1. A. Payment procedures are as set forth in COMAR 10.09.36.04 and .06.

2. B. Payments.

   1. (1) Payments shall be made directly to a qualified provider.
   2. (2) To receive payment for services under Regulation .04 of this chapter, a provider and its workers shall use the electronic visit verification method and data management system approved by the Department to document time and submit claims in accordance with COMAR 10.09.36.03-2.

   3. (3) Providers shall be paid the lesser of:

      1. (a) The provider’s customary charge to the general public unless the service is free to individuals not covered by Medicaid; or
      2. (b) The rate established according to the fee schedule published by the Department.

3. C. Rates.

   1. (1) Effective July 1, 2022, through December 31, 2023, rates for the services outlined in this regulation shall be as follows:

      1. (a) $17.87 for 15 minutes of services provided by a registered nurse to one participant;
      2. (b) $12.32 for 15 minutes of services provided by a registered nurse to each of two or more participants in the same residence;
      3. (c) $11.58 for 15 minutes of services provided by a licensed practical nurse to one participant;
      4. (d) $7.99 for 15 minutes of services provided by a licensed practical nurse to each of two or more participants in the same residence;
      5. (e) $6.12 for 15 minutes of services provided by a CNA or HHA who is also certified as a CMT to one participant;
      6. (f) $4.22 for 15 minutes of services provided by a CNA or HHA who is also certified as a CMT to each of two or more participants in the same residence;
      7. (g) $5.08 for 15 minutes of services provided by a CNA or HHA to one participant;
      8. (h) $3.50 for 15 minutes of services provided by a CNA or HHA to two or more participants in the same residence; and
      9. (i) A flat rate of $71.41 per visit for a registered nurse supervisory visit of a nurse, CNA, or HHA.

   2. (2) Effective January 1, 2024 through June 30, 2024, rates for the services outlined in this regulation shall be as follows:

      1. (a) $19.2951 for 15 minutes of services provided by a registered nurse to one participant;
      2. (b) $13.3101 for 15 minutes of services provided by a registered nurse to each of two or more participants in the same residence;
      3. (c) $12.5061 for 15 minutes of services provided by a licensed practical nurse to one participant;
      4. (d) $8.6266 for 15 minutes of services provided by a licensed practical nurse to each of two or more participants in the same residence;
      5. (e) $6.6105 for 15 minutes of services provided by a CNA or HHA who is also certified as a CMT to one participant;
      6. (f) $4.5611 for 15 minutes of services provided by a CNA or HHA who is also certified as a CMT to each of two or more participants in the same residence;
      7. (g) $5.4874 for 15 minutes of services provided by a CNA or HHA to one participant;
      8. (h) $3.7848 for 15 minutes of services provided by a CNA or HHA to two or more participants in the same residence; and
      9. (i) A flat rate of $77.13 per visit for a registered nurse supervisory visit of a nurse, CNA, or HHA.

   3. (3) Effective July 1, 2024, rates for the services outlined in this regulation shall be as follows:

      1. (a) $19.8739 for 15 minutes of services provided by a registered nurse to one participant;
      2. (b) $13.7094 for 15 minutes of services provided by a registered nurse to each of two or more participants in the same residence;
      3. (c) $12.8813 for 15 minutes of services provided by a licensed practical nurse to one participant;
      4. (d) $8.8854 for 15 minutes of services provided by a licensed practical nurse to each of two or more participants in the same residence;
      5. (e) $6.8088 for 15 minutes of services provided by a CNA or HHA who is also certified as a CMT to one participant;
      6. (f) $4.6979 for 15 minutes of services provided by a CNA or HHA who is also certified as a CMT to each of two or more participants in the same residence;
      7. (g) $5.6520 for 15 minutes of services provided by a CNA or HHA to one participant;
      8. (h) $3.8983 for 15 minutes of services provided by a CNA or HHA to two or more participants in the same residence; and
      9. (i) A flat rate of $79.44 per visit for a registered nurse supervisory visit of a nurse, CNA, or HHA.
   4. (4) The Program’s rates as specified in this regulation shall adjust each year, subject to the limitations of the State budget.
4. D. The nursing services provider shall identify the individual who ordered the nursing services by recording the individual practitioner’s National Provider Identifier (NPI) number on the claim.

