1. A. The Department shall pay the provider the rate set forth under this chapter.
2. B. The rate is the sum of the individual component, the provider component, and any add-on component.

3. C. Reimbursement for Attendance Days of Day Habilitation, Vocational Services, and Supported Employment with Fewer than the Hours as Defined in Regulation .02 of this chapter.

   1. (1) The Administration may:

      1. (a) Not approve reimbursement for an attendance day if the individual receives fewer than 4 hours of service;

      2. (b) Approve reimbursement for fewer hours than the normal attendance day if the IP:

         1. (i) Documents that the individual is not able to engage in the program activities for the normal attendance day; and
         2. (ii) Includes a plan for enabling the individual to be engaged in a normal attendance day; and

      3. (c) Approve reimbursement for an attendance day of supported employment when the individual receives fewer than 4 hours of supported employment services if the:

         1. (i) IP documents that the individual is not able to engage in supported employment activities for 4 hours a day;
         2. (ii) IP includes a plan for enabling the individual to be engaged in supported employment for at least 4 hours with the goal being a normal attendance day; and
         3. (iii) Individual is engaged in at least 4 hours of activity that may include day habilitation and vocational services, with the majority of time spent in supported employment.
   2. (2) The Administration's approval of electronic or paper attendance documentation as specified by the Administration and submitted by the provider shall constitute approval of an attendance day of fewer than 6 to 8 hours if the approved individual plan indicates this lower level of service is necessary.

4. D. Conversion of Existing Supported Employment Services from a Contract to the Rate System.

   1. (1) There is a presumption that the cost of care for existing supported employment services reimbursed by the Administration under the rate system will be the same as under the contract.
   2. (2) The Administration shall reimburse the provider at least the same amount for cost of care for existing supported employment services as the Administration reimbursed the provider under the contract.
   3. (3) The Administration shall convert the contract reimbursement for individuals into a base rate together, if appropriate, with add-on components.
   4. (4) If a utilization review audit indicates that add-on components were not required for the individual, the Administration may recover unnecessary expenditures.
   5. (5) A provider may request additional services as set forth in Regulation .08F of this chapter.
   6. (6) The Administration shall review any add-on components for existing services every 3 years unless the Administration documents a need for more frequent review.
   7. (7) The Department shall reimburse providers of existing supported employment services by converting those contracts to reimbursement under this chapter between June 30, 2001, and July 1, 2002.
5. E. For add-on components, the Department shall reimburse providers of existing augmentation services by converting those contracts to reimbursement under this chapter between June 30, 2001, and July 1, 2003.

6. F. For a single calendar day, the Administration may not reimburse a provider for two or more attendance days of any combination of:

   1. (1) Residential services under this chapter, community supported living arrangements under COMAR 10.22.18, and personal care services under COMAR 10.09.20; or
   2. (2) Day habilitation services under this chapter, supported employment services under this chapter, vocational services under this chapter, and medical day care services under COMAR 10.09.07.

7. G. Absences and Vacancies.

   1. (1) As of July 1, 2011, the Department shall only reimburse providers for 33 days of absences or vacancies per year per individual when the individual is unable to be in residential services due to illness, vacation, home visits, medical appointments, or other circumstances.
   2. (2) As of July 1, 2003, the Department may claim federal financial participation for residential absence days as permitted by the Centers for Medicare and Medicaid Services under the Home and Community-Based Waiver.
8. H. The Administration shall reimburse day and supported employment programs an additional $2,000 per year per individual for transportation to and from day habilitation and vocational programs or to and from supported employment for individuals who, because of their disabilities, must use wheelchairs or motorized scooters, if the payments are consistent with the requirements under COMAR 10.09.26 and 10.09.19.
9. I. For residential services only, the Administration shall subtract from the payment, as appropriate, SSI contributions by individuals or other copayments.

10. J. The provider shall:

    1. (1) Assist the individual in obtaining SSI, if applicable; and
    2. (2) Collect all applicable individual copayment obligations while assuring that the individual retains the personal needs allowance.

11. K. To be reimbursed under this chapter, the provider shall submit:

    1. (1) Attendance data for individuals served; and
    2. (2) Other information as required by the Administration.

