Maryland Administrative Code

.09 Administrative and Judicial Review. A. An individual has the right to appeal an action or inaction with respect to this chapter in accordance with Health-General Article, §7-406, Annotated Code of Maryland, and COMAR 10.22.16. B. An individual may prevail at the appeal only u…

.10 Eligibility for Other Services. A. An individual's eligibility for services provided by any other public or private agency may not be affected by the individual's eligibility for services under this chapter. B. An individual who is eligible for services funded by the Administ…

.01 Scope. This chapter applies to the hearing which an applicant for or a recipient of Developmental Disabilities Administration services may request under Health-General Article, §7-406(a)(1), Annotated Code of Maryland. Nothing in these regulations shall be construed to create…

.02 Purpose. The purpose of the informal hearing procedure is to seek informal and expeditious resolution when an applicant for or recipient of services is dissatisfied as a result of the Secretary's actions or inactions under Health-General Article, Title 7.

.03 Definitions. A. In this chapter the following terms have the meanings indicated. B. Terms Defined. (1) “Action or inaction of the Secretary” means a decision of the Deputy Secretary or an authorized representative of the Deputy Secretary, that: (a) Denies an application by an…

.04 Notification of Right to Request a Hearing. The Administration shall: A. Provide written notification of the right to request a hearing and the method of obtaining the hearing to each applicant for or recipient of services at the time of application, and at any time the Admin…

.05 Request for Hearing. A. An applicant or recipient, or the applicant's or recipient's representative, may request a hearing by mailing or delivering a clear, written statement to the Director of the Administration. The request shall state: (1) That the applicant or recipient d…

.06 Implementation of Action of the Secretary. A. The action of the Secretary, which is the subject of a request for a hearing, may not be implemented unless the: (1) Secretary has determined that an emergency exists when to delay action for a hearing would have a serious and adv…

.07 Secretary's Designee. A. The Director shall, in response to a request for a hearing, choose an employee of the Department to conduct the hearing and issue an administrative decision. B. An individual may not serve as the Secretary's designee if, as to this hearing, the indivi…

.08 Powers and Duties of Secretary's Designee. A. The Secretary's designee shall have authority to: (1) Engage in reasonable efforts to secure the attendance of witnesses; (2) Conduct a full, fair, and impartial hearing; (3) Take action to avoid unnecessary delay and duplication …

.09 Prehearing. A. The appellant and the Department's representative are encouraged to engage in informal discussions before the hearing for the purpose of sharing documentary evidence, clarifying facts, resolving issues, and making recommendations to the Secretary's designee reg…

.10 Hearing Procedure. A. The appellant shall have the right to request that the hearing be closed to the public. The Secretary's designee shall grant the appellant's request for a closed hearing if the Secretary's designee, after hearing from the parties, determines that the app…

.11 Burden of Persuasion. The appellant bears the burden of persuasion and may not prevail unless the appellant convinces the Secretary's designee by a preponderance of the evidence that the Secretary's action or inaction was incorrect.

.12 The Record. The Secretary's designee shall: A. Maintain the official record of the hearing; B. Include in the official record of the hearing: (1) Official correspondence regarding the hearing, including the request for the hearing and the Secretary's response, (2) Written mat…

.13 Decision of the Secretary's Designee. A. The Secretary's designee shall decide a case within 14 days of the hearing based upon the entire record in the case and according to the burden of persuasion set forth in Regulation .11. The Secretary's designee may communicate with th…

.01 Scope. A. This chapter establishes the methodology that the Department shall use to reimburse: (1) Licensed residential alternative living units, residential group homes, day habilitation programs, and vocational programs that provide services to individuals with disabilities…

.02 Definitions. A. In this chapter, the following terms have the meanings indicated. B. Terms Defined. (1) “Add-on component” means one or more units of service, each one of which includes funding for direct service and other nondirect costs not covered by the sum of the provide…

.03 General. A. The provider shall sign an agreement with the Administration. B. The rights of the Administration include but are not limited to the following: (1) Approving the individuals to be served; (2) Performing a utilization review of individual indicator rating scales; a…

.04 Licensure Requirements. To receive reimbursement under this chapter, a provider shall: A. Be licensed in accordance with Health-General Article, Title 7, Annotated Code of Maryland, and COMAR 10.22.08 or 10.22.07; and B. Comply with COMAR 10.09.26 and all other applicable reg…

.05 Reporting Requirements and Record Keeping. A. The provider shall submit an annual cost report not later than 6 months after the end of the State fiscal year that: (1) Documents the provider's actual expenditures for the fiscal year being reported; (2) Is based on the provider…

.06 Determination of Individual Component. A. The individual component is for costs the provider incurs in providing direct services to the individual. B. The Administration shall establish an individual component for new and existing services that is based on the: (1) Individual…

.07 Provider Components. Effective July 1, 2019 the provider components for all regions are as follows: A. The residential program provider component is $70.91; and B. The day habilitation, vocational, supported employment, community learning services, and employment discovery an…

.08 Add-On Component. A. An add-on component is for: (1) Residential programs; (2) Day habilitation, vocational, and supported employment programs; and (3) Professional services. B. The Administration may preauthorize and approve one or more units of add-on components for additio…

