Attachment 3.1A Page 21B STATE PLAN FOR MEDICAL ASSISTANCE UNDER TITLE XIX OF THE SOCIAL SECURITY ACT STATE OF MARYLAND

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1 Attachment 3.1A Page 21B STATE PLAN FOR MEDICAL ASSISTANCE UNDER TITLE XIX OF THE SOCIAL SECURITY ACT STATE OF MARYLAND Prgram Limitatins 8. Private Duty Nursing A. Private Duty Nursing Services are nursing services prvided t qualified individuals wh are under age 21. Services are prvided in a participant's wn hme r anther setting when nrmal life activities take the participant utside his r her hme except fr limitatins described in Sectin D belw. B. Cvered services include: ( 1) An initial assessment f a recipient's medical need fr private duty nursing by a licensed registered nurse; and (2) On-ging private duty nursing services. T be a cvered service, direct care nursing must be: (I) Ordered by the participant's primary medical prvider (Orders must be renewed every 60 days); (2) Prvided in accrdance with a Plan f Cate; (3) Prvided by a registered r licensed practical nurse with a valid unrestricted license and a current certificatin in CPR; ( 4) Of a cmplexity, r the cnditin f the participant must require, that the judgment, knwledge, and skills f a licensed nurse are required and the service can nt be delegated pursuant t Maryland's Nurse Practice Act (Health Occupatins Article, Title 8, Anntated Cde f Maryland; and (5) Of a scpe that is mre individual and cntinuus than nursing available under the Hme Health Prgram. TN# Supersedes TN #.!.Q:Q! Apprval Date FEB Effective Date vi.il[,, /H) 1/

2 Attachment 3.1A Page 21B-l STATE PLAN FOR MEDICAL ASSISTANCE UNDER TITLE XIX OF "THE SOCIAL SECURITY ACT STATE OF MARYLAND Prgram Limitatins 8. Private Duty Nursing c. On-ging private duty nursing services, with the exceptin f thse services that are preauthrized thrugh the IEP/IFSP prcess, must be preauthrized by the Medicaid Prgram. D. Private Duty Nursing services des nt include: (I) Part time/ intennittent nursing services cvered as Hme Health Services; (2) Nursing services rendered by a nurse wh is a member f the participant's immediate family r wh rdinarily resides with the participant; (3) Custdial service; (4) Services nt deemed medically necessary at the time f the initial assessment r plan f care review; (5) Services delivered by a licensed nurse wh is nt directly supervised by a licensed registered nurse wh dcuments all supervisry visits and activities; (6) Services prvided t a participant in a hspital, residential treatment center, intennediate care facility fr mental retardatin r addictin, r a residence r facility where private duty nursing services are included in the living arrangement by regulatin r statute r are therwise prvided fr payment; (7) Services nt directly related t the plan f care; (8) Services specified in the plan f care when the plan f care has nt been signed by the participan.t r the participant's legally authrized representative; (9) Services described in the plan f care whenever thse services are n lnger needed r apprpriate because f a majr change in the participant's cnditin r nursing care needs; TN#.ll.:l1 Supersedes TN #.!.Q:Q1 Apprval Date FEB t2 Effective Date ;:/VL.'f I 1 ~Oil

