1. A. General policies governing payment procedures that are applicable to all providers are set forth in COMAR 10.09.36.04.

2. B. The provider shall charge the Program the provider’s customary charge to the general public for similar services. If the service is free to individuals not covered by Medicaid:

   1. (1) The provider:

      1. (a) May charge the Program; and
      2. (b) Shall be reimbursed in accordance with §G of this regulation; and
   2. (2) The provider’s reimbursement is not limited to the provider’s customary charge.

3. C. The Program will reimburse a provider for covered services:

   1. (1) The lesser of the provider’s customary charge to the general public unless the service is free to individuals not covered by Medicaid; or
   2. (2) In accordance with §G of this regulation.

4. D. The provider may not bill the Program or the participant for:

   1. (1) Completion of forms and reports;
   2. (2) Broken or missed appointments;
   3. (3) Professional services rendered by mail; or
   4. (4) Providing a copy of a program participant’s medical record when requested by another provider on behalf of the participant.
5. E. Payments for services rendered to a Program participant shall be made directly to a qualified provider or program.
6. F. Billing time limitations for claims submitted pursuant to this chapter are set forth in COMAR 10.09.36.06.

7. G. Reimbursement.

   1. (1) Payments shall be made in 30-minute units of service.
   2. (2) Effective July 1, 2023, rates for the services outlined in this chapter shall be reimbursed at $32.76 per unit.

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

Effective date: November 13, 2023 (50:22 Md. R. 974)