1. A. Reimbursement of Maryland Chronic Hospitals.

   1. (1) In-State chronic hospitals shall be reimbursed according to:

      1. (a) Rates approved by the HSCRC pursuant to COMAR 10.37.03; or

      2. (b) The administrative day rate as follows:

         1. (i) For a participant who is not ventilator-dependent, payment for approved administrative days shall be the estimated Statewide average Medicaid nursing facility payment rate as determined by the Department; and
         2. (ii) For a participant who is ventilator-dependent, payment for approved administrative days shall be the estimated average Medicaid nursing facility payment rate for ventilator-dependent residents as determined by the Department.
   2. (2) State-operated chronic hospitals shall be reimbursed according to Regulation .10 of this chapter. The Department shall make no direct reimbursement to any State-operated chronic hospital.

2. B. Reimbursement of Out-of-State Hospitals.

   1. (1) The Department shall reimburse an out-of-State hospital that provides a level of service equivalent to that provided at a chronic hospital only if:

      1. (a) The proposed admission is first reviewed by the Department or its designee and the out-of-State placement is determined medically necessary according to Regulation .07A of this chapter;
      2. (b) The hospital possesses the same certifications and accreditations as the Program requires for a comparable level of services and specific program in a Maryland chronic hospital; and

      3. (c) The hospital meets one of the following conditions:

         1. (i) The hospital proposes to provide a service or specific treatment that the participant cannot obtain in a Maryland chronic hospital; or
         2. (ii) The hospital is located geographically closer to the established residence of the participant than a Maryland chronic hospital.

   2. (2) The Department shall reimburse an out-of-State hospital at the lesser of:

      1. (a) The average rate established by the HSCRC for an equivalent cost center for a Maryland chronic hospital; or
      2. (b) The rate charged by the out-of-State hospital pursuant to 42 CFR Part 412, Subpart O.

Authority: Health-General Article, §§2-104(b), 15-102.8, 15-103, and 15-105, Annotated Code of Maryland

Effective date: April 10, 2017 (44:7 Md. R. 354)

Regulation .01B amended effective May 20, 2019 (46:10 Md. R. 487)

Regulation .05A amended effective May 20, 2019 (46:10 Md. R. 487)

Regulation .07A amended effective May 20, 2019 (46:10 Md. R. 487)

Regulation .08A, B amended effective May 20, 2019 (46:10 Md. R. 487)