3 Attachment 3.1 A Page 21B-2 STATE PLAN FOR MEDICAL ASSISTANCE UNDER TITLE XIX OF THE SOCIAL SECURITY ACT STATE OF MARYLAND Prgram 8. Private Duty Nursing Limitatins (I 0) Services which duplicate r supplant services rendered by the participant's family caregivers r primary caregivers as well as ther insurance, ther gvernmental prgrams, r Medicaid Prgram services that the participant receives r is eligible t receive; (II) Services prvided fr the cnvenience r preference f the participant r the primary caregiver rather than as required by the participant's medical cnditin; ( 12) Services prvided by a nurse wh des nt pssess a valid, current, signed, unrestricted nursing license t prvide nursing services in the jurisdictin in which services are rendered; ( 13) Services prvided by a nurse wh des nt have a current, signed cardipulmnary resuscitatin (CPR) certificatin fr the perid during which the services are rendered; (14) Direct payment fr supervisry nursing visits; ( 15) Nursing services rendered by a nurse in the nurse's hme; (16) Nursing services nt dcumented as received by the participant as indicated by the lack f the participant's signature, r the signature f a witness, n the nursing prvider's fficial frm; (17) Respite services; and ( 18) Services prvided by schl health-related service prviders that are nt included n a child's lep r IFSP. TN# ll-12 Supersedes TN # I 0-04 Apprval Date FER 0 S 2012 Effective Date CTu L 'I 1 1.;l-0 11

4 DELETE THlS PAGE Attachment 3. 1 A Page TN # ll-12 Supersedes TN # I 0-04 Apprval Date FEB Effective Date Jvl.Lf 1 1 :kj/1

5 Attachment 4.19 A&B Page 57 A Behavir plans must be gal riented, individualized, and specifically address hw the therapeutic behavir aide will alter the envirnmental events, i.e., envirnmental factrs, antecedent, and cnsequent events, activities, and respnses. Techniques, such as structured supprt, mdeling, time-ut strategies, crisis interventin techniques, and psitively reinfrcing the desired apprpriate behavir, will be emplyed. The Therapeutic Behavir Aide is als expected t teach the family these techniques. Private duty nursing services delivered by licensed registered nurses and licensed practical nurses supervised by licensed registered nurses. Targeted case management services. Durable medical equipment r supplies nt therwise cvered under the State Plan. Inpatient psychiatric services fr individuals under age 21 year with a primary diagnsis f drug and alchl abuse (treatment is prvided in intermediate care facilities which meet the federal inpatient psychiatric services requirements fr individuals under 21 years as defined in 42 CFR and are accredited by the Jint Cmmissin n Accreditatin fhealthcare Organizatins). Otherwise, the reimbursement fr all the abve services, including therapeutic behaviral services, will be the lwer f: (I) the prvider's custmary charge t the general public; r (2) the Department's fee schedule. TN# Supersedes TN # Apprval Date FEB Effective Date :fu Lt( I 1 ;( 0 I I

6 STATE PLAN UNDER TITLE XIX OF THE SOCIAL SECURITY ACT State f Maryland Physician and Ostepath Rates Attachment 4.19-B Page5 5.a The Agency's rates fr prfessinal services rendered by a physician r stepath were set as f 7/1110 and are effective fr services n r after that date. All prviders must be licensed in the jurisdictin in which they prvide services. Services are limited t thse utlined in 3.1A f the Maryland State Plan. Prviders will be paid the lwer f the prvider's custmary fee schedule t the general public r the published fee schedule. 5.b All prviders described in 5.a, bth gvernment and nn-gvernment, are reimbursed pursuant t the same fee schedule. Prviders are paid by CPT cdes which are based n a percentage f Medicare reimbursement. The average Maryland Medicaid payment rate is apprximately 75 percent f Medicare 2011 fees beginning as f7/llll. All rates are published n the Agency's website at: FeeSchedule df 5.c Fr prfessinal services rendered by physicians t a trauma patient n the State Trauma Registry, wh is receiving emergency rm r inpatient services in a state designated trauma center, reimbursement will be I 000/ f the Baltimre City and surrunding area Title XVIJI Medicare physician fee schedule facility fee rate. All prviders must be licensed in the jurisdictin in which they prvide services and must be prviding services within a state designated trauma center. Services are limited t thse utlined in 3.1A f the Maryland State Plan. The prvider will be paid the lwer f the prvider's custmary fee schedule t the general public r the fee methdlgy described abve. 5.d All prviders described in 5.c., are paid by CPT cdes and bth gvernment and nn-gvernment prviders are reimbursed pursuant t the same fee schedule which is published n the CMS website at: TN# ll-l 2 FEB Supersedes TN# Apprval Date 1a:rrective Date \T(J Uf /, ;) 014

