Maryland Medicaid pays for in-home personal care and related services through 2 programs, including the Home and Community-Based Options Waiver (Community Options Waiver) and the Community Pathways Waiver (DDA). The MDH Office of Long Term Services and Supports runs CFC, CPAS, the Community Options Waiver, and Increased Community Services on a fee-for-service basis; the Developmental Disabilities Administration runs the Community Pathways, Community Supports, and Family Supports waivers. The Community Options Waiver has a registry waitlist through Maryland Access Point. Confirm EVV requirements with MDH.
Yes. Community First Choice (for people who meet an institutional level of care) and Community Personal Assistance Services (CPAS, for people who need help with at least one ADL) are optional State Plan programs that cover personal assistance with no enrollment cap.
Which Maryland waivers can a home care agency bill?
Each waiver below lists who it covers, the services it pays for, and how providers bill.
Home and Community-Based Options Waiver (Community Options Waiver)
Population
Adults 18 and older who need nursing facility level of care, have income up to 300% of SSI and countable assets up to $2,000 or $2,500, and are invited from the waiver registry or apply from a qualifying institution.
Services covered
case management
medical day care
Senior Center Plus
assisted living
family training
behavior consultation
dietitian/nutritionist services
Billing format
Services are requested in a Plan of Service submitted by a supports planner in LTSSMaryland and approved by the MDH Office of Long Term Services and Supports; in-home personal assistance comes through Community First Choice.
To bill Medicaid for home care you need a state license, a Type 2 NPI, state Medicaid enrollment and screening, waiver or managed care contracts, EVV and authorizations.
Private pay means higher rates and fast payment; Medicaid means steady volume at state-set rates with authorizations and EVV. Compare rates, cash timing and admin before you mix them.
Track units remaining, the end date and the service code for every client, and check them before each schedule change. Hours over the cap are unbillable.
Four units equal one hour. How to convert units to hours, the common HCPCS codes, how states round partial units, and how to stay inside the authorization.
These free tools are made by the team behind Caregiver Scheduling,
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