Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.29 - Residential Treatment Center Services › Section 10.09.29.07 - Payment Procedures

Current through Register Vol. 51, No. 14, July 12, 2024
A.
				  Reimbursement Principles.
(1) The Department
				  will make no direct reimbursement to any State-operated residential treatment
				  center for recipients. The Department will claim federal fund recoveries from
				  the Department of Health and Human Services for services to federally eligible
				  Title XIX patients in these residential treatment centers.
(2) The Department will pay the residential
				  treatment center the lesser of the provider's customary charge or the
				  provider's per diem costs for covered services according to the principles
				  established under Title XVIII of the Social Security Act, as required in 42 CFR
				  413, or on the basis of charges not to exceed $750 per day effective July 1,
				  2021 through December 31, 2022, or $850 per day effective January 1, 2023. The
				  average increase in the Department's reimbursement to the provider per
				  inpatient day for each fiscal year over the cost-settled rate for the previous
				  fiscal year, State Fiscal Year 2019 final cost per diem effective July 1, 2021,
				  may not exceed the rate of increase of the Hospital Wage and Price Index plus 1
				  percentage point, described in
				  42 CFR §
												413.40. The target rate percentage increase
				  for each calendar year will equal the prospectively estimated increase in the
				  Hospital Wage and Price Index (market basket index) for each year, plus 1
				  percentage point. If the service is free to individuals not covered by
				  Medicaid:
(a) The provider:
(i) May charge the Program; and
(ii) Shall be reimbursed in accordance with
				  the provisions of this regulation; and
(b) The provider's reimbursement is not
				  limited to the provider's customary charge.
(3) An in-State children's residential
				  treatment center shall be reimbursed the lesser of:
(a) The provider's customary charge to the
				  general public unless the service is free to individuals not covered by
				  Medicaid,
(b) The provider's per
				  diem cost for covered services established in accordance with Medicare
				  principles of reasonable cost reimbursement as described in 42 CFR 413
				  ;
(c) Effective July 1, 2021, $750
				  per day; or
(d) Effective January
				  1, 2023, $850 per day.
(4) The Department rebases prices in
				  §A(2) and (3) of this regulation between every 2 and 4 years. Prices may
				  be rebased more frequently if the State determines that there is an error in
				  the data or in the calculation that results in a substantial difference in
				  payment, or if a significant change in provider behavior or costs has resulted
				  in payment that is inequitable across providers. In years in which rates are
				  not rebased, rates are subject to annual indexing.
(5) For purposes of §A(3)(b) of this
				  regulation, the percentage increase in the Department's cost reimbursement to
				  the provider, per inpatient day for each cost reporting year over the
				  cost-settled payment rate for the previous cost reporting year, State Fiscal
				  Year 2019 final cost per diem effective July 1, 2021, may not exceed the
				  Centers for Medicare and Medicaid Services' published federal fiscal year
				  market basket index relating to hospitals excluded from the prospective payment
				  system, plus 1 percent.
(6) The
				  rate stated in §A(2) and (3)(c) of this regulation shall be updated
				  annually for each provider's cost reporting period by the Centers for Medicare
				  and Medicaid Services' published federal fiscal year market basket index
				  relating to hospitals excluded from the prospective payment system.
(7) Effective July 1, 2021, the rate stated
				  in §A(2) and (3)(c) of this regulation shall be updated annually for each
				  provider's cost reporting period by the Centers for Medicare and Medicaid
				  Services' published federal fiscal year market basket index relating to
				  hospitals excluded from the prospective payment system, plus 1
				  percent.
(8) Out-of-State
				  Providers. To be reimbursed for services provided to Maryland Medical
				  Assistance recipients, an out-of-State provider shall be licensed or formally
				  approved as a psychiatric facility or as an inpatient program in a psychiatric
				  facility, either of which is accredited by the Joint Commission on
				  Accreditation of Healthcare Organizations.