7 Page? STATE PLAN UNDER TITLE XIX OF THE SOCIAL SECURITY ACT State f Maryland Nurse Practitiner Rates fr all Nurse Practitiners and Nurse Anesthetists 6.a The Agency's rates fr prfessinal services rendered by nurse practitiners and nurse anesthetists were set as f7/l/l 0 and are effective fr services n r after that date. All practitiners must be licensed in the jurisdictin in which they prvide services. Services are limited t thse allwed under their scpe f practice in Maryland. The practitiner will be paid the lwer f the prvider's custmary fee schedule t the general public r the published fee schedule. 6.b Bth gvernment and nn-gvernment practitiners are reimbursed pursuant t the same fee schedule. All practitiners are paid by CPT cdes which are based n a percentage f Medicare reimbursement. The average Maryland Medicaid payment rate is apprximately 75 percent f Medicare 2011 fees beginning as f 7/l/ll. All rates are published n the Agency's website at: htt:// FeeSchedule pdf 6.c Payment limitatins: The Department will nt pay fr practitiner administered drugs btained frm manufacturers which d nt participate in the federal Drug Rebate Prgram. The Department will nt pay fr dispsable medical supplies usually included with the ffice visit, The Department will nt pay fr services which d nt invlve direct, face-tface, patient cntact. The Department will nt pay a prvider fr thse labratry r x-ray services perfrmed by anther facility, but will instead pay the facility perfrming the prcedure directly. In additin, fr nurse anesthetists preperative evaluatins fr anesthesia are included in the fee fr administratin f anesthesia and the nurse anesthetist may nt bill them as cnsultants. The prvider may nt bill the Prgram r the recipient fr: Cmpletin f frms and reprts; Brken r missed appintments; Prfessinal services rendered by mail r telephne; Services which are prvided at n charge t the general public; Prviding a cpy f a recipient's medical recrd when requested by anther licensed prvider n behalf f a recipient. TN# ll.:..!l FFB 0 3 Supersedes TN # Apprval Date trective Date -:Jlt L'f I, t:l 0 II

8 Page 8 RESERVE FOR FUTURE USE TN# Supersedes TN# Apprval DatFEB arrective Date Vllly I, J. () ll

9 Page9 STATE PLAN UNDER TITLE XIX OF THE SOCIAL SECURITY ACT State f Maryland Certified Nurse Mid-wife Rates 7.a The Agency's rates fr prfessinal services rendered by a certified mid-wife were set as f 7/1/10 and are effective fr services n r after that date. All nurse midwives must he licensed in the jurisdictin in which they prvide services. Services are limited t thse allwed under their scpe f practice in Maryland. The certified nurse midwife will be paid the lwer f the certified nurse midwife's custmary fee schedule t the general public r the published fee schedule. 7.b All certified nurse midwives, bth gvernment and nn-gvernment are reimbursed pursuant t the same fee schedule. Certified nurse midwives are paid by CPT cdes which are based n a percentage f Medicare reimbursement. The average Maryland Medicaid payment rate is apprximately 75 percent f Medicare 2011 fees beginning as f7/llll. All rates are published n the Agency's website at: FeeSchedule pdf 7.c Payment limitatins: The Department will nt pay fr practitiner administered drugs btained frm manufacturers which d nt participate in the federal Drug Rebate Prgram. The Department will nt pay fr dispsable medical supplies usually included with the ffice visit. The Department will nt pay fr services which d nt invlve direct, face-tface, patient cntact. The prvider may nt bill the Prgram r the recipient fr: Cmpletin f frms and reprts; Brken r missed appintments; Prfessinal services rendered by mail r telephne; Services which are prvided at n charge t the general public; Prviding a cpy f a recipient's medical recrd when requested by anther licensed prvider n behalf f a recipient. TN# Supersedes TN# Apprval DateFEB O 3 201cffective Date.::T/Al..'f I, dtj /f