.09 Supplemental Services. A. The Administration may preauthorize supplemental services. B. Supplemental services do not include any services that are in the State Medical Assistance Plan and can be provided to an individual and reimbursed under the Medical Assistance Program, or…

.10 Payment for Services Reimbursed by Rates. A. The Department shall pay the provider the rate set forth under this chapter. B. The rate is the sum of the individual component, the provider component, and any add-on component. C. Reimbursement for Attendance Days of Day Habilita…

.11 Payment For Supplemental Services. A. The Administration shall pay the lower of either: (1) Reasonable customary and actual costs not to exceed the cost to the general public; or (2) Medicaid-approved rates. B. Reasonable customary and actual costs are determined and authoriz…

.12 Contract. A. If the Department preauthorizes a professional service, the Administration shall reimburse the provider for professional services according to the rate schedule in Regulation .08J(4) of this chapter except that the Administration may procure services to be reimbu…

.13 Rates for Self-Directed Services. A. If there is an existing contract to buy vocational and supported employment services, the contract amount less the amount to be paid for fiscal management services shall be used in determining the amount of money available for purchasing s…

.14 Hearings. If an individual is denied services, the individual may request a hearing in accordance with all applicable federal and State laws and regulations, including COMAR 10.09.24.

.15 Phase-In of Provider Component. A. The Administration shall phase in the provider component for existing services. B. The Administration shall determine providers' increases and decreases as described in this regulation. C. The individual components and the day habilitation a…

.01 Scope. A. This chapter establishes the methodology by which the Department shall reimburse licensed Community Supported Living Arrangements providers for: (1) Services, the provision of which begins after June 30, 2000; and (2) Existing services provided under contract which …

.02 Definitions. A. In this chapter, the following terms have the meanings indicated. B. Terms Defined. (1) “Actual costs” means all direct and indirect costs that the provider incurs for labor performed or goods delivered. (2) “Administration” means the Developmental Disabilitie…

.03 General Requirements. A. To provide CSLA services and seek reimbursement from the Administration, a licensee shall: (1) Be licensed in accordance with Health-General Article, Title 7, Annotated Code of Maryland, and COMAR 10.22.02; (2) Comply with: (a) COMAR 10.22.08; and (b)…

.04 Rates. A. The Department shall reimburse the licensee: (1) For new individuals served after June 30, 2000, according to the rates set forth in this regulation; and (2) For individuals receiving existing services, by converting those contracts to the Community Supported Living…

.05 Supplemental Services. A. Supplemental services do not include any services that are in the Maryland Medical Assistance Program and can be provided to an individual and reimbursed under the Medical Assistance Program, or any services covered by private insurance, including Me…

.06 Requests For and Approval of Supplemental Services. A. In order for the Administration to reimburse a licensee for supplemental services, the Administration shall preauthorize the service and approve the cost. B. To be approved for reimbursement of supplemental services, exce…

.07 Payment for Base Services. The licensee shall submit invoices or electronic claims in the form determined by the Administration.

.08 Payment For Supplemental Services. A. The Administration shall pay the lower of either: (1) Reasonable customary and actual costs not to exceed the cost to the general public; or (2) Medicaid-approved rates. B. Reasonable customary and actual costs are determined and authoriz…

.09 Contract. The Administration shall contract for services needed by an individual as documented in the IP and preauthorized but not covered by rates or supplemental services in accordance with the State's procurement requirements.

.10 Rates for Self-Directed Services. A. If there is an existing contract for family support services or individual support services, the contract amount less the amount to be paid for fiscal management services shall be used in determining the amount of money available for purch…

.01 Definitions. A. In this chapter, the following terms have the meanings indicated. B. Terms Defined. (1) “Day services” means services provided by a licensed provider under COMAR 10.22.07.03E. (2) “Enclave” means a group of eight or fewer individuals with developmental disabil…

.02 Fiscal Incentive Program for Employment. A. Provider Eligibility. A provider is eligible to be included in the FIPE if the provider: (1) Is licensed as a vocational or day services program under COMAR 10.22.07; and (2) Provides services to an eligible individual. B. Individua…

.01 Purpose. The purpose of this chapter is to set forth the designation process and requirements for Organized Health Care Delivery Systems (OHCDS). Entities with this designation may subcontract with Medicaid and Non-Medicaid providers to allow individuals to receive services a…

.02 Scope. This chapter establishes the: A. Methodology that the Department shall use in the designation of entities as Organized Health Care Delivery Systems; and B. Requirements to be fulfilled by Organized Health Care Delivery Systems.

.03 Additional Regulatory Compliance. In addition to this chapter, a person who becomes an Organized Health Care Delivery System shall comply with the following regulations, as applicable: A. COMAR 10.22.01 — .10; B. COMAR 10.22.17; C. COMAR 10.22.18; and D. COMAR 10.09.26.

.04 Definitions. A. In addition to the definitions set forth in COMAR 10.22.01, in this chapter, the following terms have the meanings indicated. B. Terms Defined. (1) “Administration” means the Developmental Disabilities Administration. (2) “Organized Health Care Delivery System…

.05 Designation as an OHCDS. The Administration shall designate a provider who applies to be an OHCDS if the provider entity: A. Submits an application on a form approved by the Administration; B. Is licensed by the Administration to provide one of the following services: (1) Com…