The Program shall reimburse for the services specified in Regulations .13—.19 of this chapter, if provided in accordance with the requirements of this chapter and if the service:

1. A. Is recommended on the participant’s plan of service as necessary in order to:

   1. (1) Prevent the applicant’s or participant’s admission to an institution; or
   2. (2) Assure the health and safety of an applicant or participant in the community;
2. B. Has been pre-approved by the Department in the participant’s plan of service;
3. C. Is provided to an enrolled participant;
4. D. Is medically necessary;
5. E. Is provided by a Medicaid provider who meets the conditions for participation under this chapter; and

6. F. Is cost-neutral for the Program, which is determined by adding annualized costs of services covered under this chapter and any other State Plan services which are not covered for nursing facility residents, and ensuring that the resulting amount is not more than:

   1. (1) 125 percent of the Program's average per capita-annualized-net payments for nursing facility services for a waiver participant in accordance with the provisions of Regulation .03B(4)(d) of this chapter; and
   2. (2) In the aggregate for all waiver participants, 100 percent of the Program’s average per capita-annualized-net payments for nursing facility services.

Authority: Health-General Article, §§2-104(b), 15-103, 15-105, 15-132, and 15-141.2, Annotated Code of Maryland

Effective date:

Regulations .01—19 adopted as an emergency provision effective July 22, 1993 (20:16 Md. R. 1275); adopted permanently effective October 26, 1993 (20:21 Md. R. 1654)

Chapter revised effective December 25, 2000 (27:25 Md. R. 2281)

Chapter revised effective June 21, 2004 (31:12 Md. R. 912)

Regulation .05A amended effective July 17, 2006 (33:14 Md. R. 1164)

Regulation .33C amended effective June 20, 2005 (32:12 Md. R. 1046); July 17, 2006 (33:14 Md. R. 1164)

Chapter revised effective April 9, 2007 (34:7 Md. R. 698)

Regulation .03C amended effective September 20, 2010 (37:19 Md. R. 1284)

Regulation .14 adopted as an emergency provision effective July 1, 2008 (35:17 Md. R. 1482); adopted permanently effective December 1, 2008 (35:24 Md. R. 2078)

Regulation .14-1 adopted effective April 15, 2013 (40:7 Md. R. 610)

Regulation .15 amended as an emergency provision effective July 1, 2008 (35:17 Md. R. 1482); amended permanently effective December 1, 2008 (35:24 Md. R. 2078)

Regulation .17 adopted as an emergency provision effective June 18, 2009 (36:15 Md. R. 1163); adopted permanently effective September 21, 2009 (36:19 Md. R. 1436)

Regulation .30 adopted as an emergency provision effective July 1, 2008 (35:17 Md. R. 1482); adopted permanently effective December 1, 2008 (35:24 Md. R. 2078)

Regulation .30-1 adopted effective April 15, 2013 (40:7 Md. R. 610)

Regulation .32F, G amended as an emergency provision effective July 1, 2008 (35:17 Md. R. 1482); amended permanently effective December 1, 2008 (35:24 Md. R. 2078)

Regulation .32H adopted as an emergency provision effective June 18, 2009 (36:15 Md. R. 1163); adopted permanently effective September 21, 2009 (36:19 Md. R. 1436)

Regulation .33A, C amended as an emergency provision effective July 1, 2008 (35:17 Md. R. 1482); amended permanently effective December 1, 2008 (35:24 Md. R. 2078)

Regulation .33C amended effective April 6, 2009 (36:7 Md. R. 524); February 8, 2010 (37:3 Md. R. 176); October 31, 2011 (38:22 Md. R. 1346); April 15, 2013 (40:7 Md. R. 610)

Regulation .33D adopted effective January 6, 2014 (40:26 Md. R. 2163)

Regulations .01—.37 repealed and new Regulations .01—.27 adopted effective April 28, 2014 (41:8 Md. R. 471)

Regulation .01 amended effective November 27, 2023 (50:23 Md. R. 1004)

Regulation .04A amended effective November 27, 2023 (50:23 Md. R. 1004); May 11, 2026 (53:9 Md. R. 413)

Regulation .04D adopted effective May 11, 2026 (53:9 Md. R. 413)

Regulation .10-1 adopted effective December 11, 2014 (41:24 Md. R. 1427)

Regulation .13 amended effective January 30, 2017 (44:2 Md. R. 84)

Regulation .14 amended effective January 30, 2017 (44:2 Md. R. 84); November 27, 2023 (50:23 Md. R. 1004)

Regulation .15A amended effective January 30, 2017 (44:2 Md. R. 84)

Regulation .16A amended effective January 30, 2017 (44:2 Md. R. 84)

Regulation .16E, F, G adopted effective November 27, 2023 (50:23 Md. R. 1004)

Regulation .17 amended effective January 30, 2017 (44:2 Md. R. 84)

Regulation .17D, E, F adopted effective November 27, 2023 (50:23 Md. R. 1004)

Regulation .18 amended effective January 30, 2017 (44:2 Md. R. 84)

Regulation .18-1 adopted effective December 11, 2014 (41:24 Md. R. 1427)

Regulation .18-1 amended effective January 30, 2017 (44:2 Md. R. 84)

Regulation .19 amended effective January 30, 2017 (44:2 Md. R. 84)

Regulation .21B amended effective December 11, 2014 (41:24 Md. R. 1427)

Regulation .21C adopted effective December 11, 2014 (41:24 Md. R. 1427)

Regulation .22A amended effective May 11, 2026 (53:9 Md. R. 413)

Regulation .22C amended effective July 4, 2016 (43:13 Md. R. 712); November 27, 2023 (50:23 Md. R. 1004); May 11, 2026 (53:9 Md. R. 413)

Regulation .22D amended effective January 30, 2017 (44:2 Md. R. 84); May 20, 2019 (46:10 Md. R. 486); November 27, 2023 (50:23 Md. R. 1004); May 11, 2026 (53:9 Md. R. 413)