10 Page 10 STATE PLAN UNDER TITLE XIX OF THE SOCIAL SECURITY ACT State f Maryland Pdiatrist Rates 8.a The Agency's rates fr prfessinal services rendered by a pdiatrist were set as f7/1110 and are effective fr services n r after that date. All pdiatrists must be licensed in the jurisdictin in which they prvide services. Services are limited t thse utlined in 3.1 A f the Maryland State Plan. The pdiatrist will be paid the lwer f the pdiatrist's custmary fee schedule t the general public r the published fee schedule. 8.b All pdiatrists, bth gvernment and nn-gvernment are reimbursed pursuant t the same fee schedule. Pdiatrists are paid by CPT cdes which are based n a percentage f Medicare reimbursement. The average Maryland Medicaid payment rate is apprximately 75 percent f Medicare 2011 fees beginning as f 7/1/11. All rates are published n the Agency's website at: 11/Physicians FeeSchedule df 8.c Payment limitatins: Preperative evaluatins fr anesthesia are included in the fee fr administratin f anesthesia and the prvider may nt bill them as cnsultants. Referrals frm ne pdiatrist t anther fr treatment f specific patient prblems may nt be billed as cnsultatins. The perating pdiatrist may nt bill fr the administratin f anesthesia r fr an assistant pdiatrist wh is nt in his emply. Payment fr cnsultatins prvided in a multi-specialty setting is limited by. criteria established by the Department. The Department will nt pay a pdiatrist fr thse labratry r x-ray services perfrmed by anther facility, but will instead pay the facility perfrming the prcedure directly. The Department will nt pay fr prvider-administered drugs btained frm manufacturers which d nt participate in the federal Drug Rebate Prgram. The Department will nt pay fr dispsable medical supplies usually included with the ffice visit. The Department will nt pay fr services which d nt invlve direct, face-tface, patient cntact. The prvider may nt bill the Prgram r the recipient fr: Cmpletin f fnns and reprts; Brken r missed appintments; Prfessinal services rendered by mail r telephne; Services which are prvided at n charge t the general public; Prviding a cpy f a recipient's medical recrd when requested by anther licensed prvider n behalf f a recipient. 1N # Supersedes 1N # Apprval Date FER ffective Date VIILtj J 1 J 0 l/

11 RESERVE FOR FUTURE USE Attachment 4.19-B Page 11 TN# Supersedes TN# Apprval DatfEB EtTective Date \T«L'-f I, d () 1/ >

12 Page 12 STATE PLAN UNDER TITLE XIX OF THE SOCIAL SECURITY ACT State f Maryland Physical Therapist Rates 9.a The Agency's rates fr prfessinal services rendered by a physical therapist were set as f 7/1/1 0 and are effective fr services n r after that date. All physical therapists must be licensed in the jurisdictin in which they prvide services. Services are limited t thse utlined in 3.I A f the Maryland State Plan. The physical therapist will be paid the lwer f the physical therapist's custmary fee schedule t the general public r the published fee schedule. 9.b All physical therapists, bth gvernment and nn-gvernment, are reimbursed pursuant t the same fee schedule. Physical therapists are paid by CPT cdes which are based n a percentage f Medicare reimbursement. The average Maryland Medicaid payment rate is apprximately 75 percent f Medicare 2011 fees beginning as f 7/1/11. All rates are published n the Agency's website at: htt:// FeeSchedu1e pdf 9.c The Agency reimburses schls fr physical therapy evaluatins, re-evaluatins, and individual physical therapy sessins when required under an Individualized Educatin Prgram (IEP) r Individual Family Service Plan (IFSP) and when prvided by physical therapists that are licensed in the jurisdictin in which they prvide services. Fr all dates beginning January 1, 2010, the State will reimburse fr this service at the same rate that it reimburses all ther nngvernmental cmmunity-based licensed physical therapists as described in 9b. 9.d Payment limitatins: The Department will nt pay fr dispsable medical supplies usually included with the ffice visit. The Department will nt pay fr services which d nt invlved direct, facet-face, patient cntact. The prvider may nt bill the Prgram r the recipient fr: Cmpletin f frms and reprts; Brken r missed appintments; Prfessinal services rendered by mail r telephne; Services which are prvided at n charge t the general public; Prviding a cpy f a recipient's medical recrd when requested by anther licensed prvider n behalf f a recipient. TN# FEB ?. Supersedes TN # Apprval Date 'Effective Date

