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10.09.33.00.htm 10.09.33.00. Title 10 MARYLAND DEPARTMENT OF HEALTH Subtitle 09 MEDICAL CARE PROGRAMS Chapter 33 Health Homes Authority: Health-General Article, §2-104(b) Annotated Code of Maryland
10.09.33.01.htm 10.09.33.01. 01 Definitions.. A. In this chapter, the following terms have the meanings indicated.. B. Terms Defined.. 1) “Administrative service organization (ASO) means the entity with which the Mental Health Administration may contract to provide the services described in COMAR 10.09.70 for the public mental health system.2) “Care management tool” means a system that helps accomplish administrative tasks of the health home, including maintaining a list of health home pa
10.09.33.02.htm 10.09.33.02. 02 Licensing Requirements.. A. A PRP serving adults and participating as a health home shall be approved pursuant to COMAR 10.21.21.B. A PRP serving minors and participating as a health home shall be approved pursuant to COMAR 10.21.29.C. A MTS program participating as a health home shall be approved pursuant to COMAR 10.21.19.. D. An OTP participating as a health home shall be approved to provide opioid maintenance therapy pursuant to COMAR 10.47.02.11.
10.09.33.03.htm 10.09.33.03. 03 Participant Eligibility.. A. An individual is eligible for health home services if the individual:. 1) Is a recipient of Maryland Medical Assistance; and. 2) Meets the following criteria:. a) Receives outpatient mental health rehabilitation or treatment services with a PRP or MTS program for a serious and persistent mental illness or serious emotional disturbance, and is not currently receiving:i) 1915(i) waiver services; or. ii) Mental health case management; or.
10.09.33.04.htm 10.09.33.04. 04 Conditions for Health Home Provider Participation.. To be eligible as a health home, a provider shall:. A. Meet the conditions for provider participation in the Medical Assistance Program, as set forth in COMAR 10.09.36.03;B. Meet the approval requirements set forth in Regulation .02 of this chapter;. C. Be accredited by, or demonstrate evidence of having started the accreditation process from, an approved accrediting body as a health home;D. For PRP and MTS health
10.09.33.05.htm 10.09.33.05. 05 Health Home Provider Staff.. A. Health Home Staffing Requirements.. 1) Health Home Care Manager.. a) At minimum, the health home shall maintain health home care manager staff at a ratio of .5 FTE per 125 participants.b) Up to a staffing level of 1 FTE, the health home care manager shall be a:. i) Nurse practitioner meeting the conditions of COMAR 10.27.07; or. ii) Registered nurse licensed pursuant to COMAR 10.27.01 and meeting the conditions of COMAR 10.27.09.
10.09.33.06.htm 10.09.33.06. 06 Covered Services.. A. The Department covers the services in §B―G of this regulation when these services have been documented, pursuant to the requirements in this chapter, as necessary.B. Comprehensive Care Management. The health home shall collaborate to provide comprehensive care management services including:1) An initial assessment performed prior to the patient’s enrollment, which includes:. a) A comprehensive assessment of the participant’s physical health, mental
10.09.33.07.htm 10.09.33.07. 07 Health Home Participant Flow.. A. Enrollment.. 1) The health home shall enroll an individual only after the individual has been enrolled in the health home provider’s applicable PRP, MTS, or OTP services.2) An OTP established as a health home shall identify eligible individuals under the OTP's care and report the qualifying risk factors diagnoses through eMedicaid during enrollment.3) The health home shall provide the individual with a brief description of
10.09.33.08.htm 10.09.33.08. 08 Limitations.. A. An eligible individual may not receive services from a health home provider that is not the individual’s PRP, MTS, or OTP provider.B. Health home services do not restrict or otherwise affect:. 1) Eligibility for Title XIX benefits or other available benefits or programs, except as limited by §E of this regulation;2) The freedom of a participant to select from all available services for which the participant is found to be eligible; or
10.09.33.09.htm 10.09.33.09. 09 Payment Procedures.. A. The Department shall reimburse the health home according to the requirements in this chapter and the rate established in §C of this regulation.B. Request for Payment.. 1) The health home provider is authorized to bill for the intake and ongoing PMPM rate for a participant when:a) The participant is receiving PRP, MTS, or OTP services; and. b) The intake portion of the participant’s eMedicaid file has been submitted and initial services have been delivered.
10.09.33.10.htm 10.09.33.10. 10 Recovery and Reimbursement.. Recovery and reimbursement shall be as set forth in COMAR 10.09.36.07..
10.09.33.11.htm 10.09.33.11. 11 Cause for Suspension or Removal and Imposition of Sanctions.. A. Cause for suspension or removal from the Medical Assistance Program and imposition of sanctions shall be as set forth in COMAR 10.09.36.08.B. If the Department determines that a health home provider has failed to comply with the provisions of this chapter, the Department may initiate one or more of the following actions against the health home provider:1) Recovery of overpayment made by the Department;.
10.09.33.12.htm 10.09.33.12. 12 Appeal Procedures.. Appeal procedures shall be as set forth in COMAR 10.09.36.09..
10.09.33.13.htm 10.09.33.13. 13 Interpretive Regulation.. State regulations shall be interpreted as set forth in COMAR 10.09.36.10..
10.09.33.9999.htm 10.09.33.9999. Administrative History Effective date: September 30, 2013 (40:19 Md. R. 1544). Regulation .01B amended effective July 7, 2014 (41:13 Md. R. 752). Regulation .04 amended effective November 24, 2014 (41:23 Md. R. 1372). Regulation .09C amended effective October 24, 2016 (43:21 Md. R. 1166).
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