Maryland Medical Day Care: Medicaid Rates, S5102 Billing, and the 2026 Case Management Change

Maryland has paid for adult day services longer than most states, and it does it with unusual clarity: one waiver, one licensing chapter, one procedure code, and — for dates of service since July 1, 2024 — one statewide per diem of $116.59. The trade for that simplicity is a documentation standard written directly into regulation, and as of March 16, 2026, a change every center owner in the state is living through: adult medical day care centers no longer provide case management to their waiver participants.

ElderSuite serves adult day care centers nationwide. This piece is Maryland-specific.

One waiver, paid fee for service

Maryland's Medical Day Care Services Waiver — waiver number 0645.R03.00 on Medicaid.gov — is the state's 1915(c) home and community-based waiver for this service, approved through June 30, 2028. It serves adults 65 and older and adults 16 to 64 with physical disabilities who meet nursing facility level of care.

Unlike most Maryland Medicaid services, medical day care does not run through the HealthChoice managed care organizations. COMAR 10.67.08.03 lists it among the benefits carved out of the MCOs and paid fee-for-service by the Department — so centers deal with the state directly, not with health plans. Two chapters govern that relationship: COMAR 10.09.07 sets the provider and payment rules, and COMAR 10.09.61 the waiver eligibility rules.

Who qualifies

A participant must be 16 or older, hold full Maryland Medicaid, meet nursing facility level of care, have a medical order for medical day care, and not be enrolled in another HCBS waiver or PACE at the same time. The initial level-of-care assessment is conducted by Adult Evaluation and Review Services (AERS) at the local health departments. MDH's waiver page describes the services as a minimum of four hours daily, up to seven days a week, with applications through the local health department or Maryland Access Point at 844-627-5465.

One rule shapes every claim that follows: under COMAR 10.09.07.07, Medicaid pays only when the participant is enrolled in the waiver and the service appears in their plan of service.

What Maryland pays: $116.59 a day

The Medicaid per diem is codified in COMAR 10.09.07.08. The recent steps:

• Dates of service Jul 1, 2022 – Dec 31, 2023: per diem $104.81
• Dates of service Jan 1 – Jun 30, 2024: per diem $113.19
• Dates of service on or after Jul 1, 2024: per diem $116.59

The two newest rates implement the 8 percent increase from the FY2024 budget and the Fair Wage Act of 2023 plus the FY2025 budget's 3 percent increase, proposed in the Maryland Register of April 4, 2025 and codified by amendment effective November 24, 2025. The regulation also carries a standing escalator: subject to the limitations of the State budget, the per diem increases 4 percent each July 1. No rate beyond $116.59 has been codified, so check COMAR before assuming a newer figure — and be careful with unofficial legal mirror sites, some of which still show $104.81 as current. Payment is capped at the lesser of the per diem or your customary charge to the general public.

License first, Medicaid second

The Office of Health Care Quality licenses Adult Medical Day Care Centers under COMAR 10.12.04. The path runs Letter of Interest, OHCQ approval, then the license application — with surveys at prelicensure and every two years after, plus complaint and incident surveys in between. Medicaid participation comes second: COMAR 10.09.07 defines a provider as a facility already licensed under 10.12.04 with an agreement with the Department. MDH's active provider list counts 118 medical day care centers as of mid-2026.

Billing: S5102, from attendance to claim

Maryland's own CMS-1500 billing instructions (updated March 2026) name one procedure code for medical day care: S5102 — the same code Virginia uses for its hourly adult day health benefit, though Maryland bills it as a per diem. Electronic claims go out as 837P files, and Maryland Medicaid (payer ID A5260) is an available payer on the Availity clearinghouse — the same clearinghouse ElderSuite submits claims through. That means a Maryland center can run the whole pipeline in one system: daily attendance becomes service documentation, documentation becomes claims, and claims go out electronically. Availity requires a one-time payer enrollment before the first claim goes out.

Timely filing is 12 months from the date of service — generous next to Georgia's six months — but the billing limits in COMAR 10.09.07.06 are strict: one day of care per participant per day, never more days than the plan of service authorizes, and never more participant-days than your licensed capacity on a given date. That last rule ties your attendance records and your license together on every claim you submit. For the full workflow from attendance record to electronic claim, see ElderSuite's Medicaid billing guide.

The documentation standard is in the regulation

COMAR 10.09.07.03 requires "accurate daily attendance records that are easily retrievable and available for review by the Program" — plus nursing observation notes daily for a participant's first five days and monthly after that, a multidisciplinary plan of care within 30 days of admission reviewed at least semi-annually, and medical orders covering every service rendered. MDH's quality assurance audits work straight from that list, adding an annual utilization review and medical orders renewed every 180 days. If your daily attendance tracking can produce those records on request, a Maryland audit is a filing exercise rather than a crisis.

March 16, 2026: case management leaves the center

In Provider Transmittal PT 64-26 (February 17, 2026), MDH announced that effective March 16, 2026, adult medical day care centers no longer provide case management to waiver participants. That work now belongs to five authorized Case Management Agencies — The Coordinating Center and Total Care Services statewide; Empowering Minds, Mind Kind, and Monumental Health Systems regionally — and every participant is served by one of them.

MDH was explicit that nothing else moved: no changes to licensure requirements, the per diem, or covered medical day care services. What changes for a center is coordination — the participant's case manager now sits outside your building, and your plans of care, attendance records, and service documentation are what that agency will ask to see. Centers whose records are retrievable on request will find the new arrangement routine.

Where to check

• COMAR 10.09.07 (provider and payment rules), COMAR 10.09.61 (waiver eligibility), COMAR 10.12.04 (licensing)
• PT 64-26 on the case management change
• MDH CMS-1500 billing instructions
• MDH medical day care waiver page; Maryland Access Point 844-627-5465