13 Page 14 STATE PLAN UNDER TITLE XIX OF THE SOCIAL SECURITY ACT State f Maryland Optmetrist Rates ll.a The Agency's rates fr prfessinal services rendered by an ptmetrist were set as f 7/1/10 and are effective fr services n r after that date. All ptmetrists must be licensed in the jurisdictin in which they prvide services. Services are limited t thse utlined in 3.1A f the Maryland State Plan. The ptmetrist will be paid the lwer f the ptmetrist's custmary fee schedule t the general public r the published fee schedule. 11. b All ptmetrists, bth gvernment and nn-gvernment, are reimbursed pursuant t the same fee schedule. Optmetrists are paid based n a percentage f Medicare reimbursement. The average Maryland Medicaid payment rate is apprximately 75 percent f Medicare 2011 fees beginning as f7/l/11. All rates are published n the Agency's website at: 11/Physicians FeeSchedule df 11.c Payment limitatins: The Department will nt pay fr practitiner-administered drugs btained frm manufacturers which d nt participate in the federal Drug Rebate Prgram. The Department will nt pay fr dispsable medical supplies usually included with the ffice visit. The Department will nt pay fr services which d nt invlved direct, facet-face, patient cntact. The prvider may nt bill the Prgram r the recipient fr: Cmpletin f frms and reprts; Brken r missed appintments; Prfessinal services rendered by mail r telephne; Services which are prvided at n charge t the general public; Prviding a cpy f a recipient's medical recrd when requested by anther licensed prvider n behalf f a recipient. ~~~d!; TN # Apprval.Datf J:' R Effective Date vu L 'f I 1 ~ tj 1/

14 Page 18 STATE PLAN UNDER TITLE XIX OF THE SOCIAL SECURITY ACT State f Maryland Nutritinist Rates 12.a The Agency's rates fr prfessinal services rendered by a nutritinist were set as f 7/1/10 and are effective fr services n r after that date. All nutritinists must be licensed in the jurisdictin in which they prvide services. Services and prvider qualificatins are limited t thse utlined in 3.1.A f the Maryland State Plan. The nutritinist will be paid the lwer f the nutritinist's custmary fee schedule t the general public r the published fee schedule. 12.b All nutritinists, bth gvernment and nn-gvernment, are reimbursed pursuant t the same fee schedule. Nutritinists are paid by CPT cdes which are based n a percentage f Medicare reimbursement. The average Maryland Medicaid payment rate fr prfessinal services is apprximately 75 percent f Medicare 201 I fees beginning as f711/11. All rates are published n the Agency's website at: /Phvsicians FeeSchedule 20 II 2J!.Qf 12.c The Agency reimburses schls fr nutritinal assessments and interventins and nutritinal reassessments and interventins when required under an Individualized Educatin Prgram (JEP) r Individual Family Service Plan (IFSP) and when prvided by nutritinists that are licensed in the jurisdictin in which they prvide services. Fr all dates beginning January I, 20 I 0, the State will reimburse fr this service at the same rate that it reimburses all ther nn-gvernmental cmmunitybased licensed nutritinists as described in 12.b. 12.d Payment limitatins: The Department will nt pay fr services which d nt invlve direct, face-tface, patient cntact. The prvider may nt bill the Prgram r the recipient fr: Cmpletin f fnns and reprts; Brken r missed appintments; Prfessinal services rendered by mail r telephne; Services which are prvided at n charge t the general public with the exceptin f nutritinal services that are included as part f a child's IEP r IFSP; and Prviding a cpy f a recipient's medical recrd when requested by anther licensed prvider n behalf f a recipient. TN# Supersedes TN # NEW Apprval Oat FE B 0 3 2Q12ffective Date..:TliL<j I, ;}-ij I I