Authority: Health-General Article, §§2-104(b), 7-306.1, 7-307, 7-910(c), 15-105, 15-107, and 16-201, Annotated Code of Maryland

Effective date: August 10, 1987 (14:16 Md. R. 1775)

Regulations .01—.03, .06, and .08 amended as an emergency provision effective October 16, 1995 (22:22 Md. R. 1654)

Regulation .01B amended effective April 8, 1996 (23:7 Md. R. 552)

Regulation .02A amended effective April 8, 1996 (23:7 Md. R. 552)

Regulation .02F repealed effective June 21, 1993 (20:12 Md. R. 997)

Regulation .03D amended effective April 8, 1996 (23:7 Md. R. 552)

Regulation .06 amended effective April 8, 1996 (23:7 Md. R. 552)

Regulation .08C adopted effective April 8, 1996 (23:7 Md. R. 552)

Regulation .08D adopted as an emergency provision effective July 11, 1996 (23:16 Md. R. 1167); emergency status extended at 24:2 Md. R. 113; emergency status expired June 30, 1997

Chapter repealed and new chapter adopted effective July 1, 1998 (25:13 Md. R. 993)

Regulation .02B amended as an emergency provision effective July 1, 2000 (27:15 Md. R. 1397); amended permanently effective October 16, 2000 (27:20 Md. R. 1839)

Regulation .03C adopted as an emergency provision effective July 1, 2000 (27:15 Md. R. 1397); amended permanently effective October 16, 2000 (27:20 Md. R. 1839)

Regulation .06G amended as an emergency provision effective June 29, 1999 (26:15 Md. R. 1145); amended permanently effective October 4, 1999 (26:20 Md. R. 1545)

Regulation .06G amended as an emergency provision effective July 1, 2000 (27:15 Md. R. 1397); amended permanently effective October 16, 2000 (27:20 Md. R. 1839)

Regulation .07 amended as an emergency provision effective July 1, 2000 (27:15 Md. R. 1397); amended permanently effective October 16, 2000 (27:20 Md. R. 1839)

Chapter revised as an emergency provision effective July 1, 2001 (28:15 Md. R. 1394); revised permanently effective December 24, 2001 (28:25 Md. R. 2190)

Regulation .01A amended as an emergency provision effective July 1, 2003 (30:14 Md. R. 934); amended permanently effective September 29, 2003 (30:19 Md. R. 1332)

Regulation .02B amended as an emergency provision effective July 1, 2002 (29:14 Md. R. 1073); amended permanently effective September 30, 2002 (29:19 Md. R. 1524)

Regulation .02B amended effective March 13, 2006 (33:5 Md. R. 520); May 30, 2011 (38:11 Md. R. 671); April 15, 2013 (40:7 Md. R. 611)

Regulation .02B amended as an emergency provision effective August 12, 2021 (48:19 Md. R. 798); emergency status expired December 31, 2021

Regulation .02B amended as an emergency provision effective January 20, 2022 (49:4 Md. R. 296); emergency status expired effective March 31, 2022

Regulation .02B amended as an emergency provision effective May 27, 2022 (49:13 Md. R. 686); emergency status expired effective June 30, 2022

Regulation .02B amended as an emergency provision effective February 2, 2023 (50:4 Md. R. 120); emergency status expired effective August 1, 2023

Regulation .03C amended as an emergency provision effective July 1, 2002 (29:15 Md. R. 1139); amended permanently effective October 14, 2002 (29:20 Md. R. 1588)

Regulation .03C amended as an emergency provision effective July 1, 2003 (30:14 Md. R. 934); amended permanently effective September 29, 2003 (30:19 Md. R. 1332)

Regulation .03C amended effective December 20, 2004 (31:25 Md. R. 1790); March 13, 2006 (33:5 Md. R. 520); January 1, 2007 (33:26 Md. R. 1997); December 31, 2007 (34:26 Md. R. 2263); March 23, 2009 (36:3 Md. R. 491); May 30, 2011 (38:11 Md. R. 671)

Regulation .05 amended as an emergency provision effective July 1, 2002 (29:15 Md. R. 1139); amended permanently effective October 14, 2002 (29:20 Md. R. 1588)

Regulation .05A amended as an emergency provision effective July 1, 2003 (30:14 Md. R. 934); amended permanently effective September 29, 2003 (30:19 Md. R. 1332)

