008 (35:20 Md. R. 1774)

Regulation .01B amended effective January 6, 2014 (40:26 Md. R. 2163); May 18, 2020 (47:10 Md. R. 516); May 1, 2023 (50:8 Md. R. 338)

Regulation .02B amended effective January 25, 2010 (37:2 Md. R. 67)

Regulation .02C, D amended effective January 6, 2014 (40:26 Md. R. 2163)

Regulation .03 amended effective May 18, 2020 (47:10 Md. R. 516)

Regulation .03B, E amended effective January 6, 2014 (40:26 Md. R. 2163)

Regulation .03B, F amended effective April 9, 2007 (34:7 Md. R. 698)

Regulation .03F amended effective October 14, 2013 (40:20 Md. R. 1652)

Regulation .04 amended effective May 18, 2020 (47:10 Md. R. 516); May 18, 2020 (47:10 Md. R. 516)

Regulation .04A amended effective January 6, 2014 (40:26 Md. R. 2163)

Regulation .04B amended effective April 9, 2007 (34:7 Md. R. 698); May 1, 2023 (50:8 Md. R. 338)

Regulation .04C amended effective May 1, 2023 (50:8 Md. R. 338)

Regulation .05 amended effective April 9, 2007 (34:7 Md. R. 698)

Regulation .05 amended as an emergency provision effective July 1, 2008 (35:17 Md. R. 1481); amended permanently effective October 6, 2008 (35:20 Md. R. 1774)

Regulation .05 amended effective January 6, 2014 (40:26 Md. R. 2163); May 18, 2020 (47:10 Md. R. 516); May 1, 2023 (50:8 Md. R. 338)

Regulation .06 amended effective April 9, 2007 (34:7 Md. R. 698)

Regulation .06E adopted as an emergency provision effective July 1, 2008 (35:17 Md. R. 1481); adopted permanently effective October 6, 2008 (35:20 Md. R. 1774)

Regulation .07C amended effective January 6, 2014 (40:26 Md. R. 2163)

Regulation .07D amended effective May 18, 2020 (47:10 Md. R. 516)

Regulation .08E amended effective January 6, 2014 (40:26 Md. R. 2163)

Regulation .08F amended effective May 18, 2020 (47:10 Md. R. 516)

Regulation .09C amended effective May 18, 2020 (47:10 Md. R. 516)

Regulation .09-1 adopted effective April 9, 2007 (34:7 Md. R. 698)

Regulation .09-1 amended effective May 18, 2020 (47:10 Md. R. 516); May 1, 2023 (50:8 Md. R. 338)

Regulation .09-1C amended effective January 6, 2014 (40:26 Md. R. 2163)

Regulation .09-2 adopted as an emergency provision effective July 1, 2008 (35:17 Md. R. 1481); adopted permanently effective October 6, 2008 (35:20 Md. R. 1774)

Regulation .10B amended effective May 18, 2020 (47:10 Md. R. 516)

Regulation .11C amended effective May 18, 2020 (47:10 Md. R. 516)

Regulation .11C, D amended effective April 9, 2007 (34:7 Md. R. 698)

Regulation .12A amended effective May 18, 2020 (47:10 Md. R. 516)

Regulation .12A, C amended as an emergency provision effective July 1, 2008 (35:17 Md. R. 1481); amended permanently effective October 6, 2008 (35:20 Md. R. 1774)

Regulation .12C amended effective May 1, 2023 (50:8 Md. R. 338); March 3, 2025 (52:4 Md. R. 218); June 8, 2026 (53:11 Md. R. 485)

Regulation .13 amended as an emergency provision effective July 1, 2008 (35:17 Md. R. 1481); amended permanently effective October 6, 2008 (35:20 Md. R. 1774)