15 Attachment 4. I 9-B Page 19 STATE PLAN UNDER TITLE XIX OF THE SOCIAL SECURITY ACT State f Maryland Occupatinal Therapist Rates 13.a The Agency's rates fr prfessinal services rendered by an ccupatinal therapist were set as f 7 I I /1 0 and are effective fr services n r after that date. All ccupatinal therapists must be licensed in the jurisdictin in which they prvide services. Services and prvider qualificatins are limited t thse utlined in 3. LA f the Maryland State Plan. The ccupatinal therapist will be paid the lwer f the ccupatinal therapist's custmary fee schedule t the general public r the published fee schedule. 13.b All ccupatinal therapists, bth gvernment and nn-gvernment, are reimbursed pursuant t the same fee schedule. Occupatinal therapists are paid by CPT cdes which are based n a percentage f Medicare reimbursement. The average Maryland Medicaid payment rate fr prfessinal services is apprximately 75 percent f Medicare 2011 fees beginning as f7/1/ll. All rates are published n the Agency' s website at: htt.~www. dhmh. md. gv/mma / prviderinf/pd f/20!!/physicians FeeSchedule pdf 13.c The Agency reimburses schls fr ccupatinal therapy evaluatins andreevaluatins, individual ccupatinal therapy sessins, and grup ccupatinal therapy when required under an Individualized Educatin Prgram (IEP) r Individual Family Service Plan (IFSP) and when prvided by ccupatinal therapists that are licensed in the jurisdictin in which they prvide services. Fr all dates beginning January I, 2010, the State will reimburse fr this service at the same rate that it reimburses all ther nn-gvernmental cmmunity-based licensed ccupatinal therapists as described in 13.b. 13d. Payment limitatins: The Department will nt pay fr services which d nt invlve direct, face-tface, patient cntact. The prvider may nt bill the Prgram r the recipient fr: Cmpletin f frms and reprts; Brken r missed appintments; Prfessinal services rendered by mail r telephne; Services which are prvided at n charge t the general public with the exceptin f nutritinal services that are included as part f a child' s IEP r IFSP; and Prviding a cpy f a recipient's medical recrd when requested by anther licensed prvider n behalf f a recipient. TN# rr- Supersedes TN# NEW Apprval Date reb 0 3 2Qftective Date ;:Ju L'( I,.;j 0 II