Regulation .06G repealed and new regulation.06G adopted as an emergency provision effective July 1, 2002 (29:15 Md. R. 1139); adopted permanently effective October 14, 2002 (29:20 Md. R. 1588)

Regulation .06G amended as an emergency provision effective July 1, 2003 (30:14 Md. R. 934); amended permanently effective September 29, 2003 (30:19 Md. R. 1332)

Regulation .06G amended effective December 20, 2004 (31:25 Md. R. 1790); March 13, 2006 (33:5 Md. R. 520); January 1, 2007 (33:26 Md. R. 1997); December 31, 2007 (34:26 Md. R. 2263); March 23, 2009 (36:3 Md. R. 491); May 30, 2011 (38:11 Md. R. 671); April 15, 2013 (40:7 Md. R. 611); July 7, 2014 (41:13 Md. R. 752); October 12, 2015 (42:20 Md. R. 1265); January 2, 2017 (43:26 Md. R. 1445); April 9, 2018 (45:7 Md. R. 345); May 20, 2019 (46:10 Md. R. 488); October 5, 2020 (47:20 Md. R. 875)

Regulation .07 amended as an emergency provision effective July 1, 2002 (29:15 Md. R. 1139); amended permanently effective October 14, 2002 (29:20 Md. R. 1588)

Regulation .07 amended as an emergency provision effective July 1, 2003 (30:14 Md. R. 934); amended permanently effective September 29, 2003 (30:19 Md. R. 1332)

Regulation .07 amended effective December 20, 2004 (31:25 Md. R. 1790); March 13, 2006 (33:5 Md. R. 520); January 1, 2007 (33:26 Md. R. 1997); December 31, 2007 (34:26 Md. R. 2263); March 23, 2009 (36:3 Md. R. 491); May 30, 2011 (38:11 Md. R. 671); April 15, 2013 (40:7 Md. R. 611); July 7, 2014 (41:13 Md. R. 752); October 12, 2015 (42:20 Md. R. 1265); January 2, 2017 (43:26 Md. R. 1445); April 9, 2018 (45:7 Md. R. 345); May 20, 2019 (46:10 Md. R. 488); October 5, 2020 (47:20 Md. R. 875)

Regulation .08J amended as an emergency provision effective July 1, 2002 (29:15 Md. R. 1139); amended permanently effective October 14, 2002 (29:20 Md. R. 1588)

Regulation .08J amended as an emergency provision effective July 1, 2003 (30:14 Md. R. 934); amended permanently effective September 29, 2003 (30:19 Md. R. 1332)

Regulation .08J amended effective December 20, 2004 (31:25 Md. R. 1790); March 13, 2006 (33:5 Md. R. 520); January 1, 2007 (33:26 Md. R. 1997); December 31, 2007 (34:26 Md. R. 2263); March 23, 2009 (36:3 Md. R. 491); May 30, 2011 (38:11 Md. R. 671); April 15, 2013 (40:7 Md. R. 611); July 7, 2014 (41:13 Md. R. 752); October 12, 2015 (42:20 Md. R. 1265); January 2, 2017 (43:26 Md. R. 1445); April 9, 2018 (45:7 Md. R. 345); May 20, 2019 (46:10 Md. R. 488); October 5, 2020 (47:20 Md. R. 875)

Regulation .10 amended as an emergency provision effective August 12, 2021 (48:19 Md. R. 798); emergency status expired December 31, 2021

Regulation .10 amended as an emergency provision effective January 20, 2022 (49:4 Md. R. 296); emergency status expired effective March 31, 2022

Regulation .10 amended as an emergency provision effective May 27, 2022 (49:13 Md. R. 686); emergency status expired June 30, 2022

Regulation .10 amended as an emergency provision effective February 2, 2023 (50:4 Md. R. 120); emergency status expired effective August 1, 2023

Regulation .10G amended as an emergency provision effective April 8, 2004 (31:9 Md. R. 711); amended permanently effective August 2, 2004 (31:15 Md. R. 1185)

Regulation .10G amended effective April 15, 2013 (40:7 Md. R. 611)

Regulations .13 and .14 recodified to be Regulations .14 and .15 respectively, and new Regulation .13 adopted effective March 13, 2006 (33:5 Md. R. 520)