(a) In this section, "pilot program" means the fee-for-service payment pilot program. (b) The Department shall establish a fee-for-service payment pilot program. (c) A provider that provides waiver program services to individuals with a developmental disability who are eligible for services under Subtitle 4 of this title may participate in the pilot program. (d) The Department shall: (1) Determine and establish rates for waiver program services; and (2) Publish the rates for waiver program services, and any subsequent changes to those rates, in regulation. (e) (1) A provider participating in the pilot program shall submit a claim for payment to the Department on a form that the Department requires. (2) Payment for a claim is subject to the following limitations: (i) Payment may not be made for a claim that is received by the Department more than 1 calendar year after the date the services were provided; and (ii) A claim that is not submitted within the time period required under item (i) of this paragraph may not be charged to the recipient of services. (f) A provider may not knowingly submit to the Department: (1) A false or fraudulent claim for payment; or (2) Documentation supporting a claim that contains false information. (g) (1) A provider that participates in the pilot program must complete and submit to the Department each year financial statements for each fiscal year that were audited by an independent certified public accountant. (2) A provider participating in the pilot program shall submit information required by the Department, on a form approved by the Department, relating to wages and benefits paid to direct support professionals. (3) The Department may require a provider participating in the pilot program to submit information related to the provision of services to individuals with a developmental disability as it relates to the execution of the pilot program. (h) The Department may: (1) Conduct an audit of any records supporting a claim for payment of a provider participating in the pilot program; and (2) Recover overpayments from a provider. (i) A provider participating in the pilot program shall comply with all applicable laws and regulations governing financial documentation, reporting, and other payment-related requirements for Medicaid providers.
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