16 Page20 STATE PLAN UNDER TITLE XIX OF THE SOCIAL SECURITY ACT State f Maryland Speech Therapist Rates 14.a The Agency's rates fr prfessinal services rendered by an speech-language pathlgist were set as f 7/1/10 and are effective fr services n r after that date. All speech-language pathlgists must be licensed in the jurisdictin in which they prvide services. Ser.vices and prvider qualificatins are limited t thse utlined in 3.1 A f the Maryland State Plan. The speech-language pathlgist will be paid the lwer f the speech-language pathlgist's custmary fee schedule t the general public r the published fee schedule. 14.b All speech-language pathlgists, bth gvernment and nn-gvernment, are reimbursed pursuant t the same fee schedule. Speech-language pathlgists are paid by CPT cdes which are based n a percentage f Medicare reimbursement. The average Maryland Medicaid payment rate fr prfessinal services is apprximately 75 percent f Medicare 2011 fees beginning as f7/l/ll. All rates are published n the Agency's website at: bttp:/lwww.dhmh.md.gv/mra/prviderinf/pd1720ll/physicians Fee$chedule df 14.c The Agency reimburses schls fr speech/hearing evaluatin, individual speech therapy, and grup speech therapy when required under an Individualized Educatin Prgram (IEP) r Individual Family Service Plan (IFSP) and when prvided by speech-language pathlgists that are licensed in the jurisdictin in which they prvide services. Fr all dates beginning January l, 2010, the State will reimburse fr this service at the same rate that it reimburses all ther nngvernmental cmmunity-based speech-language pathlgists as described in l4b. l4.d Payment limitatins: The Department will nt pay fr services which d nt invlve direct, face-tface, patient cntact. The prvider may nt bill the Prgram r the recipient fr: Cmpletin f frms and reprts; Brken r missed appintments; Prfessinal services rendered by mail 'r telephne; Services which are prvided at n charge t the general public with the exceptin f nutritinal services that are included as part f a child's IEP r IFSP; and Prviding a cpy f a recipient's medical recrd when requested by anther licensed prvider n behalf f a recipient. TN# Supersedes TN# Apprval Date FEB 0 3 2Q18f'ective Date VUL<j 1, ;;?~I I

17 Page 21 STATE PLAN UNDER TITLE XIX OF THE SOCIAL SECURITY ACT State f Maryland Audilgist Rates l5.a The Agency's rates fr prfessinal services rendered by an audilgist were set as f 7/1/10 and are effective fr services n r after that date. All audilgists must be licensed in the jurisdictin in which they prvide services. Services and prvider qualificatins are limited t thse utlined in 3.1A f the Maryland State Plan. The audilgist will be paid the lwer f the audilgist's custmary fee schedule t the general public r the published fee schedule. 15.b All audilgists, bth gvernment and nn-gvernment, are reimbursed pursuant t the same fee schedule. Audi~gists are paid by CPT cdes which are based n a percentage f Medicare reimbursement. All rates are published n the Agency's website at: I 0/ Audilgy PROVIDER MANU AL fmal DEC IO 20IO.txlf 15.c The Agency reimburses schls fr audilgy evaluatins when required under an Individualized Educatin Prgram (IEP) r Individual Family Service Plan (IFSP) and when prvided by audilgists that are licensed in the jurisdictin in which they prvide services. Fr all dates beginning January 1, 20 I 0, the State will reimburse fr this service at the same rate that it reimburses all ther nngvernmental cmmunity-based audilgists as described in l5.b. 15.d Payment limitatins: The Department will nt pay fr services which d nt invlve direct, face-tface, patient cntact. The prvider may nt bill the Prgram r the recipient fr: Cmpletin f frms and reprts; Brken r missed appintments; Prfessinal services rendered by mail r telephne; Services which are prvided at n charge t the general public with the exceptin f audilgy services that are included as part f a child's IEP r IFSP; and Prviding a cpy f a recipient's medical recrd when requested by anther licensed prvider n behalf f a recipient. TN# II-I2 f 03 20? Supersedes TN # I 0-04 Apprval Dat E 8 1LEffective Date JltLlj / 1 t1 0 II