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

Effective date:

Regulations .01—.11 adopted as an emergency provision effective May 5, 1993 (20:11 Md. R. 911); adopted permanently effective August 2, 1993 (20:15 Md. R. 1220)

Regulations .01, .03—.07 amended as an emergency provision effective June 1, 1994 (21:13 Md. R. 1152); amended permanently effective September 26, 1994 (21:19 Md. R. 1635)

Regulations .01 and .03—.06 amended as an emergency provision effective January 1, 1997 (23:26 Md. R. 1856); amended permanently effective March 10, 1997 (24:5 Md. R. 408)

Regulation .01B amended effective August 23, 1999 (26:17 Md. R. 1323); January 31, 2005 (32:2 Md. R. 146); August 27, 2007 (34:17 Md. R. 1507); March 10, 2008 (35:5 Md. R. 641); April 1, 2014 (41:6 Md. R. 379); August 21, 2023 (50:16 Md. R. 726)

Regulation .02 amended effective January 31, 2005 (32:2 Md. R. 146)

Regulation .03 amended effective January 31, 2005 (32:2 Md. R. 146); April 1, 2014 (41:6 Md. R. 379)

Regulation .03C, H amended effective August 23, 1999 (26:17 Md. R. 1323)

Regulation .03D, G amended effective March 10, 2008 (35:5 Md. R. 641)

Regulation .04 amended effective March 10, 2008 (35:5 Md. R. 641); April 1, 2014 (41:6 Md. R. 379)

Regulation .04A amended effective June 24, 2024 (51:12 Md. R. 619)

Regulation .04A, C amended effective August 23, 1999 (26:17 Md. R. 1323); January 31, 2005 (32:2 Md. R. 146)

Regulation .04I adopted effective January 1, 2018 (44:26 Md. R. 1214)

Regulation .05 amended effective April 1, 2014 (41:6 Md. R. 379); June 24, 2024 (51:12 Md. R. 619)

Regulation .05A amended effective August 23, 1999 (26:17 Md. R. 1323); January 31, 2005 (32:2 Md. R. 146); March 10, 2008 (35:5 Md. R. 641)

Regulation .05C repealed effective March 10, 2008 (35:5 Md. R. 641)

Regulation .05E adopted effective January 1, 2018 (44:26 Md. R. 1214)

Regulation .06 amended effective August 23, 1999 (26:17 Md. R. 1323); January 31, 2005 (32:2 Md. R. 146); April 1, 2014 (41:6 Md. R. 379)

Regulation .06A amended effective August 27, 2007 (34:17 Md. R. 1507)

Regulation .07 amended effective July 3, 2006 (33:13 Md. R. 1064); October 31, 2011 (38:22 Md. R. 1345); April 1, 2014 (41:6 Md. R. 379); October 24, 2016 (43:21 Md. R. 1166); May 20, 2019 (46:10 Md. R. 486)

Regulation .07B amended as an emergency provision effective January 1, 2000 (27:2 Md. R. 140); amended permanently effective May 1, 2000 (27:8 Md. R. 798)

Regulation .07B amended as an emergency provision effective June 12, 2008 (35:14 Md. R. 1243); amended permanently effective December 1, 2008 (35:24 Md. R. 2077)

Regulation .07B amended effective April 6, 2009 (36:7 Md. R. 524); August 21, 2023 (50:16 Md. R. 726)

Regulation .07C amended effective November 14, 2022 (49:23 Md. R. 995); August 21, 2023 (50:16 Md. R. 726); May 11, 2026 (53:9 Md. R. 413)

Regulation .07D amended as an emergency provision effective July 1, 2007 (34:15 Md. R. 1347); amended permanently effective September 24, 2007 (34:19 Md. R. 1650)

Regulation .07D amended as an emergency provision effective June 12, 2008 (35:14 Md. R. 1243); amended permanently effective December 1, 2008 (35:24 Md. R. 2077)

Regulation .07D amended effective March 22, 2010 (37:6 Md. R. 477)

Regulation .07E repealed effective March 10, 2008 (35:5 Md. R. 641)

Regulation .07F adopted effective January 1, 2018 (44:26 Md. R. 1214)