18 Page22 STATE PLAN UNDER TITLE XIX OF THE SOCIAL SECURITY ACT State f Maryland 16. Therapeutic Behaviral Aide Rates 16.a The Agency's rates fr ne-n-ne therapeutic behaviral aide services perfrmed by therapeutic behaviral aides were set as f 1/1110 and are effective fr services n r after that date. Services and prvider qualificatins are limited t thse utlined in 3.l A f the Maryland State Plan. The therapeutic behaviral aide will be paid the lwer f the therapeutic behaviral aide's custmary fee schedule t the general public r the published fee schedule. 16.b All therapeutic behaviral aides, bth gvernment and nn-gvernment, are reimbursed pursuant t the same fee schedule. Therapeutic behaviral aides are paid a fixed amunt per each 15 minute increments. The rate is published n_ the Agency's website at: II!Physicians FeeSchedule 20 ll 2.pdf 16.c The Agency reimburses schls fr therapeutic behaviral aide services when required under an Individualized Educatin Prgram (IEP) r Individual Family Service Plan (IFSP) and when prvided by a qualified therapeutic behaviral aide prvider. Fr all dates beginning January 1, 201 0, the State will reimburse fr this service at the same rate that it reimburses all ther nn-gvernmental therapeutic behaviral aides as described in 16.b. 16.d Payment limitatins: The Department will nt pay fr services which d nt invlve direct, face-tface, patient cntact. The prvider may nt bill the Prgram r the recipient fr: Cmpletin f frms and reprts; Brken r missed appintments; Prfessinal services rendered by mail r telephne; Services which are prvided at n charge t the general public with the exceptin f therapeutic behaviral aide services that are included as part f a child's IEP r IFSP; and Prviding a cpy f a recipient's medical recrd when requested by anther licensed prvider n behalf f a recipient. TN# Supersedes TN # I 0-04 Apprval Date FE ~ffective Date J (/ L '/ I, ;;1 /) 1 I

19 Page23 STATE PLAN UNDER TITLE XIX OF THE SOCIAL SECURITY ACT State fmary1and Private Duty Nursing 17.a The Agency reimburses private duty nursing agencies fr an initial assessment fee. All ther private duty nursing services are paid fixed amunt per 15 minute intervals depending n whether the prvider is serving ne r mre children. The rates are specified in the establis\led and published fee schedule. All private duty nursing prviders, bth gvenunent and nn-gvernment, are reimbursed pursuant t the same fee schedule. Services and prvider qualificatins are limited t thse utlined in 3.1A f the Maryland State Plan. The Agency rates fr thse services were last set n July 1, 20 I 0 and can be fund at: 11/PrivateDutvNursing FeeSchedule20 I l.qm 17.b Rates, subject t the State budget, are adjusted each State fiscal year by adjusting the fee by the annual increase in the March Cnsumer Price Index fr All Urban Cnsumers, Medical Care Cmpnent, Washingtn-Baltimre, frm the U.S. Department f Labr, Bureau f Labr Statistics. 17.c The Agency reimburses schls fr private duty nursing services when required under an Individualized Educatin Prgram (IEP) r Individual Family Service Plan (IFSP) and when prvided by a qualified private duty nursing prvider. Fr all dates beginning January l, 2011, the State will reimburse fr this service at the same rate that it reimburses all ther nn-gvenunental private duty nursing prviders as described in 17.b. l7d. Payment limitatins: The Department will nt pay fr services which d nt invlve direct, face-tface, patient cntact. The prvider may nt bill the Prgram r the recipient fr: Cmpletin f frms and reprts; Brken r missed appintments; Prfessinal services rendered by mail r telephne; Services which are prvided at n charge t the general public with the exceptin f private duty nursing services that are included as part f a child's IEP r IFSP; and Prviding a cpy f a recipient's medical recrd when requested by anther licensed prvider n behalf f a recipient. TN # Supersedes TN # Apprval Date FEB 'faective Date.::/ll L '/ I,,;:; 0 I I

20 Page 24 RESERVE FOR FUTURE USE TN #!.!.:11_ Fl=' R 0 3, Supersedes TN# Apprval Date. t.ul,kective Date.;JuL-y t,1 ;;? () /1

21 Page 25 RESERVE FOR FUTURE USE TN # l.!:.11_ Supersedes TN# Apprval Date F'EB @:ective Date JLIL-lf I 1 ;A IJ II

22 Page 26 RESERVEFORFUTUREUSE TN# ll:.!l_ Supersedes TN # Apprval Date F f!ective Date VU Uj I 1 ) fj I J

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